MAPRE Insular Corporate Center,

Acacia Avenue, Madrigal Business Park, Ayala Alabang, Muntinlupa City

Tel: [632] 876-4444; Fax: [632] 876-4344
www.mapfreinsular.com; VAT REG 000-491-771-0000

VAT Official Receipt No. 712

DATE

2014-11-24

RECEIVED FROM: GALICIA

TIN: 110-154-318

THE SUM OF

TWENTY-THREE THOUSAND FIVE HUNDRED SEVENTY-NINE PESOS AND SIX CENTAVOS

ONLY
PREMIUM
VALUE ADDED TAX
LOCAL GOVT. TAX
DOCUMENTARY STAMPS

1001410000298

VAT SALES

VAT ZERO-RATED SALES

VAT EXEMPT SALES

15,782.50
3,787.80
63.13
3,945.63

15,782.50

TOTAL

23,579.06

DANIEL REY D. CIMAFRANCA

Cashier's Signature

Reference Number

201114000013

Note: This cancels our Agency/Provisional Receipt No.

This receipt shall not be binding upon the Company for any part
of the said payment covered by checks or drafts unless such are
honored on first presentation for payment.

Serial No.

ORIGINAL
LTS-1-CA-0801-00043 dated Sept 26, 2001 (Internal Serial #84000000 - 84999999)
NOT VALID UNLESS SIGNED BY THE AUTHORIZED SIGNATORY.
Not to be issued for non-VAT/exempt sale of goods, properties or services. If issued, sales shall be subjected to VAT.
Insurance coverage will not take effect if premium was paid after occurrence of a loss.