RER Form

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GAAM Vol.

II
Revised January 1992

Appendix 18

GAAM Vol. II
Revised January 1992

REIMBURSEMENT EXPENSE RECEIPT


Date

No.

Appendix 18

REIMBURSEMENT EXPENSE RECEIPT


Date

No.

RECEIVED from ______________________________


(Name)

RECEIVED from ______________________________


(Name)

____________________________________________ the amount


(Official Designation)

____________________________________________ the amount


(Official Designation)

of _____________________________________ (P _____________)
(in Words)
(In Figures)

of _____________________________________ (P _____________)
(in Words)
(In Figures)

in payment for __________________________________________


(Payments for subsistence, services,

in payment for __________________________________________


(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 ________________________________________
Address ________________________________________________
Residence Cert. No. ______________________________________
Date of Issue ____________________________________________
Place of Issue ___________________________________________

Name/Signature ________________________________________
Address ________________________________________________
Residence Cert. No. ______________________________________
Date of Issue ____________________________________________
Place of Issue ___________________________________________

WITNESS

WITNESS

Name/Signature ________________________________________
Address ________________________________________________
Residence Cert. No. ______________________________________
Date of Issue ____________________________________________
Place of Issue ___________________________________________

Name/Signature ________________________________________
Address ________________________________________________
Residence Cert. No. ______________________________________
Date of Issue ____________________________________________
Place of Issue ___________________________________________

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