General Form No. 2 Revised January 1992
REIMBURSEMENT EXPENSE RECEIPT
Date No.
RECEIVED from _______________________________
______________________________________ the amount of
_________________________________ (=P=________) in payment for
____________________________________
P A Y E E Name/Signature __________________________________
Address _________________________________________
Residence Cert. No. ________________________________
Date of Issue _____________________________________
Place of Issue ____________________________________
W I T N E S S
Name/Signature __________________________________
Address _________________________________________
Residence Cert. No. ________________________________
Date of Issue _____________________________________
Place of Issue ____________________________________
(Name)
(Official Designation)
(In Words) (In Figure)
(Payments for subsistence, services,
rental or transportation should show inclusive dates,
purpose, distance, inclusive points of t ravel, etc.)
General Form No. 2 Revised January 1992
REIMBURSEMENT EXPENSE RECEIPT
Date No.
RECEIVED from _______________________________
______________________________________ the amount of
_________________________________ (=P=________) in payment for
____________________________________
P A Y E E Name/Signature __________________________________
Address _________________________________________
Residence Cert. No. ________________________________
Date of Issue _____________________________________
Place of Issue ____________________________________
W I T N E S S
Name/Signature __________________________________
Address _________________________________________
Residence Cert. No. ________________________________
Date of Issue _____________________________________
Place of Issue ____________________________________
(Name)
(Official Designation)
(In Words) (In Figure)
(Payments for subsistence, services,
rental or transportation should show inclusive dates,
purpose, distance, inclusive points of t ravel, etc.)
Page 1
