OFFICIAL RECEIPT redefining / standards Received the Amount of Receipt Date ‘TWENTY THOUSAND SIX HUNDRED THIRTY PESOS ONLY October 16, 2020 Policy No.: $10-9775410 Payment For: Premium Settlement PHP 20,630.00 Due Date; October 28, 2020 TOTAL: PIP 20,630.00 Payment in Form of PHP 20,630.00 AutoPay AMOYOT JONAH C Distributor Code: 4323704032886 BRGY GAUB Distributor Type: CABATUAN Cashier: 1.0ILO ‘OR Number: $7970640 TLOILO 5031 ‘Wo approciate your business, Thank you Tor your confidence it AKA, ine worldwide feador ii financial protection. CONDITIONS MENTIONED ON FACE HEREOF 4. This receipt shall not be binding on the company for any part of said payment covered by check or any form of remittance other than cash, unless remittance is promptly honored upon presentation of payment. 2. Ifthis payment is not acceptable for the purpose its offered, it will be returned accordingly, following the normal course of business. 3. This payment shall be treated as premium only ifthe policy to which this payment is intended {to is approved and if itis sufficient to satisfy the required premium payment. Else, this shall be treated as a deposit until such time that all conditions mentioned are met. 4. This payment, if sufficient, shall be applied to the premium due on the policy provided that such policy isin force on the date of payment. In case this payment is insufficient, or the said policy has lapsed before this payment, the amount receipted shall be treated as deposit until the amount due is paid in full within the grace period andlor untl the said policy, if lapsed, is reinstated No person, except an executive officer, with at least a Vice-President level, of the Company is authorized to make, alter or discharge contracts or waive forfeitures.