INOW THiS POLICY WrTNESSETH: “Thal in espoc fevers oocring tring the perio of nsrance, and eubect ote terme, exceptions and conllonseonsind herein oF encores hereon (hrenater coleciviy fered tas he Tes ofthis Poy) SECTION | - LIABILITY TO THE PUBLIC 1. The company wil pay al sums necessary to dschagelably of the neues, acing rom all expenses and damages dl resulting for ary bosty uy andi destn toany Tia Party (excuding al moral. exemplary and oer incdetal arnages, expones anc lee of neate) nan ecedentcasses ty be ase cPoe Sereses hice provided hatte Insured’ eit sallhave ret ben determined, but ot exceacng nthe aggregate 100000 per aeerTonco any one oaasvence regerses OS furbe of indivi 2 interme of and subjects ho iatione of hie Pai, the Company wil indemny= 4) Any Authorized Driver wo is ceving he Schecied abil, proviod hte (G) csorves ul and be susjoa tothe Tema othe Poy star 2 they can apo, is oot ened to indy under any cher poy subject. Rowe, to Gandlon No.8 of he Cantlane Appable To al Sections the insured whet personaly diving a pivato meta car rex bolongng oh and nat ire a him ancora repurchase soroorect, 3. Inthe event of te deatn a any porcn eiest indemnity under Poly the Company Wil respect ofthe tablyicaroe to sock person indawry he personal ‘representatives in ems oad Subject ithe ers and soncons Herat 4 Inthe event of eccient noting indemnity under ths Potsy tome an ane parson, th Lins of Laity ahal net exceed he egaregat amount 0 spect by Law to al porsons ibe inden. Shu aemifoaton th lb fe tuted tat ef anobepaty (an pone ter Ruse Shes aoa Pa naess Sha have per ight art, SO 5. Uns te inns cies, te Company sak (a) range fr reereseiation at any inquest or investigation in respect any deat whiny oo the sujet of denny unde tis Seton (©) Undertake te cefense inte Insurance Commissron undo: Sacton 389 ofthe Insurance Code, cit any cou of law, lege oenaes causing, orlaing fo, any event whlca maybe the eubjet onder uncer is Sacton ‘SCHEDULE OF INDENINITIES FOR BODILY INJURY ANDIOR DEATH “The flowing sched of indomnties chal be obserid inthe setlement of cis for deat, body ie of, and prefessona ees and hospital charges for services rendered to, tafe accident viehmes under the Compulsory Motor VetclaLeblty Ineursnce coverege 1A” DEATH INDEMNITY 27090000 C. PERWANENT DISABLEMENT ‘oun oral ord Funeral Expanes 2necoo0 ase ofortosvet Use of 8, BODILY RIURIES AND FRACTURES Te er teec doom curb 50,000.09 Maximum oranges & Bo hubs 50,000.09 Professional Atendance ‘Types ofAccommacstion_—_—eimureale Fees Bam Feet sacce co Sxtnded ir Services Rendered ‘nor Charges Sra Hand & One Foot 0.00.09 4. Heap Rooms oui of dye pe actent “Ps 0 ona) es ee. ‘0000.00 oratory Exenncton ies footie ‘ane Sica 2,000.00 Any other injury causing permanent : 2. swe Expenses ter Opeaton 700 sexier Nedtum Operation Eeonoo Aim ater asove sow Iinr Oeraton ‘tsan00 ‘im Between son at wet 3. Araoshessgits Fees Major Gpeaten 2ea00 ioe Maer Operation Zecan Fou frgers and tum of one hand Mor oprton ‘Sonuo Fourtngers 4 Operating Room Maer Operation 150000 eg a oranave knee Mot Operation +0000 ey bec nce Mor Operation ‘on00 ‘one Fat 5. Medal Expenses For daly vt of Prectdone or stoas ofr fot Speaate son ay rum ‘Thee amount of meds! caer “apenses mast no onceed sho ohe {Fare sngieperovot covinement) 500060 (Seino fare . Dnuge and Maine ‘otal vate fs and lang Gro Er 2 s ‘Redionelisedbulnettoceed 2000000 ~~ _b-OTHER INCIDENTAL EXPENSES 7 hmbulnce Charge ‘ean emocrt cared er srlanoe ai ee pia ‘Transport bul not exceed 1,500.00 The Company wil pay ll perinent and ty seman Inoue im conan ih the aesitont not provided ur his ‘Schedule of incomes (3), (8) (©) bjt to masmar