(NAME OF SCHOOL)

CERTIFICATE OF TRAVEL COMPLETED

(Chief of Office) (Station)

(Positions) (Date)

I HEREBY CERTIFY that I have completed the travel authorized in the Itinerary of
Travel No;______________________dated ______________________________
under the condition indicated below:

X - Strictly in accordance with approved Itinerary

- Cut short as explained below. Excess payment in the amount of _________
was refunded under O.R. No. _________ dated ________,
- Extended due to other deviations as explained below:

EXPLANATIONS OR JUSTIFICATIONS: _________________________________

_______________________________________________________________

EVIDENCE OF TRAVEL ATTACHED HERETO:

Certified by:

(Signature)

(Name)

(Position)

On evidence and information of which I have knowledge, the travel was actually undertaken.

(Name)

(Position)