COMMONWEALTH INSURANCE COMPANY

10th FIoor, 12th FIoor and 19th FIoor, BDO Plaza

8737 Paseo de Roxas St。, Makati City
S看NCE 1935
漢もl. No。 (02) 818-7626 ” Fax No, (632) 813-8575
Website二WWW。Cic,COm。Ph
emai口nfo@cic。COm。Ph

poLICYNO. 1368姓宙

p酬・ ▲細膿汁On工人

¶譲二 ・鵡剛訂軸-ふ脚議雑的・「
当事 ここヾ 種ト屯ふY州

一正・一〇臆- ￣一二￣一￣￣￣油量些三重

COMMERCIAL VEHICLE POLICY

AU丁Ho剣玉三二D剛モ賢二

A巾y債帥e叩    嶋a事 丁h露i油虫寡をd

(b事 Any p轡‘新帝dm椅喝On町te肌Su間S O鴫er O「 W柑1 his pemission.

Provided that the pe「son蘭viT喝竜pe叩med了in accordance w柑十the =censing law o「 Othe「 「egulations, tO d「ive the Scheduied VehicIe, O「 has been

Pemitted and is not di印ua聯ied by orde「 of a Court of Law o「 by reason of any enactment or 「egulation in that behaif, P「OVided that for Sections l and
= only of this Policy an authoJized drive「 Sha旧nc]ude a duly =censed d「ive「 but whose iicense at the time of the accident had expired"

u績ITATIONS AS TO USE:

Use orty青東s(贈a上domestjc and p!easu「e purposes, and for the lnsu「ed’s business or p「Ofession. This policy does not cover

(1) use電着廿鵬hau山喝and/o「 ca「rying of logs, lumbe「, Sand手g「aVe上bo鮒ed beve「ages, gaSOline p「oducts and/or other infIammable a面cies
O「鵬董百事竜Es a「 ftr h計e or 「ewa「d.

ほ〉 Use縄r rI減量や曲「el曲Ifty t轟aI or s画tes軸g.

N_ B. Pr劇物at l軸(1) a細面@) aboue may be d譲勤ar調廿輪risks脚rnd請e岬由n covered by this Policy upon ag「eement by, and payment
of 20乳add贈onal p「emium to廿re C(珊1Pany-

(3) Use fo「the ca巾age of PASSENGERS

(4) Use fo「 any purpose in comection with the Motor Trade"
′

SECT10NS I AND = of this Policy cove「 THIRD PARTY liabi!ity arising f「om bodiIy injury andfo「 death in amounts set fo正h under the Scheduie of
Indemnities.

lN W叶NESS WHEREOF. the Qc調l軍題細ry寸前s GauSdd this Pdiey to be s屯「†ed by its du!y authorized o価ce「/ 「ep「esentative at

Documentary Stamps to the value stated

above have been a冊xed and properly COMMONWEAFTH看NSURANCE COMPANY
CanCe=ed on the o情ce copy of this Po看icy
丁IN二000-445-883-VA丁

!MPORTANT NOTICE
丁he lnsurance Commissione「, With o櫛ces in Manila, Cebu and Davao
is the Govemment o冊cia=n-Charge of the faithfuI execution and
enfo「cement of ai=aws 「elating to insu「ance and has supervision
OVe「 insu「ance companies. He is 「eady at a= times to 「ender
assistance in settling any cont「OVe「Sy between an insurance
COmPany and a poIicyholder 「elating to insurance matters.
 COMMONWEALTH
INSURANCE COMPANY S桝棚T OF ACCOuNT
十一〇〇〇・○○ - ●食-」後置-重 き○○■ヽ "ヽ○○- a〇〇一喜〃ヽ一一一一〇重一〇〇一〇〇一一一-書き-章一一雄■漢雪○○〇・

SoA N○○ SA暮DQ214689

OFFIC看A」 RECEIP丁 N○○  3824 億畦 A

COMMONWEALTH INSURANCE COMIANY

「O/F BDO PIaza 8737 Paseo De Roxas, Makati Cfty

「樹・ No・ (02〉 818-7626 ★由x No。 〈02〉 813-8575

ema旧nfo@cic・COm.Ph or visit us at www.cic.com。Ph

SINCE 1935 WIT Reg, TiN OOO-445-883-000

Dateこ 丁ime:
PASICOリ¥N, ARISTOT’LE A,
Received from:

