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GAM Appendix 46
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Reimbursement Expense Receipt
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Form No. RER-FMD-FM063Version No. 06Effectivity Date: October 15, 2024
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Entity Name: _________________Fund Cluster : ________________
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Date : _______________________RER No. : ___________________
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 RECEIVED from ____________________________________________________________________________
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 (Name)
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______________________________________________________________________________________ the amount
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 (Official Designation)
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of __________________________________________________________________________________ (P__________)
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 (In Words) (in Figures)
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in payment for ___________________________________________________________________________________
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 (Payments for subsistence, services,
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___________________________________________________________________________________________________
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rental or transportation should show inclusive dates,
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___________________________________________________________________________________________________
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purpose, distance, inclusive points of travel, etc.)
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PAYEE
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Name/Signature __________________________________________
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Address ________________________________________________
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WITNESS
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Name/Signature __________________________________________
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Address ________________________________________________
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