T R I P T I C K E T

CTRL NO:
DATE :

Vehicle/s ( ) Equipment ( )

This is to respectfully request availability of the following logistics:

Time of Departure from Origin: ( A.M.) (P.M.)
I. Vehicle/s : Type : Make : Plate No.
Destination : From : To : Km
Passenger : Position :
Purpose :
Fuel Read'g From Origin : Liters Gasoline ( ) Diesel ( )
Destination : Volume Liters Gas ( ) Diesel ( )
Arrival at Destination : ( A.M.) (P.M.)

II. Equip't : Classification: Dumptruck ( ) Ten Wheeler ( ) Excavator ( )

Loader ( ) Crane ( ) Grader ( )
Compactor ( ) Dozer ( ) Self-Loading ( )
Project : Fuel Requirement Liters
Location : Lubricants
Purpose : Others :

Requested by: Recommending Approval Approving Officer :

Authorized Personnel-Dept. Authorized Signatory Authorized Signatory

Driver : Operator :
Name & Signature Name & Signature

This form shall be accomplished in two copies( original for Purchasing and 2nd copy for the driver/operator)

Doc. Ref.: JAP-QF-YRD-001 Rev. 00 Effectivity date: Feb. 18, 2013