INSURANCE CORPORATION May 02, 2017 LOA No. DEC-PS-17-0000552 El TI Y TOYOTA MAKATI, INC. AYALA COR, METROPOLITAN AVE., MAKATI CITY Aitention Re Assured : GAY G.NUBLA Policy No. Mc-DEC-PS-16.0003664-00 OD Claimant: GAY G. NUBLA UnitModel 2016 2018 TOYOTA VIOS 1.3 £ GAS MT Plate No. Claim No. MC-DEC-PS-17-0000435 Date of Loss: Aprii24, 2017 ’ Place of Loss: ALONG 22ND AVE MCKINLEY PARKWAY CRNER RIZAL DRIEV BGC FORT BONIFACIO TAGUIG CITY Gentlemen: This will serve as yout AUTHORITY to undertake the repair of the above subject vehicle in accordance with our agreement that the following be the total cost of repairs. Total Cost of Parts PHP Total Cost of Labor & Materials Total Cost of Repairs PHP Less : Policy Deductible "3,150.00 “Depreciation 0.00 Total Participation of Our Assured 22,667.40 26,712.00 49,379.40 3,150.00 INSURER'S NET LIABILITY PHP 46,229.40 itis necessary for you to cotlect the total amount of participation of our assured before releasing the vehicle and you will ‘assume full responsibilty for the said collection. Please be advised that no additional job or increase in the cost of repair must be incurred by us outside of those items listed in the repair estimate without prior written consent from this office. This letter of authority is valid only for sixty(60) days from issue date Upon completion of the repair, kindly have the enclosed Release Papers signed by our assured/TPPD claimant. Please forward the same to us together with the Release of Claim also signed by our insured/TPPO claimant and your final bill {original copy) with specific details of parts replaced and repairs done for payment, » HEAD OFFICE Shyla Paza, Senator Gil Puyat Avenue, Mabel Cy Te Gasmesnn (sr “Pa seas You're safe and sound, wwrcharterpingan.com| $601 40 31v0 FOR THE SOLE CONSIDERATION OF FORTY FIVE THOUSAND FIVE HUNDRED NINETY THREE and 35/100 ONLY (PHP 45,593.35) the receipt whereof is hereby acknowledged, liWe GAY G. NUBLA, for myself, ourselves, my/our heirs, representatives, successors and assigns, do hereby release and forever discharge CHARTER PING AN INSURANCE CORPORATION of and from all actions, claims, demand and rights of action whatsoever that now exist or may hereafter develop and particularly fon account of all known, unknown and unanticipated injuries, damages arising out of and as a ‘consequence of an accidentiloss that occurred on or about April 24, 2017 at ALONG 22ND AVE MCKINLEY PARKWAY CRNER RIZAL DRIEV BGC FORT BONIFACIO TAGUIG CITY We further agree that this RELEASE be pledged in bar to any suit or proceedings which liWe or anyone in mylour behalf, may taken in connection with the accident hrein before mentioned; that this payment is voluntary accepted as a full and final compromise, adjustment and settlement of all claims, and that payment of said amount shall never be construad as an admission of liability by the party or parties hereby release. We further agree that the CHARTER PING AN INSURANCE CORPORATION is subrogated to all my/our rights of recovery on all claims, demands and right of actions on the account of the loss, damage or injury as a consequence of the accident herein above mentioned from any person(s), corporation or whomever may be liable therefore that I'WE further agree to assist and hereby authorized the Company to begin suit, prosecute, compromise or withdraw either in our name or in their names, all legal proceedings which they may deem necessary to enforce my/our claim(s). We manifest that the terms of the Release and Subrogation Receipt have been read and are thoroughly understood, IN WITNESS WHEREOF, We have set my/our hands this 2nd day of May, 2017 READ CAREFULLY BEFORE SIGNING GAY G. NUBLA, ‘Authorized Representative SIGNED IN THE PRESENCE OF: REPUBLIC OF THE PHILIPPINES) CITY OF )8s. Personally appeared before me this _ day of _ _ with issued at on to me known to je the person who executed the above Release, and acknowledged the same to be his/her free act and deed; and | certify that before the execution thereof the said Release was read over and fully explained to the same person by me, that he/she declared before the execution thereof that he/she fully understood the same. 7 WITNESS MY HAND AND SEAL OF MY OFFICE. NOTARY PUBLIC Until December 31 PTR No, Issued at Issued on Doc. No.™ Page No. Book No, Series of Tel a sao sto ww charterpi seine Syn Sa ttre lat You're safe and sound.[HORRATION? “EVALUATION SHEET | EvALOA fe [cncextayaBProven ny!1200 Philippines 33 loc. 110. REFERENCE GAY. NUBLA DATE arr ADRESS 1384 GOMEZ 826 PAGO MANILA CONTACT # ScieaeeCEa MODEL# 2015 TOYOTA VIOS 1.3E GAS M/T COLOR / PLATE #® ape. RED. FRAME NO. «.cp164.2050847 ENGINE # 2NZ7589369 TATURE OF WORK PARTS TO BE REPLACE: FE gH FRONT DOOR PANEL. 1,500.00 12,314.00 | FRONT DOOR SASH TAPE. 4,000.00 (A REAR DOOR PANEL 1500.00 ioarz0d BH REAR DOOR SASH TAPE a | "REFORM ALIGN: | [RH CENTER PILLAR POST PANEL 7,000.00 ‘RH REAR DOOR HINGES 14000.0 | TREPAINT & REPUTE ! |-RH FRONT DOOR PANEL 500.00 —| -RH REAR DOOR PANEL 500.00 [RH CENTER PILLAR POST PANEL 2.50000 -RH REAR DOOR HINGES 4,000.00 <-aH QUARTER PANEL — 5060-90 =| REAR BUMPER COVER ‘GLASSMAN WORK: ‘REMOVE AND INSTALL ‘RH FRONT DOOR WINDOW GLASS. 500.00. RH | DOOR WINDOW GLASS 2,500.00 E TO GIVE WAY FOR REPAIR UPHOLSTERY WORK: REMOVE AND INSTALL RH FRONT DOOR SIDINGZ O00 ‘RH REAR DOOR SIDING 500.00 TO GIVE WAY FOR REPAIR + fy ‘DURATION: WORKING DAYS { UPON PARTS ARRIVALD ESTIMATE ONLY SUBJECT FOR ADDITIONAL COST OF LABOR 37,500.00 REQUIREMENT FOR CLAIM: 12% var 4500.00 POLICE REPORT & AFFIOAVIT ORIGINAL ) sustet PHOTOCOPY OF CAR REGISTRATION WIO.R ACCESSORIES PHOTOCOPY OF DRIVER'S LICENSE WIO.R TOTAL PARTS: ———25.186.00 PICTURE OF DAMAGE PORTION TOTALJOBCOsT : 6718600. PHOTOCOPY OF INSURANCE POLICY. Crh F-Nuren, O417- oss Hay leoadanynahle @anatl «comm » NOTE Ar ikien domoged partons & parts ‘pation Tis no vod court \