丁IN:  /
1 80 GUNNACAO ST" CAmGGAMAN NUEVO, TUGUEGARAO CITY,
Ad d ress: CAGAYAN

Business Style:

771e Sum棚強nd -six hu軸red seventy岬ve

pesos and 401100
php  l,675・40

1叩卸仰e証Of軸e fo/Io鵬軸8
Policy/ Bond No.
1 /5/201 9-1 15/2022
l nception

SOA No. 1書675.40

Premium
115佗01 9
Date
Documentary Stamps
C ICH OAO238
Agent’s Code
Fire Service “屯x
Mode of payment
Premium “ねx
□ Cash
Locai Gov’t “fax
□ Check
Bank/Check No. Oth ers
1 ,6了5,40
Tbta I 青光al Sales

This OR Cance!s PR No. V割ue Added “fax

丁bta l
Vatable SaIe/Premium
V伸Exempt SaIe WithhoIdin
Zero Rated Sale

Vat Amount 1

lbtai SaIes Cashie - ∴ヽ∴輔Se十  ∴

1 ,675.4
TdeI Payment

Checksshalibecbnsid互edpremiumpaymentwhen

500 Pads (50 x 4) 375的lA - 40unA C!e害fed by the bank,

BIR Autho巾I tO P血t No. 1AUOOO1895270
Printe「’s Acc「editation No.: 039MP201400(000033
Date Issued O9-18-18 ¥falid Un聞0918-23

絡詩誌紫欝嵩米語罵
Date of Acc「editation: 02-28-14
ax and o肋er cha巧吟S Sha〃 not be re加nくted as a resu〃
Loose Leaf Pe「mit No. L-34-0711-00002 9Ver鳩aSOn. AIry and a〃 αv” and / Or ad励緬st略#ve
丁iN: 115-567-116-000 VA丁
Date Issued: JuIy 25, 2011
りeS on母
THIS OFFICIAL RECEIPT SHALL BE WE]D FOR円VE (5) YEARS FROM THE D伸E OF伸P”

K則Sとし
l15I2019 9:58:39 AM
 COMMONWEALTH
INSURANCE COMPANY S桝棚「 OFACCOuNT
lOth & 12I帥Firs. BDO馴aza 8737 Pas∞ de R‘陣asr鴫k蘭C町
TeI・ Nos. (O2) 818-7626 TheleFa州0. (o2) 813-8575
e鵬鞘nfo㊤cic.∞m"ph o「 vis韓us at肌請・dc鵬m.巾 SoA N○○ SA営DQ214689
TIN O〇〇・445"883-VI町       j

Po伽y No. / Ehdb鳩e肋en書〃o.

c y1寄鋤1β
十一二王だ∴;:シ言う㌻-嘉子

肋me and A鵬ofAssuけさd c棚履髄咋鯵

PASICOリ¥N, AR!STOTLE A。

1 80 GUNNACAO ST・ CATAGG州JE…UEVO’TUGUEGÅRAO CITY’

CAGAYÅN

Premium
1 ,285.43
′白軸髄と置〃奮′夢 Docume血ry Stamps
160.68
l仏丁
D社e曝脚部 1 54.25
Sat細山ay, J袖uary O5, 2019
Issuing O簡ce CICHOAO238 しOcaI Gov嶋Tax
9.64
Incep的n Date January O5夢2019
_ _ o地割S「_
駁p巾Da書e January O5章2022 65.40
軸0巾a9蝶 nl1
COC No. 1361294
剛直e請. POA30ま
S曾轟いめ. 南ROHABCD2J I O5脚38
細く細減議 書eD461 2之30
場地 2019
軸取e I鴎dy TOYOTA HIしUX 2書8L 4X4 G剛T 6P OO5 / PICK
c巾調 AT珊TUDE BLACK肌CA
博R NEW BUSさNESS