amount ‘ot P0,600 cout ra case sale corbery © apyrege payment ‘excoed the overl Limts of iby under Secon sh SECTION Il - NO FAULT INDEMNITY Zhe Company wl pay any cai for boa nur andlor death to ny Ta Paty witout he necessity of proving or nogigence ofan kind, provided that, (2) the total indemnty in respect anyone Third Party shal na! exceed Fitwen Thousan Pesce, sujet te foregoing Schodul of Indemntioain cave of eth or hypigal ry, wou prejucce to the cman ram pursuing hig can further, im whic cas he shal not be equ er Conpaed by fe Company e eects ay {Gur ciao: documor losing trom tty uncer the poly of rome, (©) the foloning proofs otoss, when subntied under cath, shat be sfilet evidence to ebetatae tho cli (1) Pole report of scsicant or any evidence suPisen to esis be aonont and (Gi Mecleal repr snd evidence of maseal or hasta execs actor (a) Death Cortona and evidence sucnt to establish the proper payee. SECTION Ill~ LOSS OR DAMAGE 1. The Company wil subject tothe Limits of Lab, indemnity ho Insured agaist oe or damage othe Scheduled Vehicle adits eccessovies and spare parts whilst theres (@) By ezxdentl olson or overturn, cr colson or overturn consequent upon mechanical breakcoun cr consaquen! upon wear endear (©) by fro, egcmal sxplsin,slkgnton or ightning or burglary, pousebealing o carmapna, Fay una taking ofthe car accesses cr any pat wis hereon, ‘ut exluing tose commited by an empayee of ho neured or any proon ox parsons fo winom the echaduledvehcihes been ented (@)_bymatcius act (@)_ whist in ranse ining th processes of oacng and union) incerta to sue rans by oad al, land waterway, or elevetor. 2 Allis own opton the Company may pay in cash te amour of hess or damage or may renal rartateo replace tha Sched Veh or any par thereof ots ‘accessories ox spare pars. The Lablty ofthe Company shal ol exoand the valu ofthe pal lator damaged and the reasonable eos ff such parts the value ofthe Scheduled Vehicle at the Ue of tho los or damage, whichever is the lss. Tho noureds estate of value sted nthe Shu shal be ne mass “ameunt paysbie by the Compary in respect of any clam for ace ordarane,8 Inte event of caim being payable under Secton Il this Pokey for the cost of replocarant pas, the amount ot sotlement shal be the costo brand now par) to replace the damaged par) ofthe insured veri les the shar of te Incured onthe Cost of Ue eplacamert parts comput based onthe fellowng ceprectaton schol! Aapatventie Fate o Depracaon Aceof Veco Ale of Depreciation ‘Shar ofthe inured) pw year ‘MI ver 8 years up to 7 years 35% (Ghor 3 years up to ybare zo Over? yeers 20% ver yeors up S years 25 Bete, Tes, Bal Joints, Te Rode and ‘Over 5 years up 6 years 20% ‘Shece Aor for vehioe over hoe 10% (Gears ai) Its fuer gectred and agreed tat case of te total oss of he vehicle insured this clause shal not apply But he satlament shal bo based onthe proviions of ‘Secon Il, Paragraph No.2 ofthe Poly 4. Il the Scheduled Vehicle cabled by reason of loss or damage inured under this Poly, the Company wil, subject ta the Linit of Laity fr towing bear the {eatonabo cost of protston are raya re nosrtrepate. ‘5, The insured may ashore the rar tho Schoaoa Vane recat by damage fr which the Company maybe able under he Pei, provide a= (a) the estimated cost of such ropa dose not excad the Auther2ad Repay Ln and (8) etaled estimate of te costs tarwardedta a Compa who Gly 6. In he event of oes or damage fo the Schedules Vohicio or ts accessories or spare parts necessiating the supply of pat not abainale om stocks ald in he Prilpines, ortho evort cf the Company exaring ine apton under Paragraph 2 to pay In cash the ammount ofthe oss or damage, te bly he Company ft