F-S&U-07

Revision No. 01
Revision Date : June.
26, 2013

INSURANCE QUOTATION

DATE: June 25, 2019 FQ-760

Dear Sir/Madam:

We are pleased to submit hereunder for your consideration our Insurance Proposal. Details are as follows:

ASSURED : DAVID NAVERA JR.

LOCATION OF RISK : 050 SAN JUAN EAST DISTRICT SORSOGON CITY

PROPERTY INSURED : BUILDING AND CONTENTS

BUILDING DESCRIPTION : Residential

OCCUPANCY / NATURE : Residential

PERIOD OF INSURANCE : PLEASE ADVISE

TOTAL SUM INSURED : BUILDING 4,000,000.00

CONTENTS 70,000.00

COVERAGE :
FIRE AND LIGHTNING, EARTHQUAKE, TYPHOON, EXTENDED COVARAGE, LANDSLIDE

PREMIUM COMPUTATION NET PREMIUM 3,663.00

DOC. STAMPS 458.00
EVAT 439.56
FST 73.26
LOC. GOV'T TAX 21.98
TOTAL 4,655.80

DEDUCTIBLE : SUBJECT TO STANDARD TARIFF DEDUCTIBLE

VALIDITY OF QUOTATION : 30 DAYS

OTHER INFORMATION : 0

We hope that you find the foregoing acceptable and shall look forward to hearing from you soon.
Should you have any further inquiries, please do not hesitate to call the undersigned.

In the meantime, we look forward receiving your confirmation of our proposal by affixing your signature below.

Very truly yours,

BIANCA DANE MIRADORA

SALES ASSISTANT

Page 1 of 2
 F-S&U-07
Revision No. 01
Revision Date : June.
26, 2013

CONFORME:

_________________________
PRINTED NAME & SIGNATURE
POSITION / DATE & TIME

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

Client Information “KYC Form” is a requirement for submission under the Philippine Anti-Money Laundering Act (AMLA) for
individual and corporate client.

Page 2 of 2