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Expense Reimbursement Form

This document is a standard reimbursement expense receipt form. It includes fields for the date, name of recipient, amount received in words and figures, purpose of payment, signature of payee and witness, and their contact information. The form is used to document reimbursement of expenses.

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adamfugue
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337 views4 pages

Expense Reimbursement Form

This document is a standard reimbursement expense receipt form. It includes fields for the date, name of recipient, amount received in words and figures, purpose of payment, signature of payee and witness, and their contact information. The form is used to document reimbursement of expenses.

Uploaded by

adamfugue
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

General Form No. 2 General Form No.

2
Revised January 1992 Revised January 1992
REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT
Date No. Date No.

RECEIVED from RECEIVED from


(Name) (Name)
the amount the amount
(Official Designation) (Official Designation)
of (P ) of (P )
(In Words) (In Figures) (In Words) (In Figures)
in payment for in payment for
(Payments for subsistence services, (Payments for subsistence services,

rental or transportation should show inclusive dates, rental or transportation should show inclusive dates,

purpose, distance, inclusive points of travel, etc.) purpose, distance, inclusive points of travel, etc.)
PAYEE PAYEE
Name/Signature Name/Signature
Address Address
Comm. Tax Cert. No. Comm. Tax Cert. No.
Date of Issue Date of Issue
Place of Issue Place of Issue

WITNESS WITNESS
Name/Signature Name/Signature
Address Address
Comm. Tax Cert. No. Comm. Tax Cert. No.
Date of Issue Date of Issue
Place of Issue Place of Issue
igures)

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