Reimbursement Expense Receipt Reimbursement Expense Receipt

This document contains a reimbursement expense receipt template. The template includes fields for the date, receipt number, name and designation of the person receiving payment, the amount paid in words and figures, and description of what the payment is for including any relevant dates or details. Below the payment details are fields for the payee name, signature, address and identification information as well as fields for a witness with their name, signature, address and identification details.

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Reimbursement Expense Receipt Reimbursement Expense Receipt

Uploaded by

Sabian Meinl Zildjian

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GAAM Vol.

II
Revised January 1992

Appendix 18

REIMBURSEMENT EXPENSE RECEIPT

GAAM Vol. II
Revised January 1992

Appendix 18

REIMBURSEMENT EXPENSE RECEIPT

Date: ____________________________ No.

Received from __________________________________________________

(Name)

Received from __________________________________________________

(Name)

_________________________________________________ the amount of

(Official Designation)
____________________________________________ (P ______________)
(in words)
(In figure)
in payment for _________________________________________________
(Payments for subsistence, services,
______________________________________________________________
rental or transportation should show inclusive dates,

_________________________________________________ the amount of

______________________________________________________________
purpose, distance, inclusive points of travel, etc)

PAYEE

Name/Signature _________________________________________________
Address _______________________________________________________
Residence Cert. No. ______________________________________________
Date of Issue ___________________________________________________
Place of Issue ___________________________________________________

WITNESS
Name/Signature _________________________________________________
Address _______________________________________________________
Residence Cert. No. ______________________________________________
Date of Issue ___________________________________________________
Place of Issue ___________________________________________________

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