You are on page 1of 2

Republic of the Philippines

National Police Commission


PHILIPPINE NATIONAL POLICE
NUEVA ECIJA POLICE PROVINCIAL OFFICE
ALIAGA POLICE STATION
Aliaga, Nueva Ecija
APS Date_______________

IMPOUNDING RECEIPT

To Whom It May Concern:

THIS IS TO CERTIFY that I have received this date from Mr/Mrs________________________ a


resident of _____________________________________ one (1) unit of motor vehicle described below;

Owner: _____________________________________________

Driver: _____________________________________________

Address: ___________________________________________

Make: ______________________________________________

Motor/Chassis Nr.: ___________________________________

Engine Nr.: __________________________________________

Plate Nr.: ____________________________________________

OR/CR Nr. : __________________________________________

Subject vehicle was apprehended at about ___________________ for violation committed;

a. __________________________________; b. ___________________________.

Further, said vehicle was impounded at Aliaga Police Station for proper disposition.

With conformity Apprehending Officer

___________________________ _____________________________

--------------------------------------------------------------------------------------------------------------------------------------------

Republic of the Philippines


National Police Commission
PHILIPPINE NATIONAL POLICE
NUEVA ECIJA POLICE PROVINCIAL OFFICE
ALIAGA POLICE STATION
Aliaga, Nueva Ecija
APS Date_______________

IMPOUNDING RECEIPT

To Whom It May Concern:

THIS IS TO CERTIFY that I have received this date from Mr/Mrs________________________ a


resident of _____________________________________ one (1) unit of motor vehicle described below;

Owner: _____________________________________________

Driver: _____________________________________________

Address: ___________________________________________

Make: ______________________________________________

Motor/Chassis Nr.: ___________________________________

Engine Nr.: __________________________________________

Plate Nr.: ____________________________________________

OR/CR Nr. : __________________________________________

Subject vehicle was apprehended at about ___________________ for violation committed;

b. __________________________________; b. ___________________________.

Further, said vehicle was impounded at Aliaga Police Station for proper disposition.

With conformity Apprehending Officer


___________________________ _____________________________

You might also like