epee! of ary such pat shal be esto (@)._()the pica quotes nth nine cntscgua cr pine st suas hy the Manufacturer ors Agents forthe Plppines ot (ih itno such catalogue or rice st exe, te price ast caning atthe Manuiacurers Werks pas tha reesonable cost of transport other than by al, tothe Phllpines and tha emourt othe lative grt ly. ond ()_theeananabls sot offing ssh pa. _—1. The Poin shal bo operative whet he Scheduled Vehicle is being uso for tho purpoee of ovng any ane dashed mechaiclly propelled vehi rove al = (@). such loved vice isnt towed fr rear (©) the Company shal at be bab in epee of damage W Ser owes once cr propery beng conayed teeby EXCEPTIONS TO SECTION Il ‘The Campy sha not be ate to pay for: - 4. Loss or Damage in respect of any lam or sre of claims arsing ot of one vert. the frst amount f each and every oes fr each and ery vehi sured by the Poly, such siourt beng equal to one haf of one percent (0.80%) ef the nsures's ectmate of Fair Market Value ax shawn in the Poiey Scheele wth & mieemum deductible amount of PHP 2.000, Ceneosusrial ss, copreacton, waar orto, mechanical oleic! breaicoans flues or reskages, Damage tes, unissthe Sonaced Vehice fe camaged st tha seme ima ‘Any malcous camage caused by th Insured, ary member of is fai o: Dy a person in he rsured's saree; ‘SECTION IV ~ EXCESS LIABILITY INSURANCE 1. The Company wil subject tothe Lint of Labilty, reimburse the insured forall eum actualy paid by the Insure to dischare provisions of Section | except te Lint f Labi for Secon | but only in excess ot (@)-TheLimts of abit for Sectons | ane los Pobey nen sun lite rave Seen exhausted or (©) The ability tts raqued forthe Scheduled Vehicle uncer Secton £77 of te ngurence Code, a¢ amended inthe event no coverage exists as described in paragraph (a) above. {Coverage une this paragraph snot subject tthe Sched of demos under Secon ‘The Company wil subject othe Lite of Labi, pay all urs nessesary to dacharge libilty of he Insured, in respect of damage to Third Pasty propery in en sccident caused by and arsing out ofthe use of tha Scheduled Vehicle. rin connocton with tne lading or unloading ofthe Seneculod Vehicle, prewced Wat he Insureds abity shal havo fret bean determine either by tna court Judgement ater actual til, ar by writen agreement ofthe Insured, the Claimant, and ho {Company Provided, fuer, tal the Company shall rot belle I ospect a damage to property Belonging otha noured or eld in ust by, oi he cio ot ort fhe nauted er ny member oto neura’s oueeha ox bang nveyed bythe Seneclen Venice, For the Purpose ofthis paragraph, Scneculod Venice shalincude any Brvate Cer wa being personaly ven by the Insurd nc belonging to him enol ied him under ne purchase aprosment lity in accordance witha the GENERAL EXCEPTIONS ‘The Company shal ot bo ible under ary Section oth Pele rorpecto: 5. Aayacciéet oF ibily caued, or nour (@) ouside Repub oe Prsippnes {@)__ stony Motor Vehicle in reaect of which Inder epovde by this Poy s= {Gy beng od cterwce than ny seooance with te Insane a 0 Ue (@)__ Being drven by ary poreon chor han an Athonzod Driver Gi). Snbears sea vase! on nertand ana ‘Any abit which etaced by virtue ot an agreermet ul which would not have etsched i the absence of uch agreement, except lbilly aring out of an on the pot {egreement or amicable selement of minor aczcert fo aval inpang the Bow of wae Except in respect of cams aang under Sectons | and lof his poly, any accident loss, damage or abilty director increcty, prosimaely or renctely acasioned by, conirbuted f by of traceable te, asing ou ofr in connection wih food, typhoon, huricane, vlcanc expon, eartauake ot oter contlion of nature, invasion, the aet et