Trip Ticket Sir Dagooc

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Trip ticket no.

Republic of the Philippines


Province of Bukidnon
POL form No. 1
VEHICLE TRIP TICKET

INSTRUCTIONS:
1. To be filed up in triplicate by person requesting use of the vehicle
2. Original - to driver to be attached to Fuel consumption Report (FCR)
3. Duplicate - to personal claims
4. Triplicate - to be submitted to ICD at the end of the trip
5. Quadruplicate - to be submitted to Gasoline station
TO BE FILED BY PERSON REQUESTING USE OF THE DEPARTMENT VEHICLE
TYPE OF PLATE DATE
VEHICLE: YAMAHA XTZ125 NO. SA-15089 FILED: July 19, 2022
DRIVER’S NAME:Dennis C. Dagooc
AUTHORIZED PASSENGER(S):
DESTINATION: Kahaponan, Nabag-o, Valencia City and vicinities.
PURPOSE OF TRAVEL: Validation of the incident reports submitted in BENRO
DATE OF DEPARTURE: June 25-28, 2022
RECOMMENDING DEPARTURE: APPROVED:

CECILLE M. EGNAR MERCY T. EBCAS


Provincial Environment and Natural Resources Assistant Provincial Administrator
Officer
TO BE FILLED ONLY BY THE DRIVER AFTER THE END OF THE TRIP
DISTANCE
DEPARTURE ARRIVAL ODOMETER READING
TRAVEL
Date Time Place Time Place Start End

Balance in Tank ltrs. Gear Oils Issued ltrs.

Issued from Stock ltrs. Motor Oil Issued ltrs.


Purchased Outside ltrs. Grease Issued ltrs.
TOTAL Total Distance
Travelled___
LESS
Gasoline used during the trip ltrs.
Balance in tank at the end of the trip ltrs.

CERTIFIED CORRECT

DRIVER
I HEREBY CERTIFY THAT I USED THIS VEHICLE ON OFFICIAL BUSINESS AS STATED ABOVE

20
Signature of Passenger

Trip ticket no.


Republic of the Philippines
Province of Bukidnon
POL form No. 1
VEHICLE TRIP TICKET

INSTRUCTIONS:
6. To be filed up in triplicate by person requesting use of the vehicle
7. Original - to driver to be attached to Fuel consumption Report (FCR)
8. Duplicate - to personal claims
9. Triplicate - to be submitted to ICD at the end of the trip
10. Quadruplicate - to be submitted to Gasoline station
TO BE FILED BY PERSON REQUESTING USE OF THE DEPARTMENT VEHICLE
TYPE OF PLATE DATE
VEHICLE: YAMAHA XTZ125 NO. SA-15089 FILED: October 11, 2022
DRIVER’S NAME:Dennis C. Dagooc
AUTHORIZED PASSENGER(S):
DESTINATION: Dalwangan, Mal. City/Valencia City and vicinities/North area Municipalities
PURPOSE OF TRAVEL: Conduct Inspection and Verification re: request transport of excavated materials
/Conduct data update on the local policies related to Ecological Solid Waste Management
DATE OF DEPARTURE: October 18-21, 2022
RECOMMENDING DEPARTURE: APPROVED:

CECILLE M. EGNAR MERCY T. EBCAS


Provincial Environment and Natural Resources Assistant Provincial Administrator
Officer
TO BE FILLED ONLY BY THE DRIVER AFTER THE END OF THE TRIP
DISTANCE
DEPARTURE ARRIVAL ODOMETER READING
TRAVEL
Date Time Place Time Place Start End

Balance in Tank ltrs. Gear Oils Issued ltrs.

Issued from Stock ltrs. Motor Oil Issued ltrs.


Purchased Outside ltrs. Grease Issued ltrs.
TOTAL Total Distance
Travelled___
LESS
Gasoline used during the trip ltrs.
Balance in tank at the end of the trip ltrs.

CERTIFIED CORRECT

DRIVER
I HEREBY CERTIFY THAT I USED THIS VEHICLE ON OFFICIAL BUSINESS AS STATED ABOVE

20
Signature of Passenger

Trip ticket no.


