Republic of the Philippines

DEPARTMENT OF TRANSPORTATION
LAND TRANSPORTATION OFFICE
EAST AVENUE, QUEZON CITY

QUEZON CITY EXTENSION OFFICE

Field Office: ______________________________________ 000865491001
Tin: ________________________________
1308
Office Code: ______________________________________ 03/24/2023 02:02 PM
Date: _______________________________

OFFICIAL
OFFICIALRECEIPT
RECEIPT 1357-000000085708
RECEIVED FROM (Last Name, First Name, Middle Name)
FERNANDEZ, KIYANA PONTECHA
____________________________________________________________________________________________________________
ADDRESS (No. Street, Barangay, Municipaloty, Zip Code, Province)
2 St., Therese Perpetual Village Phase 3 ,
Taguig City
____________________________________________________________________________________________________________
TIN (Tax identification Number) LTO CLIENT ID/LTO BUSINESS ID
24-630215-4496402
___________________________________________________________________________________________________________
PAYMENT DETAILS BREAKDOWN OF PAYMENT
________________________________________

________________________________________

________________________________________
Transaction : TX-DLS-20230324-108417- License Fee: PHP 585.00
01
Application: RENEWAL, NORMAL
RENEWAL WITH VALID
LICENSE, 5 YEARS LICENSE
RENEWAL
Classification: Driver's License

Lic. No.: N50-20-002711

Medical Exam

Schedule 1: DECEMBER 17, 2025 to

FEBRUARY 15, 2025
Schedule 2: DECEMBER 17, 2027 to
FEBRUARY 15, 2027
___________________________________________________________________________________________________________
TOTAL AMOUNT PAID:
PHP 585.00
AMOUNT IN WORDS: FIVE HUNDRED EIGHTY-FIVE PESOS

MODE OF PAYMENT: Cash

LOCATION: Quezon City
CASHIER: Carmina Fontanilla
POS MACHINE: DLRO ROB METRO EAST - CASHIER
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VALID AS TEMPORARY DRIVER'S LICENSE

LTO QUEZON CITY LICENSING CENTER
MERCYNITA PARAS ITY
EZON C
RELEASING OFFICER LTO QU ER
G CENT
LICENSIN

FOR INQUIRIES PLEASE CALL 09167351880 EASED

OR EMAIL AT 1345DDMPAO@GMAIL.COM
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