fooignenomes, hotles cr wartke operation (whthor war be declared or na) eke rt, cil commaten, mutiny, feelin, ieurecon, lls ‘or usurped power, oF by any ecto nde corsequeneec of any ofthe sald cecaronces and inthe evant of any lai horeundor, he nour shall prove fate _200den, loss or damage ot labiy ase Independent of and was no way connacted wh or Oceaioned by, or contd oan ofthe Sal ossurtancae, ot ay ‘onsequcs thereof, and in dfaul of such pro tho Campa shall ete lao to mak any paymnt in respect of such acim, 44. ay um which the naured would have been ented to recover fom any party But fren agreoment between the insured and sh Bm 5. Body inuy ander daa to ary poreon nthe opcy of nautederaing 69 ann fe couee of such employment. or body ary andor deat o any mer of tmeinsuads housonlé whe rang nthe Scheculed Vehiae, DEFINITIONS 1. Motor Vehicle is any vehicle as define in Section Tree, Paragraph (6) of Republe At «Numbered Four Thousand One Huied Tity-Sx Oberise known asthe “Land Tanepotaon and Trae Coc 2 ‘Third Party is any porson cher than 2 Passenger as dainod lathe lw and cal seo exclude a member of the hovschold, ora member che family win the second degree of consanguinty or any, of retor vtile osnar ois employee nrepect of death, boy ny er amaze to propery arcing ou cf and In the course of fomployment; STRONGHOLD INSURANCE COMPANY, INCORPORATED ir Moen Fei Noe88to20t0S7 Pano. ser-i223 Te Ness BTN 000-602-270 = (hep quotes nt et cmacg pie sey ea PRIVATE CAR POLICY Chit such catalogue ope at ous, he peas cag @ 2) avatanesatctanrgeun pet AUTHORIZED DRIVER: Any of the following: (a) ‘The Insured (©) Any person driving on the Insured's order or with his permission Provides that the person driving is permitted in accordance with the licensing law or other regulations, to dtive the Scheduled Vehicle or has been permitted and is not disqualified by order of a Cour of Law or by person of any enactment or regulation in that behalf, proved that for Sections | and Il only of his policy an authorized driver shall include a duly licensed driver whose license at the time ofthe accident had expired LIMITATIONS AS TO USE: Use only for social, domestic and pleasure purpose and for the Insured’s business or profession. This policy does not cover (1) Use for the hauling andlor carrying of logs, lumber, sand, gravel, boitled beverages, gasoline products andlor other inflammable articies or materials. ~ (2) Use for racing, peacemaking, reliability trial or speed testing N.B, Provided that limitations (1) and (2) above may be deleted and the risks named therein covered by this Policy upon agreement by, and payment of 20% additional premium to the Company. (3) Use for the carriage of Passengers or for hire or reward. (4) Use for any purpose in connection with the Motor Trade. SECTIONS | and II ofthis Policy caver Third Party liability arising from bodily injury andlor death in amount set forth under the ‘Schedule of Indemnities IN WITNESS WHEREOF, the STRONGHOLD INSURANGE COMPANY, INC. has caused this Policy to be signed,by its duly authorized officerireprosentative at__— Philippines, this day of 20. WHEREAS THE INSURED, by his corresponding proposal and declaration, and which shall be the basis of this Contract and deemed incorporated herein, has applied to the Company for the insurance hereinafter contained subject to the payment of the Premium as consideration for such insurance. opr eed an canceled ne clea ots potey ‘STRONGHOLD INSURAMICE COMPANY, INC. IMPORTANT NOTICE ‘The lnsurance Commicsoner wh ofl In Mania, Cb ard Davao he Government offal Iverarge of the fou Perry A, Bucay ‘xoaute end enfersement ofall ave ring fo nourence and ‘os