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TRIANON DIAGNOSTICS, INC.

CASH ADVANCE LIQUIDATION


EMPLOYEE NAME/POSITION

Edgar Vincent A. Parubrub/ Medical Representative

PURPOSE OF CASH ADVANCE Transportation


AMOUNT

DATE
04*01*15

04*02*15

04*03*15

DATE REQUESTED

LOCATION
TO & FROM
Cauayan
Cauayan
Cauayan
Cauayan
Cauayan
Cauayan
Cauayan
Cauayan
Cauayan
Santiago City
Alicia
Cauayan
Cabatuan
Aurora
Roxas
Roxas
Roxas
Roxas
Roxas
San Mateo
San Mateo
San Mateo
Santiago
Echague
Echague
Echague
Echague
Santiago
Santiago

PARTICULARS / PURPOSE
Hi-way Alicia -Cauayan Terminal
Cauayan Terminal- Ester C. Garcia Hospita
Ester C. Garcia Hospital-Dr. Donald CadeliniaTricy
Dr. Donald Cadelinia-IUDMC
IUDMC-Dr. Edwin Mauricio
Dr. Mauricio-Dr. Rachell Caballero
Dr. Caballero-Dr. Edna Uy
Dr. Edna Uy- Terminal Cauayan
Terminal Cauayan-Adventist Hospital
Adventist Hospital- Alicia Highway
Highway- Cauayan Terminal
Cauayan Terminal- Cabatuan Family Clinic
Paulo Bernard Acosta- Rene Gozum Jr.
Rene Gozum Jr- Terminal Roxas
Terminal Roxas-Roxas Diagnostic Lab.
Roxas Diagnostics Lab. -Yumena Hospital
Yumena Hospital-Dr. Karen Alibutod
Dr. Karen Alibutod-Terminal Roxas
Terminal Roxas- San Mateo
San Mateo Highway to San Mateo Munici.
San Mateo Municipality-Highway
San Mateo - Santiago
Santiago Terminal- Alicia
Alicia Highway - Echague terminal
Echague Terminal-Dr. Marjorie Lopez
Dr. Marjorie Lopez-Highway Echague
Echague Terminal-Santiago Terminal
Santiago Terminal- SIGH
SIGH-Terminal/Alicia

TOTAL EXPENSES
TOTAL AMOUNT OF CASH ADVANCE
TOTAL EXPENSE
AMOUNT DUE TO TRIANON
AMOUNT DUE TO EMPLOYEE
Instruction for Completing This Form
1. Enter all the required information above.
2. Describe the reason and/or purpose for the expense above.
3. Attach all the receipts, statement etc.
4. Sign and date where indicated
5. Submit the completed form (with attachments) with your supervisor for review and approval.

*Please note that every field constitutes required information and must completely filled in. If necessary attac
Incomplete submittal will be returned unprocessed.

I certify that all information contained in this Expense Reimbursement Form is accurate. I understa
that entering false information will be subject for disciplinary action.

Submitted by:

__________________________

Noted by:

_____________________________

Approved by:

__________________________

Checked by_____________________________

presentative

TYPE OF EXPENSE
Van
Tricycle
Tricycle
Tricycle
Tricycle
Tricycle
Tricycle
Tricycle
Van
Van
Van
Jeep
Jeep
Jeep
Tricycle
Tricycle
Tricycle
Tricycle
VAn
Tricycle
Tricycle
Van
Van
Van
Tricycle
Tricycle
Van
Tricycle
Tricycle/Van

AMOUNT
30
15
25
10
20
15
15
15
60
30
30
20
20
20
10
10
10
10
50
10
10
20
30
10
10
10
20
20
50

605

y filled in. If necessary attach additional sheets

orm is accurate. I understand

___________________

___________________

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