Appendix 46

Appendix 46

REIMBURSEMENT EXPENSE RECEIPT

REIMBURSEMENT EXPENSE RECEIPT

Entity Name: _________________

Fund Cluster : ________________

Entity Name: _________________

Fund Cluster : ________________

Date : _______________________

RER No. : ___________________

Date : _______________________

RER No. : ___________________

RECEIVED from ______________________________________

RECEIVED from ______________________________________

(Name)

(Name)

_________________________________________________ the amount

_________________________________________________ the amount

(Official Designation)

(Official Designation)

of __________________________________________ (P__________)
(In Words)

of __________________________________________ (P__________)

(in Figures)

(In Words)

in payment for _______________________________________________

(in Figures)

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 ________________________________________________

WITNESS

WITNESS

Name/Signature __________________________________________

Name/Signature __________________________________________

Address ________________________________________________

Address ________________________________________________

123