Reimbursement Expense Receipt

This document contains a reimbursement expense receipt form with fields for the entity name, fund cluster, date, receipt number, name and designation of the person receiving reimbursement, amount in words and figures, purpose of payment including inclusive dates if for subsistence, services, rental or transportation, and spaces for signatures of the payee and witness with their addresses.

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Reymond Ballesteros

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Reimbursement Expense Receipt

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Reymond Ballesteros

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REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT

Entity Name: _________________ Fund Cluster : ________________ Entity Name: _________________ Fund Cluster : ________________
Date : _______________________ RER No. : ___________________ Date : _______________________ RER No. : ___________________

RECEIVED from RECEIVED from

(Name) (Name)

_ the amount _ the amount

(Official Designation) (Official Designation)

of ________ (P) of (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,

_________________________________________________________ _________________________________________________________
purpose, distance, inclusive points of travel, etc.) purpose, distance, inclusive points of travel, etc.)
PAYEE PAYEE
Name/Signature __________________________________________ Name/Signature __________________________________________
Address ________________________________________________ Address ________________________________________________

WITNESS WITNESS
Name/Signature __________________________________________ Name/Signature __________________________________________
Address ________________________________________________ Address ________________________________________________

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Reimbursement Expense Receipt

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Reimbursement Expense Receipt

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REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT

RECEIVED from ______________________________________ RECEIVED from ______________________________________

_________________________________________________ the amount _________________________________________________ the amount

of __________________________________________ (P__________) of __________________________________________ (P__________)

in payment for _______________________________________________ in payment for _______________________________________________

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RECEIVED from RECEIVED from

_ the amount _ the amount

of ________ (P) of (P)

in payment for _ in payment for _