Republic of the Philippines

Province of Antique
Municipality of Valderrama
OFFICE OF THE MUNICIPAL MAYOR

OFFICIAL TRIP TICKET

Trip Ticket No. ___________________________ Date: _____________________________
Government Vehicle to be used: _____________________________________
Places to be visited: ________________________________________________
Purpose: ______________________________________________________________________________________________________________
A.M. P.M.
Time of Departure : ____________________ __________________
Time of Arrival/Destination: ____________________ __________________
Time of Arrival back to Station: ____________________ __________________
_______________________________________________________________________________________________________________________
FUEL AND OIL: Issued/Purchased Consumed Balance
Gasoline/Diesel ______________________ ________________ _________________
Gears Oils/Brake Fluid ______________________ ________________ _________________

TOTAL DISTANCE TRAVELLED: __________________ Official Authorizing to Travel:

MARY JOYCE M. ROQUERO

Municipal Mayor
I HEREBY CERTIFY to the correctness of the above statement of official travel undertaken:

Driver
I HEREBY CERTIFY that I have used the government vehicle on an official business:

Official Passenger

Republic of the Philippines

Province of Antique
Municipality of Valderrama
OFFICE OF THE MUNICIPAL MAYOR

OFFICIAL TRIP TICKET

Trip Ticket No. ___________________________ Date: _____________________________
Government Vehicle to be used: _____________________________________
Places to be visited: ________________________________________________
Purpose: ______________________________________________________________________________________________________________
A.M. P.M.
Time of Departure : ____________________ __________________
Time of Arrival/Destination: ____________________ __________________
Time of Arrival back to Station: ____________________ __________________
_______________________________________________________________________________________________________________________
FUEL AND OIL: Issued/Purchased Consumed Balance
Gasoline/Diesel ______________________ ________________ _________________
Gears Oils/Brake Fluid ______________________ ________________ _________________

TOTAL DISTANCE TRAVELLED: __________________ Official Authorizing to Travel:

MARY JOYCE M. ROQUERO

Municipal Mayor
I HEREBY CERTIFY to the correctness of the above statement of official travel undertaken:

Driver
I HEREBY CERTIFY that I have used the government vehicle on an official business:
Official Passenger
____________

______________

____________

______________