Republic of the Philippines
Province of Bukidnon
POL form No. 1
VEHICLE TRIP TICKET

INSTRUCTIONS:
11. To be filed up in triplicate by person requesting use of the vehicle
12. Original - to driver to be attached to Fuel consumption Report (FCR)
13. Duplicate - to personal claims
14. Triplicate - to be submitted to ICD at the end of the trip
15. Quadruplicate - to be submitted to Gasoline station
TO BE FILED BY PERSON REQUESTING USE OF THE DEPARTMENT VEHICLE
TYPE OF PLATE DATE
VEHICLE: YAMAHA XTZ125 NO. SA-15089 FILED: October 20, 2022
DRIVER’S NAME: Dennis C. Dagooc
AUTHORIZED PASSENGER(S): Dennis C. Dagooc
DESTINATION: Dalwangan, Malaybalay City; Cabanglasan; Impasug-ong, Bukidnon
PURPOSE OF TRAVEL: Conduct Inspection and area verification re: request for excavated materials; Conduct
data update on the local policies related to Ecological Solid Waste Management
DATE OF DEPARTURE: October 24-26, 2022
RECOMMENDING DEPARTURE: APPROVED:

CECILLE M. EGNAR CHERRY P. PEPITO


Provincial Environment and Natural Resources Provincial Administrator
Officer
TO BE FILLED ONLY BY THE DRIVER AFTER THE END OF THE TRIP
DISTANCE
DEPARTURE ARRIVAL ODOMETER READING
TRAVEL
Date Time Place Time Place Start End

Balance in Tank ltrs. Gear Oils Issued ltrs.

Issued from Stock ltrs. Motor Oil Issued ltrs.


Purchased Outside ltrs. Grease Issued ltrs.
TOTAL Total Distance
Travelled___
LESS
Gasoline used during the trip ltrs.
Balance in tank at the end of the trip ltrs.

CERTIFIED CORRECT

DRIVER
I HEREBY CERTIFY THAT I USED THIS VEHICLE ON OFFICIAL BUSINESS AS STATED ABOVE

20
Signature of Passenger

Trip ticket no.


Republic of the Philippines
Province of Bukidnon
POL form No. 1
VEHICLE TRIP TICKET

INSTRUCTIONS:
16. To be filed up in triplicate by person requesting use of the vehicle
17. Original - to driver to be attached to Fuel consumption Report (FCR)
18. Duplicate - to personal claims
19. Triplicate - to be submitted to ICD at the end of the trip
20. Quadruplicate - to be submitted to Gasoline station
TO BE FILED BY PERSON REQUESTING USE OF THE DEPARTMENT VEHICLE
TYPE OF PLATE DATE
VEHICLE: YAMAHA XTZ125 NO. SA-15089 FILED: October 12, 2022
DRIVER’S NAME:Dennis C. Dagooc
AUTHORIZED PASSENGER(S):
DESTINATION: Valencia City and vicinities
PURPOSE OF TRAVEL: Attend dialogue: as per request by Brgy. Vintar re: settlement of boundary
conflict/MONITORING AND INSPECTION w/ -in the contested area.
DATE OF DEPARTURE: October 13-14, 2022
RECOMMENDING DEPARTURE: APPROVED:

CECILLE M. EGNAR CHERRY P. PEPITO


Provincial Environment and Natural Resources Provincial Administrator
Officer
TO BE FILLED ONLY BY THE DRIVER AFTER THE END OF THE TRIP
DISTANCE
DEPARTURE ARRIVAL ODOMETER READING
TRAVEL
Date Time Place Time Place Start End

Balance in Tank ltrs. Gear Oils Issued ltrs.

Issued from Stock ltrs. Motor Oil Issued ltrs.


Purchased Outside ltrs. Grease Issued ltrs.
TOTAL Total Distance
Travelled___
LESS
Gasoline used during the trip ltrs.
Balance in tank at the end of the trip ltrs.