月棚t p山e

Php 1着675,40

Co房伯geS 寄贈miが棚S

1 00,000.00

0。00
Authorized Signature:
○○00

0.00
AVRIS KATHRINA R. 1DQUIVAL

0.00
p- 雷

・1 7o881 5263

1 4雷9輔〉442 1

P舶Se make a〃 chec応paya捉to; CO州肋O肌朝L柵WSuRANCE CO勅桝NY

耽ase nofe that pay鵬nf for Docmenfary Sfa叩s 7むValue Added 7むLocal Govemme舶棚nd o鵬r cha郎S sta〃 not be refun的as a res雄
Of f*e cance伯励Or endbrsement of the po働O“ rech‘C伽On the pre励h du両面hafever reason・ Ary and a〃 αwl and / or ad棚廟鵬
ac伽S a駒g out of f鵬fransac伽s sha〃 be鵬d in p′aper COu応of鵬Cfty of Afa同朋妬x巾es o砂

KRIS各し
1I5俄01 9 9:58:39 AM
 COMMONWEALTH INSURANCE COMPANY
10肋& 12肋刷rs. BDO刷aza紺37露seo de Roras,舶akafJ CJ坪
碑L Nos.仲卸81櫨7626 7七ぬ励x No.砂勾813」8575
e肋a肪励め@c細.com.ph o′庵剃脂a[ w肌肌c比CO肋・Ph

酬00(山鳩も883・甑「

NEW BUSINESS Motor PoIicy No.

cV1368418
Certificate of Cover No.
1 361294

Issuing O怖ce

Name and Add細ess Toyota isabeIa - MBO

PASICOLAN, ARISTOTLE A,
CICHOAO238
180 GUNNACAO ST. CATAG
CAGAYAN

MODEL 2019
SAIDQ21 4689

剛V FiIe Numb

PU¥TE NO POA302 MOTOR N繕.

SECTION I/lI しIMITOFLIABILITY Ph職〇二

: PREMIUMS:
L看A圃」lTY
PREMIUM PAID Php臆ここ- 1 ,285.43
of indemnit!es) 《 _言二二二三謙二

Section l/l
S電CTIONI‖ ;

f S億1edule Vehide..〇・…・・・・・・・・
Php 了さす
￣ ㌔∴鴨

鍵ui輌ふノ 0.00

玉田面‡
￣≒甘由書軸三重轟 0.00
3. MAGWH駐L 0,00
__B櫨王lt・i n
4. OTHERS _
0.00

Deductibie Towing Authd由Zed

1暮285.43
Php   印0鶉
1 60.68
_低4重25

A. Bodily I巾ury 9,64

Php 65.40

曇∴華
Auto Passenge「 Personal Accident TOTAL AMOUNT DUE l ,675.40

Authorized Signature
VAしID FOR TOYOTA USE ONしY

II5I2019 9:58:39 AM VERY I軸PORTANT NOTICE:

KRIS巨し PしEASE INFORM US IMMEDIAT軋Y IF YOUR V珊ICしE IS酬ROLしED TO UB駅/GRAB, uV EXPRESS AND T堕しIKE
p ・1708815263 SERVICES OR BEING USED FOR THE CARRIAGE OF PASS削G日RS. OTH駅WISE, THE COMPANY WlしL NOT BE
i -99738540寄 LIABしE FOR ANY CしAIM THAT MAY ARISE uNDER THIS POLICY.

c 726492537
FOR PROPER ADJUSTMENT AND MORE INFORMATION, PLEASE CALしOUR HEAD OFFICE.
 3, ln the event of a claim being paYable under Section I= of this Policy fo「 the cost of replacement pa巾S, the amount of settIement sha= be the cost
Of b「and new part(S) to replace the damaged pa巾(S) of the insu「ed vehicle Iess the sha「e of the lnsured on the cost of the repiacement parts
COmPuted based on the fo=owing depreciation schedule:
Age of VehicIe Rate of Dep「eciation Age of Vehicle Rate of Depreciation

U〇〇〇
a「e O nSu「e a「e O
P tO 3 yea「S Over 6 years up to 7 years
Ver 3 years up to 4 years Ove「 7 yea「s 45%
Ver 4 years up to 5 years Rebu岨and Reconditioned Vehic看e 45%
Ver 5 years up to 6 years Batteries, Tires, Ba= Joints, Tie Rods and
国王墨 Shock Abso「be「s (fo「 Vehicle ove「 th「ee
(3) years oId〉 50%

lt is fu巾her decla「ed and agreed that in case ofthe tota=oss of the vehicle insu「ed this CIause sha= not apply but the se則ement shali be based on the

P「OVisions of Section冊, Pa「agraph No. 2 of the Policy.