superar oer sone corel, He ey a Viee President times t ander asestance In sefting any conoversy Between n 2 trance corer an poy ong are TOTHORIZED SIGNATURECONDITIONS APPLICABLE TO ALL SECTIONS 4. This Poly and the Schedule shall bo red together, 28 cne contrat, nd ary word or expression lo hich a space meaning hasbeen attached inary prt ofthis Poly orf the Sened hal ber such spect rearing ereva it may appear 2, Every nates oreonminicaton to be gven of made under tis Pelcy shale Selvered in wring to te Company, ‘The Inoured shal ate al egoonableseps to safeguard the Scheduled Vehicle from loss or Semage ond fo maintain the Schadifad Vehicle in efciont condition, and the Cempony shal have ata mea fes and fal ates to examine te Schodulod atic rary por threo or any dvor er omployee ole Insured nthe eve of ‘ry avalon ot breahconm, tho Scheduled Veice shal not ba let natended without proper precaution bln ‘akan to proven urer loss or damage an, the Sched Vice be dion fore tne necessary pais ae efecod. any extension of ie darago cr any furher damage tothe Scheduled Vehicle shall be excluded ‘fom the scape fhe inn gant by this Pali. 4, Ine event ofeny accident whieh may give fee 1o 4 claim under this Potcy the Insured shel a8 200n 8 possible, give nti thoroof othe Company with fll potculars Every lle, claim, wf, cummons ang procs shal be nti a forwarded to tra Company rmmodlaolyon receipt Noize enall azo be gwen tthe Company immediatly oe eoon ae the naured shal hava cnowledge of ny Inpecing prosection Inquest or fatal Iqury/ncanecton wth any such ocurence. Incase Stearapping or cer crinal ct wnich may ave ise alm uncer this Paley, ha Insured shak give nadie notie othe Police nd coopers wih the Company Insecunng tha conviction of ne ofonder. 5. Witout prelude to No. 2 ofthe General Exceptions, nc admission, offer, promise or payment shal be made by or on behalf the sured without the writen consant Uitte Company whien chal be ontiod fake over tho conduct his name the Gafsnee cr sllersnt of any lam, ato prosacute in his ram orton Benet any ‘for ndcrnity or damages or othe, but shal ot exarece any dscrtonprejueal tt norest of tho Nsuod inthe conduct of any proceedings i he ‘Sttlement of any clam. and te insured sal gve al such information an asistance asthe Company may requ. to Comipary shall wie) the convent of te insured ‘make any payment stlerent of any clam, and Such payment incudes any arturt ol covered by this Poy, the insured shal epay the Company the amount nok ‘so ooered 16. any ime efter the happoning of any event giving rcs to a claim or saris of clime under ths Policy, the Company may pay otha insure and te Third Paty ‘lament oi the ful amount ofthe Company's labity and ralngulsh the concuct of any defers, sttomont or proceedings, andthe Company shal not be fesponaibe or any damarsalloged to have been caubad tothe inured In consoguence of ar alleged aclon or omlesn of tye Compa in cormecton with such Cofonc,settemert or proceedings oof te Company reinauching such cond, nor shal the Company be able fr ary otis or expensoe whatsoever need by the insured or any claimant or ler person ater the compar shal have 3 elinguches. 