Republic of the Philippines

PROVINCE OF BILIRAN
MUNICIPALITY OF KAWAYAN
OFFICE OF THE MUNICIPAL TREASURER
No.

DRIVER’S TRIP TICKET

A. To be filled by the administrative official authorizing official travel.

1. Name of Driver of the vehicle ____________________________________________
2. Government Car to be used Plate No. ____________________________________________
3. Name of Authorized Passenger ____________________________________________
4. Place or Places to be Visited, Inspection ____________________________________________
5. Charge to Project ____________________________________________
6. Purpose ____________________________________________

_____________________________ HON. RODOLFO J. ESPINA, SR.

Municipal Mayor

B. To be filled by the Driver

1. Approximate distance travelled (to and from) ____________________________ Kms/miles

2. Gasoline Issued, purchased and used:
a. Balance in tank ______________________________________________liters
b. issued in tank _______________________________________________liters
c. add, purchased during trip _____________________________________liters
TOTAL __________________________________________liters
d. Deduct, used during trip _______________________________________liters
e. Balance in tank at the end of the trip _____________________________liters
3. Gear oil used ____________________________________________________________________liters
4. Lubricating oil issued _____________________________________________________________liters
5. Grease _________________________________________________________________________liters
6. Speed or meter reading, if any ______________________________________________________liters
7. Remarks _______________________________________________________________________liters
I HEREBY CERTIFY to the correctness of the above statement of the record of

__________________________
Driver/Operator

I HEREBY CERTIFY that I used the car on Official business as stated above.

_______________ __________________________
Date Name of Passenger

This form should be accomplished in triplicate, the original of which to be attached to the
monthly report of official travel, the duplicate id for the guards and the triplicate to be filed in the office
of the official concerned.