APPENDIX B

Republic of the Philippines

Regional Office No. X

CERTIFICATE OF TRAVEL COMPLETED

(Station)

(Date)

I HEREBY CERTIFY that I have completed the travel authorized in Itinerary of Travel with Travel
Order No. _Unnumbered COA Memo__, dated __11/16/2016___ under conditions indicated below:

ü Strictly in accordance with approved itinerary.

Cut short as indicated below. Excess payment in the amount of P_______ was refunded under
O.R. No. ______ dated _______.
Extended as explained below. Revised itinerary was submitted.

Other deviations as explained below.

Explanations or Justifications:

Evidence of Travel Attached Hereto:

1. Certificate of Appearance
2. Unnumbered COA Memorandum dated Nov. 16, 2016
3. Itinerary of Travel

Respectfully submitted:

On the evidence and information of which I have knowledge, the travel was actually undertaken.