General Form No. 2 General Form No.

2
Revised January 1992 Revised January 1992
REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT
Date 8/9/22 No. Date No.

RECEIVED from RECEIVED from

(Name) (Name)
the amount the amount
(Official Designation) (Official Designation)
of Five hundred sixty two pesos and 50 centavos (P 562.50 ) of (P )
(In Words) (In Figures) (In Words) (In Figures)
in payment for Fidelity Bond 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 Jeselle Faith B. Duque Name/Signature
Address Magsaysay, Saguday, Quirino Address
Comm. Tax Cert. No. 23993796 Comm. Tax Cert. No.
Date of Issue 8/9/22 Date of Issue
Place of Issue Land Bank of the Philippines, Cabarroguis, Quirino 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
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