GENERAL FORM NO. 2 GENERAL FORM NO.

2
Revised January 2003 Revised January 2003

REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT

Date No. Date 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)

to payment for to payment for

(Payments for subsistence, services, (Payments for subsistence, services,

rental or transportation should show points of travel, etc.) rental or transportation should show points of travel, etc.)

PAYEE PAYEE
Name/Signature Name/Signature
Address Address
Residence Cert. No. Residence Cert. No.
Date of Issue Date of Issue
Place of Issue Place of Issue

WITNESS WITNESS
Name/Signature Name/Signature
Address Address
Residence Cert. No. Residence Cert. No.
Date of Issue Date of Issue
Place of Issue Place of Issue