FACULTY RESEARCH PROGRAM
University Research Coordination Office

LIQUIDATION/REIMBURSEMENT FORM

PROJECT NO.:	 	

PROJECT TITLE:	 	

ACCOMPLISHED BY:	 	

CASH ADVANCED:	 	

AMOUNT TO BE REIMBURSED:	 	

Transportation Expenses

DATE	TO	FROM	AMOUNT	

				

				
		
TOTAL		

Reproduction of Materials (Xeroxing) Expenses

COST/PAGE	NO. OF PAGES	AMOUNT	

			

			
	
TOTAL		

Liquidation/Reimbursement Form Page -2-

Materials, Supplies, Chemicals, Glasswares, etc. Expeses

QUANTITY	ITEM	AMOUNT	

			

			
	
TOTAL		

Others

QUANTITY	ITEM	AMOUNT	

			

			
	
TOTAL		

Grand Total	:	 	

Balance of Cash (Amount Refundable) :	 	

NOTE:	ALL RECEIPTS SHOULD BE ATTACHED TO THIS FORM

I hereby certify that the above figures are true and correct.

Signature of Research Grantee

Date