LINE FIRE PREMIUM 1,250.

00
DOC STAMPS 156.50
POLICY NO. F-HO-036496 FST 25.00
REPLACING POLICY NO. F-HO-032538 VAT 150.00
TERM FROM June 3, 2015 04:00PM LGT 6.25
TO June 3, 2016 04:00PM AMOUNT DUE 1,587.75
ISSUE DATE May 11, 2015
AGENT: RA-037 / KLG CURRENCY PHILIPPINE PESO

ASSURED : DR. GREGORIO SUNGCAD, JR.

ADDRESS : NO.30, 3RD STREET, SAN ANTONIO VILLAGE, APAS, CEBU CITY, CEBU

LOCATION OF RISK : NO.30, 3RD STREET, SAN ANTONIO VILLAGE, APAS, DISTRICT: NIL
CEBU CITY, CEBU, REGION VII BLOCK : UNBLK
TOTAL SUM INSURED : P 1,250,000.00 ON THE FOLLOWING ITEM(S):

ITEM PROPERTY INSURED

1 ON THE BUILDING ONLY (excluding foundation). 1,000,000.00

OCCUPANCY : RESIDENTIAL
CONTRUCTION : ONE STOREY CLASS "A" BUILDING, UNDER G.I. ROOF
BOUNDARIES : FRONT: BY 3RD STREET
RIGHT: BY 3RD STREET
LEFT: BY A BUILDING OF THE SAME CONSTRUCTION & OCCUPANCY
REAR: BY A BUILDING OF THE SAME CONSTRUCTION & OCCUPANCY
2 ON CONTENTS ONLY 250,000.00

SCHEDULE OF RATES AND PREMIUMS :

ITEM PERILS TI SUM INSURED RATES(%) PREMIUMS
1 FIRE AND LIGHTNING 4.1.1 1,000,000.00 0.1000 1,000.00
------------------
ITEM SUB-TOTAL 1,000.00
2 FIRE AND LIGHTNING 4.1.1 250,000.00 0.1000 250.00
------------------
ITEM SUB-TOTAL 250.00
------------------
TOTAL 1,250.00
==================

WARRANTIES AND CLAUSES AT THE TIME OF ISSUE :

DOCUMENTARY STAMPS ADVISORY/PROPERTY DAMAGE CLARIFICATION CLAUSE/RESIDENTIAL
OCCUPANCY WARRANTY/OTHER INSURANCE ALLOWED (BLDG)/TERRORISM EXCLUSION
ENDORSEMENT/WAR AND TERRORISM EXCLUSION ENDORSEMENT

Documentary Stamps to the value stated above have been affixed and properly cancelled on the office copy of
the policy
ATTACHED TO AND FORMING PART OF POLICY NO. F-HO-036496 Page 2

IN WITNESS WHEREOF, the Company has caused this policy to be signed by its duly
authorized officer/representative at Cebu City, Philippines on May 11, 2015.

VISAYAN SURETY & INSURANCE CORPORATION

____________________________________
Rachel M. Lacuesta
Branch Manager
User: charle Date and Time Printed July 28, 2016/14:22:18