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Republic of the Philippines

DEPARTMENT OF TRANSPORTATION
LAND TRANSPORTATION OFFICE
P. GOMEZ ST. LAOAG CITY

Field Office: LAOAG CITY DISTRICT OFFICE TIN: 000865491002


Office Code: 0124 Date: 07/20/2022 11:20 AM

OFFICIAL RECEIPT 0124-000000131099


RECEIVED FROM (Last Name, First Name Middle Name)
ASUNCION, ROGELIO ANTONIO
ADDRESS (No. Street, Barangay, Municipality, Zip Code, Province)
N/A, Bgy. No. 33-B, La Paz Proper, Laoag City (Capital), 2900, Ilocos Norte
TIN (Tax Identification Number)

PAYMENT DETAILS BREAKDOWN OF PAYMENT


Transaction: TX-DLS-20220720-609206 - License Fee PHP 585.00
01
Application: RENEWAL, EXPIRED Penalty Fee PHP 75.00
LICENSE (FIRST YEAR), 10-
YEARS LICENSE RENEWAL
Lic. No: A03-93-031818
Classification: Driver's License

TOTAL AMOUNT PAID: PHP 660.00


AMOUNT IN WORDS: SIX HUNDRED SIXTY PESOS

MODE OF PAYMENT: GCash


LOCATION: -

This is a system generated Official Receipt. No Signatures needed.

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