Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
Office of the City Fire Marshal
BACOLOD CITY FIRE STATION
San Juan St., Bacolod City
Tel. No. 434-50-22/23/16000
-oOo-

BCFS/Inves

FIRE CLEARANCE CERTIFICATE

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY, that as per available records of this office, on or about

01:10 a.m, September 17, 2015, a fire incident occurred and partially damaged the Blue
Mitsubishi Pajero Wagon, year model 2001 with Plate No. FEW 777 owned by Zairo D.
Lapore located at Blk. 6, Lot 58 NHA Village Brgy. Pahanocoy, Bacolod City

Investigation conducted on this fire incident disclosed that fire originated at the
engine compartment specifically on the Battery Terminals of the above mentioned
vehicle, was caused by electrical short circuit. The fire incident resulted to a fire damage
amounting to Four Hundred and Fifty Five Thousand Pesos (P455,000.00) more or less
based on the Affidavit of damage submitted to this office by Zairo D. Lapore dated
December 10, 2015.

After careful examination of all documentary and physical evidences, this fire
incident that partially burned the vehicle owned by Zairo D. Lapore, is considered closed
and solved for being “accidental” in nature, without prejudice to case reopening or
reinvestigation if the law and circumstances warrants.

This Fire Clearance Certification is issued this 11 th day of December 2015 upon
the request of Zairo D. Lapore for reference use; requirements for insurance claims to
MAA General Assurance Phils., Inc. under policy number MQ-01-15-BC-000759
covering period from August 01, 2015 to August 01, 2016 amounting to Three Hundred
Thousand Pesos (P300,000.00) only.

For any verification and inquiry, the Final Investigation Report (FIR) of this fire
incident was completed on October 20, 2015 with FIR Case Nr: 2015-09-03 dated
October 20, 2015, investigated by FO3 Marc Stephen L. Trajeras, BFP and FO2 John
Stewart Mondido, BFP Fire & Arson Investigators, Bacolod City Fire Station with
Telephone Number 434-50-22 to 23.

SIGNED this 11th day of December 2015 at Bacolod City Fire Station, City of
Bacolod, Philippines.

O.R Number : 14-1191894

Date : 11 Dec. 2015
Amount : php. 100.00

PUBLIO D PLOTEÑA , MPA

FSINP BFP
Acting City Fire Marshal