Appendix 35 - LR
Appendix 35 - LR
Appendix 35 - LR
PARTICULARS Amount
AMOUNT TO BE REIMBURSED
A Certified: Correctness of the B Certified: Purpose of C Certified: Supporting documents
above data travel/cash advance duly complete and proper
accomplished
Signature over Printed Name Signature over Printed Name Signature over Printed Name
Claimant Immediate Supervisor Head, Accounting Division Unit
Date:_______________ Date:__________________ Date:__________________