REIMBURSEMENT EXPENSE RECEIPT

Entity Name: Plate No. _______ Fund Cluster : ___

Date : RER No. : ___________________

RECEIVED from
(Name)

(Official Designation)
the amount of __ ______________ (P ___ _____)
(In Words) (in Figures)
in payment for ___________________________________________
___________________________________________________________
___________________________________________________________
rental or transportation should show inclusive dates,

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

PAYEE
Name/Signature :
Address :

WITNESS
Name/Signature __________________________________________
Address ________________________________________________

123