General Form No.

2
Revised January 1992

General Form No. 2

Revised January 1992

REIMBURSEMENT EXPENSE RECEIPT

Date

REIMBURSEMENT EXPENSE RECEIPT

No.

Date

RECEIVED from

No.

RECEIVED from
(Name)

(Name)
the amount

the amount

(Official Designation)
of

(Official Designation)
(P

(In Words)

)
(In Figures)

in payment for

of

(P
(In Words)

)
(In Figures)

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

Name/Signature

Address

Address

Comm. Tax Cert. No.

Comm. Tax Cert. No.

Date of Issue

Date of Issue

Place of Issue

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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