CERTIFIED CORRECT

DRIVER
I HEREBY CERTIFY THAT I USED THIS VEHICLE ON OFFICIAL BUSINESS AS STATED ABOVE

20
Signature of Passenger

Trip ticket no.


Republic of the Philippines
Province of Bukidnon
POL form No. 1
VEHICLE TRIP TICKET

INSTRUCTIONS:
21. To be filed up in triplicate by person requesting use of the vehicle
22. Original - to driver to be attached to Fuel consumption Report (FCR)
23. Duplicate - to personal claims
24. Triplicate - to be submitted to ICD at the end of the trip
25. Quadruplicate - to be submitted to Gasoline station
TO BE FILED BY PERSON REQUESTING USE OF THE DEPARTMENT VEHICLE
TYPE OF PLATE DATE
VEHICLE: YAMAHA XTZ125 NO. SA-15089 FILED: November 11, 2022
DRIVER’S NAME: Dennis C. Dagooc
AUTHORIZED PASSENGER(S):
DESTINATION: Kahaponan, Valencia City
PURPOSE OF TRAVEL: Conduct update on the renewal of contract of lease on the leased quarry checkpoints
DATE OF DEPARTURE: November 10, 2022
RECOMMENDING DEPARTURE: APPROVED:

CECILLE M. EGNAR CHERRY P. PEPITO


Provincial Environment and Natural Resources Provincial Administrator
Officer
TO BE FILLED ONLY BY THE DRIVER AFTER THE END OF THE TRIP
DISTANCE
DEPARTURE ARRIVAL ODOMETER READING
TRAVEL
Date Time Place Time Place Start End

Balance in Tank ltrs. Gear Oils Issued ltrs.

Issued from Stock ltrs. Motor Oil Issued ltrs.


Purchased Outside ltrs. Grease Issued ltrs.
TOTAL Total Distance
Travelled___
LESS
Gasoline used during the trip ltrs.
Balance in tank at the end of the trip ltrs.

CERTIFIED CORRECT

DRIVER
I HEREBY CERTIFY THAT I USED THIS VEHICLE ON OFFICIAL BUSINESS AS STATED ABOVE

20
Signature of Passenger

Trip ticket no.


Republic of the Philippines
Province of Bukidnon
POL form No. 1
VEHICLE TRIP TICKET

INSTRUCTIONS:
26. To be filed up in triplicate by person requesting use of the vehicle
27. Original - to driver to be attached to Fuel consumption Report (FCR)
28. Duplicate - to personal claims
29. Triplicate - to be submitted to ICD at the end of the trip
30. Quadruplicate - to be submitted to Gasoline station
TO BE FILED BY PERSON REQUESTING USE OF THE DEPARTMENT VEHICLE
TYPE OF PLATE DATE
VEHICLE: YAMAHA XTZ125 NO. SA-15089 FILED: November 15, 2022
DRIVER’S NAME: Dennis C. Dagooc
AUTHORIZED PASSENGER(S):
DESTINATION: Cabanglasan and Valencia City
PURPOSE OF TRAVEL: Conduct data update on the local policies related to Ecological Solid Waste
Management
DATE OF DEPARTURE: November 17-18, 2022
RECOMMENDING DEPARTURE: APPROVED:

CECILLE M. EGNAR CHERRY P. PEPITO


Provincial Environment and Natural Resources Provincial Administrator
Officer
TO BE FILLED ONLY BY THE DRIVER AFTER THE END OF THE TRIP
DISTANCE
DEPARTURE ARRIVAL ODOMETER READING
TRAVEL
Date Time Place Time Place Start End

Balance in Tank ltrs. Gear Oils Issued ltrs.

Issued from Stock ltrs. Motor Oil Issued ltrs.


Purchased Outside ltrs. Grease Issued ltrs.
TOTAL Total Distance
Travelled___
LESS
Gasoline used during the trip ltrs.
Balance in tank at the end of the trip ltrs.

CERTIFIED CORRECT

DRIVER
I HEREBY CERTIFY THAT I USED THIS VEHICLE ON OFFICIAL BUSINESS AS STATED ABOVE

20
Signature of Passenger

Trip ticket no.