1. The Company mey eancal the Pooy in acoordance ulin Section 64,68 and 380 ofthe Ineurance Code, in which case, the Company shal there upon return tthe inoue pomlime fd lea the proven prion three forte pana hon the Pokey has boon infos. The sured ay. at any ume, cance the Pokey by surendering 12s no claim has arisen during the then curet prio of Insurance) the Insured shal be entioa fa return oft promium at the (Company's Shot Period fod when tne ploy has bean nforen, Honver, in respoct of Sone | andl, the cancedaton made by tho Insured shall ot be etfecve urios he hes secuted « simiar poly cf nesraren or suey bon ia replace ine ply to bo cancelled or mako a each Gepost in sufcint amount wit the Commissioner and wtheu any gop fe within ve (5) working Gaye fom th dato of cancaaton te requifeddorumentson wih ie Bureau of Land ranspetton in Soterdance wih Section 381 a he insurance Code 12, ratte time any dam arses under ts Poky, there [s any otter ineurance covering the same loss, damage or abit, the Company sll ot be Eble to pay or ontibute more than i etable proportion of any lees, damage, compenalo, east o expences Povides away that toting in iz Conaton shall impose on the ‘Somsny any ably tom wich, ta forthe Condon, weuld havo ben rofewed unr provi (i) cf Sacton £2 (a ofthis Poy. 8, Exoopt in cave of cars arising under Sansone | an Il of tus Poly any difference or ispuse shai arse wih respect the amount ofthe Cor"ponys ably under the Boley, the come shal be flere to tha dacsion ofa sngia arity, to be agreed upon by bot paris er, faling such agreement of single aba, t the fociston wo aria. one tobe appointed in wring by each otha partes wthin ave calor month after having been cequed in wring todo 20 by ether of he Dates ana Incase of GswgrsementBetwson the astro, fo the dein of an uno wa hal Rave boon appointed in wring by the abst, before entering on fieveterence ane tho coo of ard exponace Insdanta2 the reference eal be oat wiht the avara. Arc te heroby expressly stipulated ana dered that shal bo. contin precedent to any rato! soton or st upon hs Poly tat te ewordby such atbiratos or ump of the mount ofthe Company’ iatily hereunder, epuied,shalfbe it oblined. Irs clam be made and rejected and an Scion or Sut be nol eanenancod vshin twee months ae such rejection, or in case ofan Sfotation tating lace a provided herein, win vee months atc the abraor or able or unpie sal have made te awerd, ton the cam chal, fr a purposes, be detec to have been ebandoned and sha nt hereafter be recoverable herounder. Provided, howover, hak n cate of any dispute in the enforcement of {he peaions or Section {ana Section I ofthis Paley, the adjudieaton of such disput shall be win tne ginal an exclusive juadieton ofthe Insurance (Gannisioner suet tothe Initsone povded'n Secon 418 ofthe insurance Cade, a9 amencos 10, Tho cue cbservance and faflmnt ofthe Terms of ts Poi. neotar as they relate fo anything tobe done ct to be cane by the Insured, andthe uth of the ‘Beloments ad answer te proposal shal be condor presedert ay tabi ofthe Company lo makes) payment under his Poli. 11, nine even hate Gompany shoul pa ot beheld tabla ta pay any Sim o aia under tho "No Pau povon of tho Insure Cod, te Insured shall eimburse the Company allsuch sume, whenever he Iauted or ha authonaed rer orrprocontatve has corsa broach fen ofthe warranties, clauses or condtons of {he Sotey of whenever ne creamsarces fll urcer anya he EXCEPTIONS fata n he Ply, or whch the Comary woul not have boot Hable were not fr te Eppleston of 2No-FaUt provision one surance Cede. NUCLEAR EXCLUSIONS CLAUSE 41. This Poly does notcover: (Gh Laws or destusion of or damage o any prope whistaover or any loss or expance whatsoever resting cr acng thertro, oany consequential os (2) Anylopal tabi of whatsoever nature, rely or idrecy caused by of contoute fo By, o ring tom nizing radians of contamination by ecioactly from any nua’ el, or fom ary nuclear waste rom the combustion of near ful For ine purpase fis excason only combustion shal aude any el ‘istaring process of rusia faacn 2. The acely srvidd by he Ploy ebal not apply ener iacide any oes, destucton, damage or legal sbi crt or nec caused by or