Republic of the Philippines

Province of Isabela
MUNICIPALITY OF SAN ISIDRO
MUNICIPAL HEALTH OFFICE

TRAVEL ORDER
TO: CHRISTOPHER ALEJANDRO
SUBJECT: ORDER TO DRIVE THE MUNICIPAL AMBULANCE
Date:

You are hereby directed to drive the Municipal Ambulance and bring/fetch
to
For your guidance and compliance.

Date Issued Time Out Mileage Out

Date Returned Time In Mileage In

VILMER B. BRAVO
Municipal Mayor

CONTRACT FOR THE USE OF MUNICIPAL AMBULANCE

I/We, of
(Name of requesting party) (Address)
wish to request the use of Municipal Ambulance to transport/fetch patient
(Name of patient)
from/to on
(Destination) (Date)
For the use of ambulance I/We agree to:
1. Shoulder the cost of gasoline to be used.
2. Shoulder the subsistence (meals and snacks) of the driver/s.

Further understand that I/We shall not hold the driver, the municipal government of San Isidro and its
official, and liable or accountable in case of accident will happen to our patient or us on the way to our destination.

Signed this _____ day of ____________________ at San Isidro, Isabela.

________________________________
(Name and Signature of Borrower)

CERTIFICATE OF APPEARANCE

This is to CERTIFY that CHRISTOPHER ALEJANDRO, official driver of ambulance of the municipality
of San Isidro, Isabela appeared in this office/institution on ________________________________for the
purpose of __________________________________________.

This Certification is issued upon the request of the above-named person for whatever legal purpose it
may serve.
Issued this ____ day of ____________________________________________.

___________________________________
(Authorized Person)