Date:__________________

DRIVER’S TRIP TICKET

A. To be filled by the Administrative Office authorizing official travel

1. Name of driver _________________________________________________________________

2. Government car to be used ________________________________________________________
3. Name of authorized passenger _____________________________________________________
4. Place/to be visited/inspected _______________________________________________________
5. Purpose _______________________________________________________________________

HON. DELFIN M. DE CLARO

Chief agency/Office

B. To be filled by the driver

1. Time of departure from office/garage _________________________________________

AM/PM
2. Time of arrival at (per No. 4 above) _________________________________________ AM/PM
3. Time of departure (per No.4) _______________________________________________ AM/PM
4. Time of arrival back to office/garage _________________________________________ AM/PM
5. Appropriate distance travelled ______________________________________________ kms.
6. a) balance in tank __________________________________________________________ Liters
b) Issued by office from stock ________________________________________________ Liters
c) Add: Purchased during trip _________________________________________________ Liters
d) Deduct: Used during trip __________________________________________________ Liters
e) balance in tank at the end of trip ____________________________________________ Liters
TOTAL - - - - - - - - - - - - - - - - - - - - - - _________________________________ Liters
7. Gear oil issued ____________________________________________________________ Liters
8. Lubrication oil, issued ______________________________________________________ Liters
9. Grease issued _____________________________________________________________ Liters
10. Speed meters reading of any:
At the beginning of the trip ________________________________________ miles/kms.
At the end of the trip _____________________________________________ miles/kms.
Distance travelled (per No. 5) ______________________________________ miles/kms.
11. Remarks ______________________________________________________________________

I hereby certify the correctness of the above statements/information of Itinerary of Travel

I hereby certify that I used this car on Official Travel

__________________________
Driver