Republic of the Philippines

National Police Commission

NATIONAL HEADQUARTERS PHILIPPINE NATIONAL POLICE
REGIONAL HIGHWAY PATROL UNIT 4A
Camp BGen Vicente P Lim, Mayapa, Calamba City, Laguna

July 26, 2019

ACKNOWLEDGEMENT RECEIPT OF MOTOR VEHICLE

THIS IS TO CERTIFY that the undersigned recipient has received from RHPU4A
the motor vehicle described as follows:

Make/Type Toyota Vios

Motor Nr. 2NZ7879539
Chassis Nr PA1BW9F30G2074843
Plate Nr. VC 1388
Reg. Owner GUMABAY GLESON JAY NINO
FANDINO
Address Ph 6, B15, L27, Wellington Place Pasong,
Camachille II, General,CAVITE

Subject MV is released after presenting the pertinent documents below:

1. Copy of LTO Certificate of Registration Nr

2. Copy of Vehicle Sale Invoice
3. Voluntary Surrender from registered owner
4. Identification Card
5. Certification from BDO
6. Voluntary surrender with authority to sell
7. Deed of Conveyance of Motor Vehicle
8. Acknowledgement receipt Between registered owner and the possesor

FURTHER CERTIFY that I received the motor vehicle in good running condition
as it was impounded at HPG4A Office. I further certify that I have no complaint against
any personnel of RHPU4A.

Verified/prepared by: Claimant/Owner:

Noel T. de Quiroz GUMABAY GLESON JAY NINO FANDINO

Police Staff Sergeant July 26, 2019/1:00PM
Investigator, RHPU4A Date/Time

Withness by:
Clark Terrence K Borja
Repossesor