Annex 13

REIMBURSEMENT EXPENSE RECEIPT

SK of Barangay: RER No.:

City/Municipality: Date:
Province:

RECEIVED from ____________________________________________,

(Name)
_________________________________________________ the amount
(Official Designation)
of ___________________________________________ (P____________)
(In Words) (in Figures)
in payment for _______________________________________________
(Payments for subsistence, services,
___________________________________________________________
rental or transportation should show inclusive dates,
___________________________________________________________
purpose, distance, inclusive points of travel, etc.)

PAYEE
Name/Signature __________________________________________
Address ________________________________________________

WITNESS
Name/Signature __________________________________________
Address ________________________________________________