Vehicle Trip Ticket Form

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VEHICLE TRIP TICKET

2021-05-
Control No. Date

A. To be filled-up by the Administrative Official authorizing Official Travel

1. Name of Driver of the Vehicle:


2. Gov’t. Car to be Used/Plate No.
3. Name of Authorized Passenger/s:
4. Places to be visited/destination:
5. Date
Departure
Arrival

Recommending Approval: Approved:

B. To be filled-up by the Driver (To be accomplished in 4 copies: driver, dispatcher, Guard, Gas Station)

DEPARTURE ARRIVAL
Initial Initial
Trip No. Remarks
Time Place Odometer Time Place Odometer
Reading (km) Reading (km)

Fuel Used Other Vehicle Expenses


Balance in Tank Ltrs. Item Receipt No. Amount
Issued from Stock Ltrs.
Purchase Outside Ltrs.
TOTAL Ltrs.
Fuel Used Ltrs.
Balance in Tank Ltrs.
Total Distance Travelled Ltrs.
Remarks:

CERTIFIED CORRECT: I/We hereby certify that I/we used this vehicle on official business as stated above.

Driver/s

Date Printed Name of Passengers and Signature

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