LTO FORM NO.

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REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF TRANSPORTATION
LAND TRANSPORTATION OFFICE
East Avenue, Quezon City
TO: MV INSPECTOR - THIS FORM WILL BE USED AS A
SOURCE DOCUMENT IN COMPUTERIZATION. FILL
MOTOR VEHICLE
UP COMPLETELY AND ACCURATELY IN INK. INSPECTION REPORT MVIR NO.
OWNERSHIP AND DOCUMENTATION
OWNER'S COMPLETE NAME AND ADDRESS AGENCY DATE

AUTHORIZED AGENCY (For hire only) FILE NUMBER

ACQUIRED FROM (Complete Name and Address) TYPE OF REGISTRATION

D 1. NEW 02. RENEWAL D 3. OTHERS (Specify)
MVRR NUMBER (Latest) CHPG CONTROL NUMBER

ENCUMBRANCE (Complete Name and Address) CERT. OF PAYMENT NUMBER (C.P.) ~

INFORMAL ENTRY NUMBER (I.E.)

INSURER: .........,
POLICY NUMBER

KIND OF VEHICLE
D 1. NEW D 4. CAR D 7. MC 9. OTHERS (Specify)
EXPIRY DATE: I CERT. OF COVER NO. ENDORSEMENT NO

Cl 2. 2ND HAND Cl 5. TRUCK DATE OF ENDORSEMENT: AMOUNT PL TPL

D 3. REBUILT 0 6. HIRE D 6. TC OF
COVERAGE p p
1 HEREBY CERTIFY THAT ALL

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I N FORMATION ANO THC
STENCIL BELOW ARE TRUE
ANO CORRECT. INSPECToR·s PRINTED NAME & SIGNATURE
IDENTIFICATION AND INSPECTION
CLASSIFICATION
I MAKE PLATE NO.

·-
TYPE OF FUEL
o GAS o CNG
MOTOR NUMBER
,......
SERIAUCHASSIS NUMBER Cl DIESEL 0 ELECTRIC
CJ LPG 0 OTHERS
SERIES I TYPE OF BODY COLOR NO. OF DOOR I YR. MODEL I TOTAL PISTON DISPLACEMENT (cuJcm.) 1 NO. CYL

BODY 0 1 SAFE 0 2. UNSAFE 0 3. DILAPIDATED Cl RADIO Cl YELPER Cl SPARE TIRE D EWO

' ACCESSORIES
0 cs Cl AJRCON 0 TOOLS 0 BATIERY
OOORIWlNDOW 01 GOOO 0 2. LOOSE D 3. UNSAFE
DRIVE D AUTOMATIC 0 POWER DOVER 0 CONVENTIONAL
WINDSHIELD

CAPACITY
MARKING
CJ 1. GOOO

Cl 1 COMPLETE
0 2. DEFECTIVE

D 2. INCOMPLETE
D 3. NONE

0 3. INACCURATE O 4. NONE
MAX HEIGtff MAx.LENGTH MAX.WIDTH I OVERHANG EXCESS
OVERHANG
l WHEELBASE

FRONT SEAT NO. OF AXLE SIZE OF TIRES KIND OF TIRES

APPEARANCE Cl 1. NEAT Cl 2. FAIR 03 UNSIGHTLY
FRONT I REAR FRONT
IREAR
CHASSIS CJ 1. GOOD CJ 2. UNSAFE
T GROSS WEIGHT WEIGHT EMPTY SHIPPING WEIGHT
R c
SPRING CJ 1. GOOD D 2. UNSAFE D 3. WEAK
" 0 4. LOOSE
u A
c NET WEIGHT PASS. CAPACITY R PASS. CAPACITY
SEAT D 1. NEAT Cl 2. FAIR 0 3. WORN OUT K

BATTERY 0 1. GOOD D 2. DEFECTNE D 3. LEAKING I HEREBY CERTIFY THAT ALL

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INFORMATION CONTAINED
FUEL TANK 0 1. GOOD HEREIN ARE TRU E AND
0 2. LEAKING 0 3. UNSAFE
CORRECT. INSPECTOR'S PRINTED NAME & SIGNATURE
OPERATION AND SAFETY TEST
REFRIGERANT Cl 1. R134A CJ 2. OTHERS AIRCON Cl 1. EQUIPPED CJ 2. NOT APPLICABLE
TYPE

ENGINE D 1. NEAT 0 2. FAIR CJ a. DIRTY CLUTCH 0 1. GOOD CJ 2. DEFECTIVE 0 3. LOOSE

SYSTEM

HEAD LIGHTS 0 1. COMPLETE 0 2. NO DIMMER 0 3. GLARING HORN Cl 1. STANDARD 0 2. DEFECTIVE Cl 3. ILLEGAL

FOOT
STOPLIGHT Cl I. GOOD 0 2. OEFECTNE 0 3. NONE
BRAKE
0 1. GOOD 0 2. DEFECTIVE a 3. LOOSE

PARK LIGHT 0 1. GOOD 0 2. DEFECTNE Cl 3. NONE HAND 0 1. GOOD D 2. DEFECTIVE 0 3. LOOSE

BRAKE

SIGNAL LIGHTS D 1. GOOD D 2. DEFECTIVE CJ 3. NONE PANEL

GAUGES 0 1. GOOD Cl 2. DEFECTIVE 0 3. COMPLETE 0 4. INCOMPLETE

INTERIOR 0 1. GOOD 0 •. DEFECTIVE CJ 3. INCOMPLETE SMOKE 0 1. NORMAL 0 2. SMOKE BELCHER

LIGHTS EMISSION

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DIMMER '
D 1. GOOD 0 2. DEFECTIVE 0 3. NONE
SWITCH ' ""''"' CERTIN
INFORMATION ""' ANO
ARE TRUE "-'
CORRECT AND THAT AN ACTUAL
TIRES 0 1, GOOD 0 2. WORN OUT 0 3. UNSAFE 0 4. SPARE TEST WAS CONDUCTED. INSPECTOR'S PRINTED NAME & SIGNATURE

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WHEELS 0 1. NORMAL 0 2. UNSAFE 0 3. WOBBLY 0 4. UNALIGNED CHIEF INSPECTOR/TDS
DAPPROVED
STEERING 0 1. NORMAL CJ 2. STIFF 0 3. LOOSE 0 4 UNSAFE D DISAPPROVED

WIPER D 1. GOOD D 2. DEFECTIVE D 3. NONE BY: TOO PRINTED NAME & SIGNATURE

MOTOR NO. STENCIL HERE CHASSIS/SERIAL/BODY NUMBER STENCIL HERE