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RER

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42 views2 pages

RER

Uploaded by

skbarangaygarcia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Gen Form No 3-A Revised January 1992 Gen Form No 3-A Revised January 1992

REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT


Date No. Date No.
Received from ______________________________________ Received from ______________________________________
(Name) (Name)
______________________________the amount of ___________ ________________________ _____the amount of _____________
(Official designation) (In Figures) (Official designation) (In Figures)
_ _________________________________ __ ________________________________________________________
(In Words) (In Words)
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: _______________________________________
Residence Certificate No. __________________________ Residence Certificate No. _________________________
Date of Issue: ___________________________________ Date of Issue: ___________________________________
Place of Issue:___________________________________ Place of Issue:___________________________________

WITNESS WITNESS

Name/Signature: _______________ ______ Name/Signature: ________________________________


Address: _______________________________________ Address: _______________________________________
Residence Certificate No.__________________________ Residence Certificate No.__________________________
Date of Issue: ___________________________________ Date of Issue: ___________________________________
Place of Issue:___________________________________ Place of Issue:___________________________________

Gen Form No 3-A Revised January, 1992 Gen Form No 3-A Revised January, 1992
REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT
Date No. Date No.
Received from ____ ______ Received from _____________________________________
(Name) (Name)
__ __________the amount of___________ _________________ the amount of ___________________
(Official designation) (In Figures) (Official designation) (In Figures)
_____ ____________________ _______ __________________
(In Words) (In Words)
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: _______________________________________
Residence Certificate No. __________________________ Residence Certificate No. _________________________
Date of Issue: ___________________________________ Date of Issue: ___________________________________
Place of Issue:___________________________________ Place of Issue:___________________________________

WITNESS WITNESS

Name/Signature: ______ ________________ Name/Signature: _____ ______________


Address: ___ ____________ Address: ____ __________
Residence Certificate No.__________________________ Residence Certificate No.__________________________
Date of Issue: ___________________________________ Date of Issue: ___________________________________
Place of Issue: ___________________________________ Place of Issue: ___________________________________

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