Republic of the Philippines
Province of Bukidnon
POL form No. 1
VEHICLE TRIP TICKET

INSTRUCTIONS:
31. To be filed up in triplicate by person requesting use of the vehicle
32. Original - to driver to be attached to Fuel consumption Report (FCR)
33. Duplicate - to personal claims
34. Triplicate - to be submitted to ICD at the end of the trip
35. Quadruplicate - to be submitted to Gasoline station
TO BE FILED BY PERSON REQUESTING USE OF THE DEPARTMENT VEHICLE
TYPE OF PLATE DATE
VEHICLE: YAMAHA XTZ125 NO. SA-15089 FILED: November 16, 2022
DRIVER’S NAME: Dennis C. Dagooc
AUTHORIZED PASSENGER(S):
DESTINATION: Maramag, Valencia City, San Fernado
PURPOSE OF TRAVEL: Conduct Inspection and area verification re: request for excavated materials; Conduct
data update on the local policies related to Ecological Solid Waste Management

DATE OF DEPARTURE: November 22,23,24, 2022


RECOMMENDING DEPARTURE: APPROVED:

CECILLE M. EGNAR CHERRY P. PEPITO


Provincial Environment and Natural Resources Provincial Administrator
Officer
TO BE FILLED ONLY BY THE DRIVER AFTER THE END OF THE TRIP
DISTANCE
DEPARTURE ARRIVAL ODOMETER READING
TRAVEL
Date Time Place Time Place Start End

Balance in Tank ltrs. Gear Oils Issued ltrs.

Issued from Stock ltrs. Motor Oil Issued ltrs.


Purchased Outside ltrs. Grease Issued ltrs.
TOTAL Total Distance
Travelled___
LESS
Gasoline used during the trip ltrs.
Balance in tank at the end of the trip ltrs.

CERTIFIED CORRECT

DRIVER
I HEREBY CERTIFY THAT I USED THIS VEHICLE ON OFFICIAL BUSINESS AS STATED ABOVE

20
Signature of Passenger

Trip ticket no.


Republic of the Philippines
Province of Bukidnon
POL form No. 1
VEHICLE TRIP TICKET

INSTRUCTIONS:
36. To be filed up in triplicate by person requesting use of the vehicle
37. Original - to driver to be attached to Fuel consumption Report (FCR)
38. Duplicate - to personal claims
39. Triplicate - to be submitted to ICD at the end of the trip
40. Quadruplicate - to be submitted to Gasoline station
TO BE FILED BY PERSON REQUESTING USE OF THE DEPARTMENT VEHICLE
TYPE OF PLATE DATE
VEHICLE: YAMAHA XTZ125 NO. SA-15089 FILED: December 15, 2022
DRIVER’S NAME: Dennis C. Dagooc
AUTHORIZED PASSENGER(S):
DESTINATION: Maramag, Quezon, Don Carlos, Bukidnon
PURPOSE OF TRAVEL: Conduct data update on the local policies related to Ecological Solid Waste
Management

DATE OF DEPARTURE: December 21,22,23, 2022


RECOMMENDING DEPARTURE: APPROVED:

CECILLE M. EGNAR CHERRY P. PEPITO


Provincial Environment and Natural Resources Provincial Administrator
Officer
TO BE FILLED ONLY BY THE DRIVER AFTER THE END OF THE TRIP
DISTANCE
DEPARTURE ARRIVAL ODOMETER READING
TRAVEL
Date Time Place Time Place Start End

Balance in Tank ltrs. Gear Oils Issued ltrs.

Issued from Stock ltrs. Motor Oil Issued ltrs.


Purchased Outside ltrs. Grease Issued ltrs.
TOTAL Total Distance
Travelled___
LESS
Gasoline used during the trip ltrs.
Balance in tank at the end of the trip ltrs.

CERTIFIED CORRECT

DRIVER
I HEREBY CERTIFY THAT I USED THIS VEHICLE ON OFFICIAL BUSINESS AS STATED ABOVE

20
Signature of Passenger

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