You need to fill out the back and Part I of the front.
As you notice the form says the information must be TYPED. If you can do this that would help us out. You will need Adobe Acrobat and a fairly recent version to do this. The reader is not good enough. It is sufficient to mail the printout with your reimbursement form.
If you can't figure out how to type on the form using your system you can send a hand written copy, but please print neatly and write the numbers 0123456789 at the bottom of the page so we can recognize how you write te digits.