Appendix 46

REIMBURSEMENT EXPENSE RECEIPT

Entity Name: CASAPA ELEMENTARY SCHOOL

October 9, 2023
Date : _ ___________________________________ RER No. : ___________________

ANDREA O. JABIEN
RECEIVED from _____________________________________________
(Name)
TEACHER-IN-CHARGE (TIC)
______________________________________________________________, the amount of
(Official Designation)

____________________________________________________________ (P__________)
(In Words) (in Figures)
Transportation of 2 sacks of Iron Fortified Rice
in payment for _________________________________________________________________
(Payments for subsistence, services,
from Jiabong Central Elem. School to Brgy. Jose Roňo Paranas, Samar.
____________________________________________________________________________
rental or transportation should show inclusive dates,

____________________________________________________________________________
purpose, distance, inclusive points of travel, etc.)

PAYEE

Name/Signature ___________________________________________________________

Address ________________________________________________

WITNESS

NANETH G. NUEVA
Name/Signature ____________________________________________________________
Brgy. Casapa Jiabong, Samar.
Address ________________________________________________

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