Republic of the Philippines

PROVINCE OF AGUSAN DEL SUR

Gov. Democrito O. Plaza Government Center, Prosperidad

OFFICE OF THE PROVINCIAL GOVERNOR

Information Technology Unit

_____________
Date
Control No.____________________

DRIVER’S TRIP TICKET

TO BE FILLED UP OF THE DRIVER:

1. Name of Driver:____________________________
2. Government Truck Plate No.__________________
3. Place to be visited project:____________________
4. Authorized Passenger:_______________________

____________________________
Chief of Bureau/
Authorized Representative

5. Time of departure from equipment garage :___________AM/PM___________

6. Time of departure per No. 3 above :___________AM/PM___________
7. Time of arrival per No. 3 above :___________AM/PM___________
8. Time of arrival garage/office :___________AM/PM___________
9. Approximate distance traveled :_______________________KMS.
10. Diesel/Gas fuel balance in tanked :_______________________LTS.
11. Purchase/Borrowed :_______________________LTS.
12. Issued by the office stock :_______________________LTS.
13. Total diesel/gasoline fuel :_______________________LTS.
14. Deduct during the trip :_______________________LTS.
15. Balance in tank at the end of the trip :_______________________LTS.
16. Gear/Motor oil issued /used :_______________________LTS.
17. Greased issued/used :___________________LBS/KLS.
18. Brake fluid issued/used :___________________LTS/PTS.
19. Speedometer reading if any at the end of the trip :_______________________KMS.
20. Speedometer if any at the beginning of the trip :_______________________KMS.
21. Speedometer total reading :_______________________KMS.
22. Purpose:_______________________________________________________________
_______________________________________________________________

I HEREBY certify the correctness of the above statement of the travel.

_____________________________
(Driver)

I HEREBY certify that I/we use the car/vehicle on official business state above.

______________________________
(Authorized Passenger/Designation)
 Republic of the Philippines
PROVINCE OF AGUSAN DEL SUR
Gov. Democrito O. Plaza Government Center, Prosperidad

OFFICE OF THE PROVINCIAL GOVERNOR

Information Technology Unit

_____________
Date
Control No.____________________

DRIVER’S TRIP TICKET

TO BE FILLED UP OF THE DRIVER:

1 Name of Driver:____________________________
2. Government Truck Plate No.__________________
3. Place to be visited project:____________________
4. Authorized Passenger:_______________________

____________________________
Chief of Bureau/
Authorized Representative

23. Time of departure from equipment garage :___________AM/PM___________

24. Time of departure per No. 3 above :___________AM/PM___________
25. Time of arrival per No. 3 above :___________AM/PM___________
26. Time of arrival garage/office :___________AM/PM___________
27. Approximate distance traveled :_______________________KMS.
28. Diesel/Gas fuel balance in tanked :_______________________LTS.
29. Purchase/Borrowed :_______________________LTS.
30. Issued by the office stock :_______________________LTS.
31. Total diesel/gasoline fuel :_______________________LTS.
32. Deduct during the trip :_______________________LTS.
33. Balance in tank at the end of the trip :_______________________LTS.
34. Gear/Motor oil issued /used :_______________________LTS.
35. Greased issued/used :___________________LBS/KLS.
36. Brake fluid issued/used :___________________LTS/PTS.
37. Speedometer reading if any at the end of the trip :_______________________KMS.
38. Speedometer if any at the beginning of the trip :_______________________KMS.
39. Speedometer total reading :_______________________KMS.
40. Purpose:_______________________________________________________________
_______________________________________________________________

I HEREBY certify the correctness of the above statement of the travel.

_____________________________
(Driver)

I HEREBY certify that I/we use the car/vehicle on official business state above.

______________________________
(Authorized Passenger/Designation)