VEHICLE TRIP TICKET

INSTRUCTION:

1. To be filed in duplicate by person requesting for the use of Department vehicle

2. Original copy should be returned to the Admin Division upon completion for control purposes.
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TO BE FILLED ONLY BY PERSON REQUESTING THE USE OF THE DEPARTMENT VEHICLE

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Date: _____________________ Vehicle Plate No: ____________________________

Driver’s Name: _____________________________________________
Authorized Passenger/s: ___________________________________________________________________________
Destination: _____________________________________________________________________________________
Purposes: _______________________________________________________________________________________
Authorized by: ___________________________________________________________________________________

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TO BE FILLED BY THE DRIVER AT THE END OF THE TRIP
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DEDOMETER READING NO: _____________________________________________________________________

TRIP: DEPARTURE ARRIVAL

TIME PLACE TIME PLACE
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Balance in tank _______________________________ Liters

Issued from stock
Purchased outside
Balance in tank
Gear oil put it
Motor oil put in
Brake fluid put in
Grease issued
Total distance traveled
Total distance traveled
_______________________________ Liters
_______________________________ Liters
_______________________________ Liters
_______________________________ Liters Certified Correct:
_______________________________ Liters
_______________________________ Liters ______________
_______________________________ Liters Driver
_______________________________ Liters
_______________________________ Kms

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I HEREBY CERTIFY that the vehicle was used on official business as stated above

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Passenger