Republic of the Philippines

MUNICIPALITY OF CATARMAN
Province of Northern Samar

March 9, 2023
Date
DRIVER’S TRIP TICKET

A. TO BE FILLED BY THE ADMINISTRATION OFFICIAL AUTHORIZING OFFICE TRAVEL

1. Name of Driver: ROMEO A. MOLLEJON N

2. Government to be used Plate No.: ___________GENSET 150Kva ___________________
3. No. of Authorized Passenger: ____________________________________________________
4. Place or Place to be Visited Inspected________________________________________
5. Purpose: USE AS BACK UP DIESEL INCASE OF POWER INTERRUPTION.

CARLITO O. DANQUE FRANCISCO AURELIO E. ROSALES III

Municipal Engineer Municipal Mayor

B. TO BE FILLED BY THE DRIVER:

1. Time of Departure from office/Garbage: ____________________________________________

2. Time of Arrival at (per No. 4 above): ________________________________________________
3. Time of Departure from (per No. Above): ____________________________________________
4. Approximate/Diesel issued, purchased and consumed: _____________________________
5. Gasoline/Diesel issued, purchased and consumed : ________________________________
 Balance in tank: ____________________________________________________ ___ liter/s
 Issued by the Office from Stock: DIESEL TWO HUNDRED (200)___ liter/s
 Add Purchase during Trip: ____________________ ____________ _ liter/s
 Deduct: Used during Trip (to and from) __________________________ ______ liter/s
 Balance in Tank at the end Trip ___________________________ _______ ___ _ liter/s
6. Gear Oil issued: ________________________ ___________ liter/s
7. Lubricating Oil issued _______________________________________________ _____liter/s
8. Grease issued ______________________________________________________________ liter/s
9. Speedometer readings, if any at beginning of trip ___________________________
Miles/Kms.
10. REMARKS:_________________________________________________________________

ROMEO A. MOLLEJON
Electrician

I HEREBY CERTIFY that I used this car on official business as stated above.

___________________ ______________________
Date Name of Passenger