Appendix 46 Reimbursement Receipt Form

This document is a reimbursement expense receipt form used to record the reimbursement of funds. It includes fields for the entity name, date, reimbursement number, name and designation of the person receiving funds, amount in words and figures, purpose of the reimbursement, and spaces for signatures of the payee and a witness with their addresses.

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Appendix 46 Reimbursement Receipt Form

Uploaded by

MennaldzAkinAmilhasan

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Appendix 46

REIMBURSEMENT EXPENSE RECEIPT

Entity Name: _ Fund Cluster :

Date : _______________________ RER No. : ___________________

RECEIVED from ______________________________________

(Name)

_________________________________________________ the amount

(Official Designation)

of __________________________________________ (P__________)
(In Words) (in Figures)

in payment for _______________________________________________

(Payments for subsistence, services,

_________________________________________________________
rental or transportation should show inclusive dates,

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

WITNESS
Name/Signature __________________________________________
Address ________________________________________________

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Appendix 46 Reimbursement Receipt Form

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Appendix 46 Reimbursement Receipt Form

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Appendix 46

REIMBURSEMENT EXPENSE RECEIPT

Entity Name: _________________ Fund Cluster : ________________

RECEIVED from ______________________________________

_________________________________________________ the amount

in payment for _______________________________________________

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Entity Name: _ Fund Cluster :