Republic of the Philippines

UNIVERSITY OF EASTERN PHILIPPINES

University Town, Northern Samar
TRIP TICKET
Date:___________, 2012
Trip Ticket No:________
A.
1.
2.
3.
4.
5.

To be filled by representative official authorizing travel.

Name of the driver of the vehicle:______________________________________
Government car to be used:___________________________________________
Name of authorized passenger(s):______________________________________
Place/places to be visited/inspected:____________________________________
PURPOSE:_________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
___________________________________________________________________
APPROVED:

DR. NESTOR P. GALAROZA

Head, General Services Unit
B.
1.
2.
3.
4.
5.
6.

ATTY. MAR P. DE ASIS

President

To be filled by the driver:

Time of departure from office/garage:
Time of arrival at (per no. 4 above):
Time of departure from (per no.4 above):
Time of arrival back to office/garage:
Approximate distance traveled in (to and from):
GASOLINE/DIESEL FUEL Issued/purchase or use:
a. Balance of the vehicle on tank:
Liters
b. Issued by the office from stock: __________________________ Liters
c.

A.M./P.M.
A.M./P.M.
A.M./P.M.
A.M./P.M.
A.M./P.M.