Sheet1TRIANON DIAGNOSTICS, INC.CASH ADVANCE LIQUIDATION

EMPLOYEE NAME/POSITIONEdgar Vincent A. Parubrub/ Medical Representative

PURPOSE OF CASH ADVANCETransportation

AMOUNTDATE REQUESTED

DATELOCATIONPARTICULARS / PURPOSETYPE OF EXPENSEAMOUNTTO & FROM04*01*15CauayanHi-way Alicia -Cauayan TerminalVan30CauayanCauayan Terminal- Ester C. Garcia HospitaTricycle 15CauayanEster C. Garcia Hospital-Dr. Donald CadeliniaTricycleTricycle 25CauayanDr. Donald Cadelinia-IUDMCTricycle10CauayanIUDMC-Dr. Edwin MauricioTricycle 20CauayanDr. Mauricio-Dr. Rachell CaballeroTricycle15CauayanDr. Caballero-Dr. Edna UyTricycle 15CauayanDr. Edna Uy- Terminal Cauayan Tricycle15CauayanTerminal Cauayan-Adventist HospitalVan60Santiago CityAdventist Hospital- Alicia HighwayVan3004*02*15AliciaHighway- Cauayan TerminalVan30CauayanCauayan Terminal- Cabatuan Family ClinicJeep20CabatuanPaulo Bernard Acosta- Rene Gozum Jr.Jeep20AuroraRene Gozum Jr- Terminal RoxasJeep20RoxasTerminal Roxas-Roxas Diagnostic Lab.Tricycle10RoxasRoxas Diagnostics Lab. -Yumena HospitalTricycle10RoxasYumena Hospital-Dr. Karen AlibutodTricycle10RoxasDr. Karen Alibutod-Terminal RoxasTricycle10RoxasTerminal Roxas- San MateoVAn50San MateoSan Mateo Highway to San Mateo Munici.Tricycle10San MateoSan Mateo Municipality-HighwayTricycle10San MateoSan Mateo - SantiagoVan 20SantiagoSantiago Terminal- AliciaVan 3004*03*15EchagueAlicia Highway - Echague terminal Van10EchagueEchague Terminal-Dr. Marjorie LopezTricycle10EchagueDr. Marjorie Lopez-Highway EchagueTricycle10EchagueEchague Terminal-Santiago TerminalVan20SantiagoSantiago Terminal- SIGHTricycle20SantiagoSIGH-Terminal/AliciaTricycle/Van50

TOTAL EXPENSES605

TOTAL AMOUNT OF CASH ADVANCETOTAL EXPENSEAMOUNT DUE TO TRIANONAMOUNT DUE TO EMPLOYEEInstruction for Completing This Form1. Enter all the required information above.2. Describe the reason and/or purpose for the expense above.3. Attach all the receipts, statement etc.4. Sign and date where indicated5. Submit the completed form (with attachments) with your supervisor for review and approval.*Please note that every field constitutes required information and must completely filled in. If necessary attach additional sheetsIncomplete submittal will be returned unprocessed.

I certify that all information contained in this Expense Reimbursement Form is accurate. I understandthat entering false information will be subject for disciplinary action.

Submitted by: __________________________ Noted by: _____________________________Approved by: __________________________ Checked by_____________________________