4・ If the Scheduied Vehicie is disabled by 「eason of ioss or damage insured under this PoIicy, the Company will, Subject to the Limit of Liability for
towing, bear the reasonable cost of protection and removaI to the nearest repai「er,
5“ The insured may autho「ize the repair of the ScheduIed VehicIe necessitated by damage for which the Company may be liable under this Po=cy,

PrOVided that:一
(a) the estimated cost of such repai「 does not exceed the Autho「ized Repair Limit and;
(b) a detaiIed estimate of the cost is forwa「ded to the Company without deIay.
6〃 ln the event of loss o「 damage to the Scheduled Vehicle or its accessories o「 SPare Pa巾S neCeSSitating the supply of a pa巾not obtainab!e from
StOCks held in the PhiIippines, O「 in the event of the Company exe「cISing the option under Parag「aph 2 to pay in cash the amount of the loss or
damage, the liab冊y of the Company in 「espect of any such pa巾ShaIl be limited to:一
(a) (i) the p「ice quoted in the latest catalogue o「 p「ice list issued by the Manufactu「e「 or his Agents for the Phiiippines o「
(ii) lf no such catalogue o「 Price list exists, the p「ice Iast obtaining at the Manufacturer’s Works plus the reasonable cost of transport other
than by ai「, tO the Phi!ippines, and the amount of the relative import duty, and,

(b) the reasonab[e cost of冊ing such part.

7〃 丁his po鵜icy shall be ope「ative whilst the Scheduled Vehicle is being used for the pu「pose of towing any one disabied mechanica!iy prope11ed
OVided that。

(a) such towed vehic書e is not towed for臆reWard;           _一二三三三三三三三二二_二三十ニー<=二一書=- -〇一二ニーへ三-へ---二

(b) the Company sha書寡not be-漢iable面esPe軒研司書inag5￨(㌻S市棚oテp「operty being conveyed the;eby。

EXCEPT書ONS TO SEC丁ION I看i

The Company shail not be Iiable to pay fo「;一

1. Loss o「 Damage in 「espect of any claim or serfes of claims ans-ng Out Of one event, the first amount of each and eve「y loss fo「 each and eve「y
Vehicle insu「ed by this Policy’〇号uCh amo…t being equa看to one pe「cent (1"00%) of the insu「ed’s estimate of Fair Market VAiue as shown
in the Po!icy Schedule with a mlnlmum deductibie amount of PHP3,000。00;
2〃 Consequentia=oss’dep「eciation’Wea「 and tea「, meCha=ical o「 elect「ica寒b「eakdowns" faiIures or breakages〃
3・ Damage to ti「es, unless the ScheduIed vehicIe is damaged at the same time;
4“ Any malicious damage caused by the insu「ed, any membe「 of his family or by a person in the lnsured,s service.
5。 Damage caused by overloading or st「ain;
6" Damage caused by expIosion of any boile「 fo「ming pa巾Of, O「 a請ached to, Or On the Scheduled Vehicle.

SECT音ON IV - EXCESS L8AB漢L漢TY看NSURANCE

l " The Company wiII suPject to the limits of Liab冊y, 「eimbu「se the lnsured fo「 alI sums actua!ly paid by the lnsured to discha「ge liab冊y in accordance
With al=he provisions of Section i excep=he⊥imits of Liab掴ty fo「 Section l but only in excess oト

(a) the Limits of Liability fo「 Section l and = of this Policy, When such limits have been exhausted or,
(b〉 The liability Iimits required for the Scheduled Vehicie unde「 Section 377 of the Insurance Code, aS amended in the event no coverage exists
as described in paragraph (a) above.
Coverage under this pa「agraph is not suPjec=o the Schedule of indemnities under Section I
2" 丁he Company wiii, Subject to the Limits of Ljab冊y, Pay ali sums necessary to discharge Iiability ofthe lnsu「ed, in respect of damage to Third Pa巾y

