Republic of the Philippines

PHILIPPINE NATIONAL POLICE

LOGISTICS SUPPORT SERVICE
TRANSPORTATION AND MAINTENANCE DIVISION
Camp Crame, Quezon City

Date:
TRIP TICKET
NR:
Official Driver: Signature:
Vehicle: Plate # Official User:
Purpose:
Destination: Authority: D, LSS
Estimated distance (in Km): ETD (time/date) :
Number of Liters Filled up by Gasman/Inspector
Duty Dispatcher

Remarks:
Duty Gasman

Checked/Noted By:_____________________________________
Signature over Printed Name of C, POL Sec SSDD-LSS/Authorized Representative
I HEREBY CERTIFY to the correctness of the statement/record of travel.
CONFORMED:

PSUPT RONALD G HIPOLITO

SIGNATURE OVER PRINTED NAME D, LSS or Duly Authorized
(OIC, TMD or Duly Authorized TMD personnel) NOTE: NOT VALID WITH ERASURES
:Representative
 Logistics Support Service
Transportation and Maintenance Division
Camp Crame, Quezon City

Gas Dispensing coupon

Date:
TRIP TICKET #

Duty Gasman:

Numer of liters filled by 0

Gasman/Inspector: (in words and figure)

Driver's Signature Duty Dispatcher

over Printed Name

Inspector's Signature
over Printed Name
Gasman's Copy

Logistics Support Service

Transportation and Maintenance Division
Camp Crame, Quezon City

Gas Dispensing coupon

Date: 0
TRIP TICKET # 0

Duty Gasman: 0

Numer of liters filled by 0

Gasman/Inspector: (in words and figure)

0 0
Driver's Signature Duty Dispatcher
over Printed Name

Inspector's Signature
over Printed Name
Dispatchers's Copy
 Transportation and Maintenance Division
Camp Crame, Quezon City
Gas Dispensing coupon

TRIP TICKET #
Duty Gasman: Date

Number of liters filled by (in words and figure)

Gasman/Inspector
PO3 VINARAO PO2 MIEN
Driver's Signature Duty Dispatcher

Inspector's Signature over Printed Name

Gasman's Copy

Transportation and Maintenance Division

Camp Crame, Quezon City
Gas Dispensing coupon

TRIP TICKET #
Duty Gasman: Date

Number of liters filled by (in

(in words
words and
and figure)
figure)
Gasman/Inspector
PO3 VINARAO PO2 MIEN
Driver's Signature Duty Dispatcher

Inspector's Signature over Printed Name

Dispatcher's copy
 Hi Ace/Grandia
# Vehicle Plate # Driver Destination User
1 Hi Ace SAA 3817
2 Hi Ace SAA 3846
3 Hi Ace(marked) SAA 3795
4 Hi Ace SAA 3832
5 Hi Ace SAA 3822
6 Hi Ace SKY 799
7 Grandia SJT 248
Innova
Vehicle Plate # Driver Destination User
1 Innova SGH 940
2 Innova(marked) SKA 227
Coaster
Vehicle Plate # Driver Destination User
1 Coaster(Marked) SHV 209
2 Coaster(Marked) SHV 229
3 Coaster XET 259 Vinarao
4 Hyundai Coaster NNI 150 Cat tel
Truck/Troop Carier
Vehicle Plate # Driver Destination User
1 Isuzu Truck SGV 102 Mabborang
2 Isuzu Truck SGV122
3 Isuzu Truck SGV 132
4 Mitsubishi Truck SGD 614
5 Mitsubishi Truck SGD 631
6 Mitsubishi Truck SHN 703
Bus
Vehicle Plate # Driver Destination User
1 Foton Bus SKE 441
2 Hyundai Bus NQE 296 Fagela Baler
ELF
Vehicle Plate # Driver Destination User
1 Elf XBS 204 Esparago
2 Elf XBS 274
Duration Remarks

Duration Remarks

Duration Remarks

Duration Remarks

Duration Remarks

Duration Remarks
# Time/Date Driver Vehicle Plate # User Destination
1 0900H/May 26 2016 PO3 Wacan R Coaster SHV 209 LSS-CIA Bicutan Taguig
2 1400H/May 26 2016 PO2 Cat-tel Coaster XET 259 DRD Cocoon Hotel, Quezon City

1 0400H/May 27 2016 SPO1 Singueo Isuzu Truck SGV 122 DL/PCI Reyes San Mateo, Rizal - Cabangan, Zambalez
2 0400H/May 27 2016 PO1 Cenizal Mitsu. Truck SHN 703 PNPA Morong Bataan to Silang Cavite
3 0400H/May 27 2016 PO1 Mabborang Isuzu Truck SGV 102 PNPA Morong Bataan to Silang Cavite
4 0400H/May 27 2016 PO3 Noay R Foton Bus SKE 441 PNP Lakas Tulungan Morong Bataan
5 0400H/May 27 2016 PO1 Rallang Hi Ace SAA 3817 DRD Lumban, Laguna
6 0400H/May 27 2016 PO1 Timajo Hi Ace SAA 3832 DRD Lumban, Laguna
7 0400H/May 27 2016 PO1 Fagela B Bus NQE 296 ES SJDM Bulacan
8 0700H/May 27 2016 PO1 Muyong Hi Ace SAA 3822 TCDS Ortigas Center
9 0700H/May 27 2016 PO2 Jacinto Grandia SJT 248 OLC NAIA, Pasay City
* 0 0 0 0

Fuel
Liters XCS
Liters ADF
0 0 0 0
0