Republic of the Philippines

DEPARTMENT OF TRANSPORTATION
LAND TRANSPORTATION OFFICE
4/F ARANETA SQUARE MALL MONUMENTO
KALOOKAN CITY

Field Office: DLRC ARANETA SQUARE CALOOCAN TIN: 000865491001

Office Code: 1305 Date: 04/28/2023 10:18 AM

OFFICIAL RECEIPT 1305-000000039930

RECEIVED FROM (Last Name, First Name Middle Name)

RACCA, BENIGNO JR BALBUENA
ADDRESS (No. Street, Barangay, Municipality, Zip Code, Province)
18-E Anecita St Kaingin Road, Apolonio Samson, Quezon
City, 1106, Metro Manila, Second District
TIN (Tax Identification Number) LTO Client ID / LTO BUSINESS ID
21-790428-3136966

PAYMENT DETAILS BREAKDOWN OF PAYMENT

Transaction: TX-DLS-20230428-049819 - License Fee PHP 585.00
01
Application: RENEWAL, NORMAL
RENEWAL WITH VALID
LICENSE
Classification: Driver's License
Lic. No: N25-06-014798
Medical Exam
Schedule 1: FEBRUARY 27,2026 to APRIL
28,2026

TOTAL AMOUNT PAID: PHP 585.00

AMOUNT IN WORDS: FIVE HUNDRED EIGHTY-FIVE PESOS

MODE OF PAYMENT: Cash

LOCATION: Dlrc Araneta Square Caloocan
CASHIER: Amelita Raymundo
POS MACHINE: DLRO ARANETA SQUARE - CASHIER

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

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