General Form No. 2 General Form No.
2
Revised January, 1992 Revised January, 1992
REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT
Date: No. Date: No.
Receive from ___________________________________ Receive from ___________________________________
(Name) (Name)
________________________________________ the amount of ________________________________________ the amount of
(Official Designation) (Official Designation)
___________________________________________________ ___________________________________________________
(in words) (in words)
_______________________________ ( P ________________). _______________________________ ( P ________________).
(in words) (in figures) (in words) (in figures)
in payments for ______________________________________ in payments for ______________________________________
(Payments for subsistence, services, (Payments for subsistence, services,
___________________________________________________ ___________________________________________________
rental or transportation should show rental or transportation should show
___________________________________________________ ___________________________________________________
inclusive dates, purposes, distance, inclusive dates, purposes, distance,
___________________________________________________ ___________________________________________________
inclusive points of travel, etc.) inclusive points of travel, etc.)
PAYEE PAYEE
Name/ Signature ______________________________________ Name/ Signature ______________________________________
Address ________________________________________ Address ________________________________________
Res. Cert. No. ________________________________________ Res. Cert. No. ________________________________________
Place/ Date of Issue __________________________________ Place/ Date of Issue __________________________________
3 3
WITNESS WITNESS
Name/ Signature ______________________________________ Name/ Signature ______________________________________
Address ________________________________________ Address ________________________________________
Res. Cert. No. ________________________________________ Res. Cert. No. ________________________________________
Place/ Date of Issue __________________________________ Place/ Date of Issue __________________________________
