Gen. Form No.
2 Revised January 1992
REIMBURSEMENT EXPENSE RECEIPT
Date: No.
RECEIVED from ______________________________________________________________________
(Name)
_________________________________ the amount of _____________________________________
(Official Designation)
_________________________________________________________ (P _____________________)
(In Words) (In Figures)
In payment for ______________________________________________________________________
(Payments for subsistence, services, rental or transportation
___________________________________________________________________________________
Should show inclusive dates, purpose, distance, inclusive prints of travel, etc.)
PAYEE
Name/Signature ____________________________________________________________________
Address ___________________________________________________________________________
Residence Cert. No. __________________________________________________________________
Date of Issue _______________________________________________________________________
Place of Issue _______________________________________________________________________
WITNESS
DATE: ____________________
Name/Signature ____________________________________________________________________
Address ___________________________________________________________________________
Residence Cert. No. __________________________________________________________________
Date of Issue _______________________________________________________________________
Place of Issue _______________________________________________________________________
