Annex A-3 Annex A-3

Republic of the Philippines Republic of the Philippines

Province of South Cotabato Province of South Cotabato
SANGGUNIANG PANLALAWIGAN OFFICE SANGGUNIANG PANLALAWIGAN OFFICE
City of Koronadal City of Koronadal

Drivers Trip Ticket No. ______ Drivers Trip Ticket No. ______
Date:________ Date:________

A.To be filled out by the Officer authorizing the travel: A.To be filled out by the Officer authorizing the travel:

1.Name of driver of vehicle FERDINAND P. YUNGCO, SR. 1.Name of driver of vehicle

2.Vehicle used and plate number
3.Name of authorized passenger
4.Place to be visited
5.Purpose
6.Km reading before travel
7.Km reading after travel
FORD EVEREST SHE 509
HON. VICENTE C. YUNGCO, JR.
2.Vehicle used and plate number
3.Name of authorized passenger
4.Place to be visited
5.Purpose
6.Km reading before travel
7.Km reading after travel

Approved: Approved:
VICENTE C. YUNGCO, JR. VICEN
SP Member

B.To be filled out by the Driver: B.To be filled out by the Driver:

1.Time of departure from the office/garage A.M./P.M. 1.Time of departure from the office/garage
2.Time of arrival at (per item A.4) A.M./P.M. 2.Time of arrival at (per item A.4)
3.Time of departure from (per item item A.4) A.M./P.M. 3.Time of departure from (per item item A.4)
4.Time of arrival back to office/garage A.M./P.M. 4.Time of arrival back to office/garage
5.Approximate distance travelled (to&from) A.M./P.M. 5.Approximate distance travelled (to&from)
6.GOL issued, purchased and used: 6.GOL issued, purchased and used:
1.Balance in tank liters 1.Balance in tank
2.Issued by office from stock liters 2.Issued by office from stock
3.Added purchases during the trip liters 3.Added purchases during the trip
TOTAL liters TOTAL
4.GOL used during the trip (to&from) liters 4.GOL used during the trip (to&from)
5.Balance in tank, end trip liters 5.Balance in tank, end trip
7. Oil issued/purchase/consumed 7. Oil issued/purchase/consumed
8. Remarks: 8. Remarks:

I hereby certify to the correctness of records of travel. I hereby certify to the correctness of records of travel.

FERDINAND P. YUNGCO, SR.

Driver

I hereby certify that I/we used this vehicle on official business as stated above: I hereby certify that I/we used this vehicle on official busines
Passenger/s Signature Passenger/s
A-3
Philippines
th Cotabato
ALAWIGAN OFFICE
onadal

g the travel:
FERDINAND P. YUNGCO, SR.
FORD EVEREST SHE 509
HON. VICENTE C. YUNGCO, JR.

VICENTE C. YUNGCO, JR.

SP Member

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

liters
liters
liters
liters
liters
liters

ords of travel.

FERDINAND P. YUNGCO, SR.

Driver

e on official business as stated above:

Signature