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Reimbursement Expense Receipt

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General Form No.

(A)
Revised June, 1951
REIMBURSEMENT EXPENSE RECEIPT
___________________________________________ ________________ RER No. ___________
(Barangay, Municipality, Province) (Date)

Received from: _______________________ _______________________ of Barangay ___________________


(Name) (Official Designation)
the amount of _______________________ (₱____________) as payment for transportation.
(In Words)

(Payment for subsistence, services, rental or transportation should show inclusive dates, purpose, distance, inclusive points of travel, etc.)

Inclusive Dates: ________________ Distance: ________________

Purpose: _____________________________________________________________________________
_____________________________________________________________________________

Witness: Payee:
Address: Lingayen, Pangasinan Address: ____________________
I.D. No. ____________________ Driver's License No. ____________________
Issued on: ____________________ Issued on: ____________________
Issued at: ____________________ Issued at: ____________________

General Form No. (A)


Revised June, 1951
REIMBURSEMENT EXPENSE RECEIPT
___________________________________________ ________________ RER No. ___________
(Barangay, Municipality, Province) (Date)

Received from: _______________________ _______________________ of Barangay ___________________


(Name) (Official Designation)
the amount of _______________________ (₱____________) as payment for transportation.
(In Words)

(Payment for subsistence, services, rental or transportation should show inclusive dates, purpose, distance, inclusive points of travel, etc.)

Inclusive Dates: ________________ Distance: ________________

Purpose: _____________________________________________________________________________
_____________________________________________________________________________

Witness: Payee:
Address: Lingayen, Pangasinan Address: ____________________
I.D. No. ____________________ Driver's License No. ____________________
Issued on: ____________________ Issued on: ____________________
Issued at: ____________________ Issued at: ____________________

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