Republic of the Philippines

Department of Justice

_____________
Date

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 authorize passenger: ____________________________
4. Place or places to be visited/inspected: _____________________
5. Purpose______________________________________________

B. To be filled by the Driver:

1. Time of departure from Office/garage________________________________ AM/PM

2. Time of arrival at (per No. 4 above) _________________________________ AM/PM
3. Time of departure from (per No. 4) __________________________________AM/PM
4. Time of arrival back to garage/office_________________________________ AM/PM
5. Approximate distance traveled (to and from) ___________________________ AM/PM
6. Gasoline issued, purchased and consumed:

a. Balance in tank__________________________________liters
b. Issued by office from stock ________________________liters
c. Add-Purchased during trip_________________________liters
TOTAL___________________________________liters

7. Gear oil issued_____________________________________________________liters

8. Lub. oil issued_____________________________________________________liters
9. Greased issued ____________________________________________________liters
10. Speedometer readings, if any:
At beginning of trip____________________________________miles/kms
At end of trip _________________________________________miles/kms
Distance travelled (per 5 above)

11. Remarks: ____________________________________________________________

____________________________________________________________

I hereby certify to the correctness of the above statement of record of travel.

Regional Director

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

(Authorized Passenger/Designation)