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I HEREBY CERTIFY THAT I have completed the travel authorized in itinerary of Travel No.

212, series of 2010 under conditions indicated below: Strictly in accordance with the approved itinerary. Cut short as explained below. Excess payment in the amount of P ______ was refunded on O. R. No. ___________ dated ________________________ Extended as explained below. Additional itinerary was submitted. ( X ) Other deviations as explained below.

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