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FORM NO.

: F-LF-001

DRIVER DEPARTMENT
VEHICLE PLATE NUMBER
TRAVEL ORDER DATE E.T.D. E.T.A. CONTROL NO.

ITINERARY OF TRAVEL
STARTING POINT DESTINATION POINT
TOTAL TOTAL ACKNOWLEDGE-
# PURPOSE OF TRAVEL DESTINATION ODOMETER ODOMETER
TIME TIME HRS KMS MENT
READING READING

TOTAL

FUEL BALANCE
½ ½ ½ ½
¼ ¾ ¼ ¾ ¼ ¾ ¼ ¾

E F E F E F E F

DEPARTURE BEFORE REFIL AFTER REFIL ARRIVAL

Departure (Ltrs) Refill (Ltrs) Total Ltrs Arrival (Ltrs)


KM Reading KM Reading KM Reading KM Reading
Total Fuel Consumed = Total KM run = Tuel Tank Capacity = Fuel Consumption Rate =

NOTES
PROBLEM/ISSUE/DEFECT :
SOLUTION :
ACTION TAKEN :
RESULT :
REQUESTED BY APPROVED BY DRIVER ADMIN/DISPATCHER ACCOUNTING

PRINTED NAME & SIGNATURE PRINTED NAME & SIGNATURE PRINTED NAME & SIGNATURE PRINTED NAME & SIGNATURE PRINTED NAME & SIGNATURE

Revision No. 001: (25 October 2018)

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