PrOPe巾y in an accident caused by and arising out of the use of the Scheduled Vehicle, O「 in comection with the loading or unloading of
the Scheduled VehicIe, P「OVided that the insured’s liab冊y sha= have first been determined either by軸al cou印udgement a債er actual t「ialずOr by
W皿en agreement of the Insu「ed, the Claimant and the Company〃 Provided’fur the「, that the Company sha= not be =able in respect of damage to
P「OPerty belong-ng tO the Insu「ed, O「 held in trust by’in the custody or controI of the Insu「ed or any member of the lnsured,s household, Or being
COnVeyed by the ScheduIed VehicIe.

GENERAL EXCEPT寡ONS

The Company shall not be liabIe unde「 any Section of this PoIicy in 「espect oト
1。 Any accident, O「 Iiab帥ty caused, O「 incu「「ed

(a〉 outside the Republic of the Ph掴ppines.

(b〉 whiist the Scheduled Vehicie is二
(i〉 being used othenNise than in accordance with t十晦￣1imitatio打電きto u§e;
g=     (ii) being driven by any person other than an Autho「ized D「iver;
-      (iii) on board a sea vessel on inte「isiand transit;

¥ 2. Any liability which a舶Ched by virtue of an agreement but which wou-d not have attached in the absence of such agreement, eXCeP=iab冊y
arising out of an on the spot ag「eement o「 amicabie se冊ement of minor accident to avoid impalr音ng the ¶ow of tra怖c。
3〃 Except in 「espect of claims a「一S-ng unde「 Sections I and = of this Policy’any aCCident, Ioss’damage or liab胴y directly or indirect-y, P「OXimateIy or
「emotely occasioned by contributed to by or traceable to, Or a「lSIng Out Of’Or COmeCtion with flood’tyPhoon, hurricane, VOIcanic eruption,
ea皿quake or other convuision of natu「e, invasion, the act of fo「eign enemies, hostilities or wa「like ope「ations (Whethe「 wa「 be deciared or not),
Strike, 「iot, Civ= commotion’mutiny’rebellion’insu「「ection, miiitary o「 usurped powe「章Or by any direct or indirect consequences of any of the said
OCCurenCeS and in the event of any claim hereunde「, the Insu「ed sha= p「ove that the accident’Ioss o「 damage o「 liab冊y arose independent-y of,
and was in no way connected with’Or OCCaSioned by’Or COntributed to, any Of the said occu「ences, Or any COnSequenCe thereof, and in defauIt
Of such proof’the Company sha書l not be Iiable to make any payment in respect of such a claim"
4“ Any sum which the lnsured wouId have been en珊ed to recove「 from any pa巾y but for an ag「eement between the Insured and such party
5" BodiIy injury and /o「 death to any person in the empIoy ofthe看nsu「ed arising out of and in the cou「se of such emp書oyment, O「 bodiIy injury and/or
death to any member of the lnsured’s househoId who is riding in the Scheduled Vehic看e。
6・ Death, bodiiy injury or damaged caused or arlSing beyond the limits of any car「iageway o「 thoroughfare, in comection with the bringing of the load
to the Moto「 vehicIe for loading the「eon or taking away of the Ioad f「om the Moto「 Vehicle a什e「 unloading thereform。
7. Damage to any bridge, Weighbridge or viaduct or to any road or anything beneath by vibration or by the weight of the Motor Vehicle or of the load
Carried by the Motor VehicIe

DEFINI丁IONS

l. MOTOR VEHICLE is any vehicle as de軸ed in Section Three, ParagraPh (a) of RepubIicAct - Numbered Four Thousand One Hundred Th皿y Six,
Othervise known as the “Land Transportation and T「a飾c Code’’.                                  ‘
2・ THiRD PARTY is any person other than a PASSENGER as defined in the law and sha= aIso exc!ude a member ofthe househoId, O「 a member of
the famiIy within the second degree of consanquinity or a軸ity, Of a motor vehicie owner or his empIoyee in respect of death, bodiIy injury or
damage to property arISlng Out Of and in the course of empIoyment.