Appendix A Republic of the Philippines No.

________
APPENDIX A Province of Compostela Valley
OFFICE OF THE GOVERNOR
Provincial Capitol Building
Republic of the Philippines No. ________ Cabidianan, Nabunturan, Compostela Valley
Province of Compostela Valley
OFFICE OF THE GOVERNOR DRIVER’S TRIP TICKET
Provincial Capitol Building ___________
Cabidianan, Nabunturan, Compostela Valley (Date)
A. To be filled by the Administrative Official Authorizing Official Travel:
DRIVER’S TRIP TICKET
___________ 1. Name of Driver of the vehicle _______________________________________________
(Date) 2. Government car to be used, Plate No. ________________________________________
A. To be filled by the Administrative Official Authorizing Official Travel: 3. Name of authorized passenger ______________________________________________
4. Place or places to be visited/inspected ________________________________________
1. Name of Driver of the vehicle _______________________________________________ 5. Purpose _________________________________________________________________
2. Government car to be used, Plate No. ________________________________________
3. Name of authorized passenger ______________________________________________
4. Place or places to be visited/inspected ________________________________________
5. Purpose _________________________________________________________________ PLACIDO ALCOMENDRAS JR, CPA
Executive Assistant IV
Chief of Office/Authorized Representative
.
PLACIDO ALCOMENDRAS JR, CPA B. To be filled by the Driver:
Executive Assistant IV
Chief of Office/Authorized Representative 1. Time of departure from Office/Garage _____________________________ a.m./p.m.
. 2. Time of arrival at (per No. 4 above) ________________________________ a.m./p.m.
B. To be filled by the Driver: 3. Time of departure from (per No. 4) ________________________________ a.m./p.m.
4. Time of arrival back to Office/Garage ______________________________ a.m./p.m.
1. Time of departure from Office/Garage _____________________________ a.m./p.m. 5. Approximate distance travelled (to and from) ________________________ a.m./p.m.
2. Time of arrival at (per No. 4 above) ________________________________ a.m./p.m. 6. Gasoline Issued, purchase and consumed:
3. Time of departure from (per No. 4) ________________________________ a.m./p.m. a. Balance in tank ________________________________________ liters
4. Time of arrival back to Office/Garage ______________________________ a.m./p.m. b. Issued by office from stock _______________________________ liters
5. Approximate distance travelled (to and from) ________________________ a.m./p.m. c. Add-purchased during trip _______________________________ liters
6. Gasoline Issued, purchase and consumed: T O T A L . . . _____________________________ liters
a. Balance in tank ________________________________________ liters d. Deduct: Used during the trip (to and from) __________________ liters
b. Issued by office from stock _______________________________ liters e. Balance in tank at the end of trip __________________________ liters
c. Add-purchased during trip _______________________________ liters 7. Gear off issued _______________________________________________ liters
T O T A L . . . _____________________________ liters 8. Lub. off issued _______________________________________________ liters
d. Deduct: Used during the trip (to and from) __________________ liters 9. Grease issued ________________________________________________ liters
e. Balance in tank at the end of trip __________________________ liters 10. Speedometer readings, if any:
7. Gear off issued _______________________________________________ liters At beginning of trip _________________________________ miles/kms.
8. Lub. off issued _______________________________________________ liters At end of trip ______________________________________ miles/kms.
9. Grease issued ________________________________________________ liters Distance travelled (per 5 above) _______________________ miles/kms.
10. Speedometer readings, if any: 11. Remarks: _________________________________________________________
At beginning of trip _________________________________ miles/kms.
At end of trip ______________________________________ miles/kms. I hereby certify to the correctness of the above statement of record of travel.
Distance travelled (per 5 above) _______________________ miles/kms.
11. Remarks: _________________________________________________________ ________________________
Driver
I hereby certify to the correctness of the above statement of record of travel. I hereby certify that I used this car on official business as stated above.
________________________
________________________ Name of passenger
Driver ___________, 20 ______
I hereby certify that I used this car on official business as stated above.
________________________
Name of passenger
___________, 20 ______