May 2, 2019

KRISTY ANN B. DE VERA

103 GUIGUILONEN MANGALDAN PANGASINAN
TBA
Dear KRISTY ANN B. DE VERA,

Subject : MOTOR CAR INSURANCE QUOTATION

We are pleased to submit for your consideration our motor insurance quotation to cover the unit described below.

Details of Cover:

Unit / Make & Model : 2016 - KIA - Rio - 1.4L EX Gas Hatchback A/T
Plate No. : TBA
Serial No. : KNADN512BG6623258
Motor No. : G4FAFS951338
Color.: TBA
Mortgagee: TBA

Coverages Limit of Liability Price

Own Damage/Theft 691,944 8,303.33
Acts of Nature 691,944 3,688.06
VTPL-Bodily Injury* 200,000 420.00
VTPL-Property Damage* 200,000 1,245.00
24/7 Roadside Assistance YES 300.00
Unnamed Passenger Accident 200,000 200.00
YES@ PHP 40000 per Passengers NET PREMIUM 13,856.39
Doc. Stamps 1,732.05
EVAT 1,662.77
Loc. Gov't Tax 103.92
TOTAL PREMIUM 17,655.13
*VTPL-Voluntary Third Party Liability
Deductible: OD/THEFT : 3,459.72
Acts of Nature 3,459.72

Warranties and Clauses: Payment of Documentary Stamp Tax Warranty

Property Damage Clarification Clause
Auto Passenger and Driver Travel Personal Accident Coverage
Table of Permanent Disablement Benefit
War and Terrorism Exclusion Clause
Airbag Clause
Built-in / Standard Accessories
Non-Casa Clause (for vehicles more than 36 months old)
Drunken Driver Clause
Acts of Nature Cover Endorsement for Private Car
Pair and Set Endorsement

Subjectivities : Quotation valid for 15 days from date of proposal.

It is hereby understood that upon issuance of the policy, no Documentary Stamp Tax will be refunded
as a result of the cancellation or endorsement of the policy or reduction in the premium due,
for whatever reason, outside the issuance month of the policy.

All non-built-in/non-standard accessories are not covered unless declared, approved by CPAIC, and
with corresponding premium paynment.

We trust that this quotation merits your favorable consideration and we shall look forward to hearing
from you at these numbers: Trunk line – 580-6800 loc. 6846 and 511-9820 to issue the policy the
soonest.
If you decide to avail the Compulsory Third Party Liability Coverage, please notify the agent.

Thank you for giving us the opportunity to quote and be of service.

Very truly yours,

Rowell Vincent R. Esguerra

Sales Associate

Noted by:

Arvinal Gonzales
ADM

CLIENT CONFIRMATION

This confirms my acceptance of the above quotation and I, hereby, confirm issuance of my Motor Car
policy.
Policy Term: Inception Date: Expiry Date:

CONFORME:____________________
Insured’s TIN No:________________
Contact Nos.: __________________