MOTOR CAR POLICY SCHEDULE

--------------------------

Line : MOTOR CAR Policy Period

Subline : PRIVATE CAR - NON-FLEET From : August 7, 2020 12:00:00 NOON
Place Issued : MARIKINA CITY To : August 7, 2021 12:00:00 NOON
Issue Date : August 7, 2020
Policy No. : MC-MNP-MR-20-0000338-00 PREMIUM : PHP 14,188.00
Insured : MARQUESES, TRIXIA FAYE DE DOCUMENTARY STAMPS : 1,773.50
LEON LOCAL GOVERNMENT TAX : 78.03
Address : 152 STA. MARIA TALISAY VAT : 1,702.56
BATANGAS

AMOUNT DUE : PHP 17,742.09

Mortgagee : UNITED COCONUT PLANTERS BANK

INSURED
Vehicle Insured : 1 - 2018 SUZUKI ERTIGA GL RED M/T
Type of Body : WAGON MV File No. :
Plate No. : NCU7447 Seating Capacity : 5
Motor/Engine No. : K14BT1286859 COC No. : 0000000-20
Serial/Chassis No. : MHYZE81S7KJ302367
Color : RED
Accessories : STEREO (BUILT-IN) 0.00
AIRCON (BUILT-IN) 0.00
FIVE (5) PCS. MAGWHEELS 0.00
SPEAKERS 2PCS. (BUILT-IN) 0.00

Peril/s Sum Insured

OWN DAMAGE PHP 700,000.00
THEFT PHP 700,000.00
VTPL - BODILY INJURY PHP 200,000.00
VTPL - PROPERTY DAMA PHP 200,000.00
AUTO PERSONAL ACCIDE PHP 154,000.00
ACTS OF NATURE PHP 700,000.00

DEDUCTIBLES

0.5% of Insured Value, minimum of Php 2,000.00 shall apply for Own Damage, Theft, Acts of
Nature and RSCC if applicable for each and every loss

Towing : 100.00
Authorized Repair Limit : Deductible + Towing( 100.00)

WARRANTIES AND CLAUSES

NON CASA OR NON DEALER REPAIR SHOP CLAUSE

MOTOR CAR ACCESSORY CLAUSE

Attached to and forming part of MC-MNP-MR-20-0000338-00 Page 2 of 3

ACTS OF NATURE ENDORSEMENT

DRUNKEN DRIVERS CLAUSE

KALAKBAY ENDORSEMENT

AIRBAG CLAUSE

AUTO PASSENGER PERSONAL ACCIDENT CLAUSE

I. AD & D : PHP 20,000.00/PASSENGER
II.MER : PHP 2,000.00/PASSENGER

MAXIMUM OF 7 PASSENGERS INCLUDING DRIVER

MORTGAGEE CLAUSE #2 (NON-CANCELLATION CLAUSE)

It is hereby declared and agreed that loss and/or damage, if any under this policy
is payable to the mortgagee stated in the policy schedule as its interest may appear
subject to the terms and conditions of this policy.

It is hereby declared and agreed that this policy or any renewals thereof shall
not be cancelled without any prior written notification and conformity of the mortgagee
stated herein. . Except as herein varied, all other terms and conditions on
this policy remain the same.

INFECTIOUS DISEASE EXCLUSION CLAUSE

"Notwithstanding any provision to the contrary, this policy is not liable for and excludes
any loss, damage, liability, expense, fines, penalties or any other amount directly or
indirectly caused by, in connection with, or in any way involving or arising out of any of
the following ¿including any fear or threat thereof, whether actual or perceived:

- Any infectious disease, virus, bacterium or other microorganism (whether asymptomatic or

not); or
- severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus disease
(COVID-19), including any mutation or variation thereof; or
- Pandemic or epidemic, as declared as such by the World Health Organization or any
governmental authority.

If the Insurer alleges that, by reason of this exclusion, any amount is not covered by this
agreement, the burden of proving the contrary shall rest on the Insured.

GENERAL INFORMATION

ACTUAL DEDUCTIBLE AMOUNT : PHP3,501.00 FOR EACH AND EVERY LOSS

Attached to and forming part of MC-MNP-MR-20-0000338-00 Page 3 of 3

UCPB General Insurance Company, Inc.

ATTY. DARREN M. DE JESUS

President

THIS CONTRACT IS BETWEEN MARQUESES, TRIXIA FAYE DE LEON AND UCPB GENERAL
INSURANCE CO., INC. ALL TRANSACTIONS ARISING OUT OF OR RELATED TO THIS
CONTRACT SHALL BE BINDING ONLY BETWEEN THESE TWO (2) CONTRACTING PARTIES.
IT IS UNDERSTOOD THAT THIS TRANSACTION IS NEITHER INSURED BY THE
PHILIPPINE DEPOSIT INSURANCE CORPORATION (PDIC) NOR GUARANTEED BY THE
UNITED COCONUT PLANTERS BANK.