Scribd
Upload
166 views2 pages

Appendix 46 Reimbursement Form

This document contains a reimbursement expense receipt form with fields for the entity name, fund cluster, date, receipt number, payee name and designation, amount paid in words and figures, purpose of payment, payee and witness signatures, and their addresses. The purpose field specifies that payments for subsistence, services, rentals or transportation should include inclusive dates, distance, and points of travel. The form is duplicated with the same fields.

Uploaded by

Rich Cane Villondo
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
166 views2 pages

Appendix 46 Reimbursement Form

This document contains a reimbursement expense receipt form with fields for the entity name, fund cluster, date, receipt number, payee name and designation, amount paid in words and figures, purpose of payment, payee and witness signatures, and their addresses. The purpose field specifies that payments for subsistence, services, rentals or transportation should include inclusive dates, distance, and points of travel. The form is duplicated with the same fields.

Uploaded by

Rich Cane Villondo
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
  • Reimbursement Expense Receipt Forms
  • Reimbursement Expense Receipt Forms

Appendix 46 Appendix 46

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 ________________________________________________

123
Appendix 46 Appendix 46
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 ________________________________________________

123

123 Appendix 46 Appendix 46 REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT Entity Name: _________________ Fund
123 Appendix 46 Appendix 46 REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT Entity Name: _________________ Fund

You might also like