Gen. Form No. 2 Revised January 1992 Gen. Form No.
2 Revised January 1992
REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT
Date No. Date No.
RECEIVED from __________________________________________ RECEIVED from __________________________________________
(Name) (Name)
_____________________________________________ the amount of _____________________________________________ the amount of
(Official Designation) (Official Designation)
__________________________________________ (P___________ ) __________________________________________ (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.
________________________________________________________ ________________________________________________________
purposes, distance, inclusive points of travel, etc.) purposes, distance, inclusive points of travel, etc.)
PAYEE PAYEE
Name/Signature____________________________________________ Name/Signature____________________________________________
Address__________________________________________________ Address__________________________________________________
Residence Cert. No.________________________________________ Residence Cert. No.________________________________________
Date of Issue______________________________________________ Date of Issue______________________________________________
Place of Issue_____________________________________________ Place of Issue_____________________________________________
WITNESS WITNESS
Name/Signature____________________________________________ Name/Signature____________________________________________
Address__________________________________________________ Address__________________________________________________
Residence Cert. No.________________________________________ Residence Cert. No.________________________________________
Date of Issue______________________________________________ Date of Issue______________________________________________
Place of Issue_____________________________________________ Place of Issue_____________________________________________
Gen. Form No. 2 Revised January 1992 Gen. Form No. 2 Revised January 1992
REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT
Date No. Date No.
RECEIVED from __________________________________________ RECEIVED from __________________________________________
(Name) (Name)
_____________________________________________ the amount of _____________________________________________ the amount of
(Official Designation) (Official Designation)
__________________________________________ (P___________ ) __________________________________________ (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.
________________________________________________________ ________________________________________________________
purposes, distance, inclusive points of travel, etc.) purposes, distance, inclusive points of travel, etc.)
PAYEE PAYEE
Name/Signature____________________________________________ Name/Signature____________________________________________
Address__________________________________________________ Address__________________________________________________
Residence Cert. No.________________________________________ Residence Cert. No.________________________________________
Date of Issue______________________________________________ Date of Issue______________________________________________
Place of Issue_____________________________________________ Place of Issue_____________________________________________
WITNESS WITNESS
Name/Signature____________________________________________ Name/Signature____________________________________________
Address__________________________________________________ Address__________________________________________________
Residence Cert. No.________________________________________ Residence Cert. No.________________________________________
Date of Issue______________________________________________ Date of Issue______________________________________________
Place of Issue_____________________________________________ Place of Issue_____________________________________________
