REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT

Date No. Date No.

RECEIVED from _____________________________________________ RECEIVED from _____________________________________________

(Name) (Name)

_____________________ the amount of __________________________ _____________________ the amount of __________________________

(Official Designation) (Amount in words) (Official Designation) (Amount in words)

(P ___________) as payment for _______________________________ (P ___________) as payment for _______________________________

(Payments for subsistence, services, (Payments for subsistence, services,

________________________________________________________ ________________________________________________________
rental of transportation should show inclusive clothes, purpose, distance, rental of transportation should show inclusive clothes, purpose, distance,
inclusive points of travel, etc.) inclusive points of travel, etc.)

PAYEE PAYEE

Name & Signature: Name & Signature:

Address: Address:

Residence Cert. No. : Residence Cert. No. :

Date of Issue: Date of Issue:

Place of Issue: Place of Issue:

WITNESS WITNESS

Name & Signature: Name & Signature:

Address: Address:

Residence Cert. No. : Residence Cert. No. :

Date of Issue: Date of Issue:

Place of Issue: Place of Issue: