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COHACO MERCHANDISING & DEVT CORP.

2246 Don Chino Roces Ave.,Makati City


Tel. No.: 478-1295 / Fax No.: 819-6403
Vat Reg.TIN No.: 242-650-000-000

Liquidation for Fuel Expenses Form


No: ______

Date Issued: ___________20____


Name: ____________________________________________________

Territory: ___________________________________________________

Date PARTICULARS KM/s AMOUNT

(please
indicate the
km/s run from
the start of
territory to
the End of
last area)
(Please Attach Receipt/Supporting Document)

________________________
Signature over Printed Name Approve
by: Ferdinand Co

COHACO MERCHANDISING & DEVT CORP.


2246 Don Chino Roces Ave.,Makati City
Tel. No.: 478-1295 / Fax No.: 819-6403
Vat Reg.TIN No.: 242-650-000-000

Liquidation for Fuel Expenses Form


No: ______

Date Issued: ___________20____


Name: ____________________________________________________

Territory: ___________________________________________________

Date PARTICULARS KM/s AMOUNT

(please
indicate the
km/s run from
the start of
territory to
the End of
last area)
(Please Attach Receipt/Supporting Document)

________________________
Signature over Printed Name Approve
by: Ferdinand Co

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