CARAGA Administartive Region
Division of Agusan del Sur
BUNAWAN NATIONAL HIGH SCHOOL
Bunawan, Agusan del Sur
DRIVER'S TRIP TICKET
December 4,20
Date
A. To be filled by the Administrative Official authorizing travel
1. Name of Driver of the Vehicle: ARNELSON C. DERECHO
2. Government Car to e used Plate no 1201-431347
3. Name of Authorized Passenger: CHRIS D. POMOY
4. Place to be visited/Inspected
: Patin-ay,
: Prosperidad, Agusan del Sur
5. Purposes: To convey the principal to submit follow-up replacement of teacher and submit form 86.
COA FILE
APPROVED BY:
CHRIS D. POMOY
PRINCIPAL-IV
B. To be filled by the Driver
1. Time Departure from the Office/Garrage : 7:30 AM_____________________________
2. Time Arrival at (per No. 40) : 9:50 AM_____________________________
3. Time Departure from at (per No. 40) : 12:45 PM_____________________________
4. Time Arrival at the Office/Garage : 3: 25 PM_____________________________
5. Approximate Distance Travelled (to & from) : 125.8 km____________________________
6. Gas issued Purchased and used : Diesel________________________
a. Balanced in Tank : 18 Liters
b. Issued by the Office from stocks : 30 Liters
c. Add purchased during the trip : _____ Liters___________________________
Total : 48 Liters_____________________________
d. Deduct used during the trip : 30 Liters____________________________
e. Balance in tank at the end of the trip: 18 Liters_________________________
Gear Oil Used: n/a
Lubricator Oil used: n/a
Speed meter reading if any : ______________________
a. at the begginning of the trip : _____________________km _____________Miles
b. at the end of the trip : _____________________km______________Miles
Remarks : ____________________________________________________________
I hereby certify to the correctness of the statement of reecord of travel.
ARNELSON C. DERECHO
Driver
Other Passengers:
CHRIS D. POMOY
Name of Passenger
PRINCIPAL-IV
Designation
December 4,2023
Date
er and submit form 86.
RIS D. POMOY
PRINCIPAL-IV
___________
___________
____________
___________
_____________
____________
__________
____________
___________
___________
____________Miles
____________Miles
vel.
ERECHO
MOY
enger
-IV
on
