Republic of the Philippines

Department of Health
REGIONAL OFFICE NO.IV-A
Project 4, Quezon City
CERTIFICATE OF TRAVEL COMPLETED
CORAZON I. FLORES, MD, MPH, CESO IV

RO4A.,Project 4, Quezon City

Agency Head

Station

Director IV
Designation

October 2015
Date

I certify that I have completed the travel in the itinerary of travel Regional Personnel Order
No._____________________ dated ___________________ respectively under conditions
indicated below.
X Strictly in accordance with approved itinerary.
o Cut short as explained below. Excess payment in the amount of P_________
was refunded on O.R. No.__________dated__________________________
o Extended as explained below. Additional itinerary was submitted
o Other deviations as explained below.
Explanation or Justification: ______________________________________________
______________________________________________________________________
Evidences of travel attached hereto: Special Travel Order, Appendix A & B, Certificate
of Appearance & Narrative Report.

Prepared by:
Charlyn R. Fernandez R.N.
RAIDERS
Noted by:
GERARDO G. MEJORADA. MD.
PHTL