| Date | |
| RECEIVED FROM | |
| ADDRESS | |
| PREMIUM SALES | |
| DOCS. STAMP | |
| LG TAX | |
| MISC. | |
| TOTAL | |
| THE SUM OF PESOS | |
| COC NO | |
| COC AUTH | |
| POLICY NO | |
| DATE ISSUED | |
| FROM 12:00 NN | |
| TO 12:00 NN | |
| OFFICIAL RECEIPT | |
| MODEL NO | |
| MAKE | |
| TYPE OF BODY | |
| COLOR | |
| MV FILE NO. | |
| PLATE NO. | |
| SERIAL/CHASSIS | |
| MOTOR NO | |
| OTHERS | |
| DOCS. STAMP | |
| LGT | |
| PLACE | |
| DATE | |
| MONTHS | |
| YR | |
|
|
|
||||||
| 100,000.00 | .00 |
| .00 |
| .00 |
| .00 |
| .00 |
|
|
|
||||||||||
.00 |
| .00 | |
| .00 | |
| .00 | |
| .00 | |
| .00 | |
| .00 | |
|
|
|
||||||
| .00 |
| .00 |
| .00 |
| .00 |
| .00 |
| .00 |
| 26 | |||
|
|
|
||||||||
.00 |
| GE20098 | |
| JULY 03, 2022 | |
| .00 | |
| .00 | |
| .00 | |
| .00 | |
| .00 | |
| .00 | |
|
|
|
||||||||
| .00 |
| 2026 | ||
|
|
|
||||||||
| | | .00 |