contbuted to, by. Ming fom nocloarweopons motor. CIVIL CODE ARTICLE 1250 WAIVER CLAUSE Its herby doctored and agred that tha proven of ele 1250 ofthe Civ Codec he Phippines (Repub Act No. 36) which reas vin case an extacrainsy Pifation or efation ofthe crency siplated shoud suparvena, fio value of te currency alte ie ofthe estelshment othe cbtgaton ‘fell be the basso payment" shal not apply in cserming tho ert of aby under he provlions ofthe Policy. SHORT PERIOD RATE SCALE tis hecaby agreed inthe ever this Poly ls surenderod by te Insured fer cancelation, the Company sha retain pemium in ascordance with he fllowng sale for he fine the Poly has been fee No.of Manis i 2 3 4 5 é 7 3 10 1 Percentage 20 30 40 Ey 0, 7. 5 0 35 20 5 1.2. Please road the Condkions and examine the Poles, and if incorect tum timmediatly forateration.6 STRONGHOLD eS INSURANCE COMPANY, INCORPORATED DUPLICATE COPY CONFIRMATION OF COVER NON-LAND TRANSPORTATION OPERATORS VEHICLE semcaainemte "7 Flor, Secuty Bank Cente 6776 Ayala Avene, Makati City Tel. Nos. 891-1329 to 87 Fox. Nos, 891-1640; 091-1920, 891-1383 TIN -000-802-270-VAT NC6 705361 TAEATRSPERESD FORSAHARA VILLA BUSES PROFESSION CONFIRMATION GF COVER MALABANAN peooset DATES! ‘OFFICIAL RECEPTNO. a ‘6/26/2024 GT TOWER INTL AYALA AVE COR HV DELA PERIOD OF INSURAN COSTA ST., SALCEDO VILL MAKATI CITY METRO i Fon eTEBIEOZA TOW NGIDEDO2A | s@R@uLeD veneue TOYOTA VIOS 1.3 XLE CVT- ALUMINA JADE. Re ‘OF BODY Ic My. “S2R250 “ASP atB18F31M414877| "iNRX709999 ae PLATERO, SERIAL /GHASSIS NO. WOTOR NO. TRUTHORIZED CAPAGTIY.[ONADEN WEIGHT 98. ‘SECTION tir & M}uursoruasury = 100,000.00 THIRD PARTY LIABILITY Q | enue ea pe 1,285.43 SUBJECT TO THE SCHEDULE OF NDENNITES SHOWNATTHE BACKHEREOE § | reteset ase) econ BD OQOT BK iy smn ent Ghar Comat Wt ncn wane etna Sees onstrate aaSCHEDULE OF INDEMNITIES FOR BODILY INJURY AND/OR DEATH The folowing schedule of indents shal be observed in be sotlementof cis for death, ody nutes of, and professional fees an hosp charges for Services rendered to, af acienticim under he Compusary otr Veil Ly Isuranoo Coverage DEATH INDEMNITY s 70,000.00 Bufal and Funeral Expenses 3000.00 B. BODILY INJURIES AND FRACTURES. “Types of Accommodation oF aera Professional Attendance Fanci reat Extonded Sonices Rendered ai ac 4. Hospi Roonie asim 4 day per acide Psoo.0nitay Laboratory Examination foes, Xap, 2.00.00 2. Surat Expires jor Operaton 7,500.00 eur Operation 5000.00, Minor Operaton 4,500.00 &.Anaesthsilogst’s Fees Mejor Operation 2800.0, exéur Operation 2000.00 nor Operation ‘500.00 4, Operating Room Major Operation 2% v9 a0 pone ecu Operation 4000.00 Minor Operatn | 500.00 5 Medical Expenses For day ss of Proctioeré Specialist 400.00ay Theta amaurt of medial exgersos mst not exceed ‘5000.00 (Fora single pened corer) 6 Drugs and Medcres Atul valu of drugs and 20,000.00 2 rene used but net exceed 7. Ambulance ‘Actual amauntchargd fr aulance transport 1,500.00, butaot exceed ©. PERMANENT DISABLEMENT AMOUNT Loss ot Lee of Usa of Two nbs sopo0.00, Both Hands ora Fg toh Munbs 5000.00 Bath Foe si000.00 One Hand One Fost 000.00 Sahota Eyes 9.0000 lures esig he pemenen been 5.1000 00 ‘Avjlber muy casa pemanenDideebement 50.0000 [Am alorator sow 9000.00 ‘Am between owas ‘000.00, Hard ‘s0000, FeurFigns rd Thinbofora fend 1,000.00, Fou Figes i 12,000.00 Legato ines 20000.00 ie! 4500.00 One bat A 1500000 AMtescfone fot 900.0 Thane | 3000.00 ero, 6000.00 Spite eye 000.00 Heatrg ton eas 900.00 Hearrg-ere at 000.0 (OTHER INCIDENTAL EXPENSES. ‘The Gargary wil py pertnont od reasonable oxerses cured Fr comectn hte acn o rved unr hs Saas of IMPORTANT NOTICE sent whofe loa md DaeSTRONGHOLD INSURANCE COMPANY, INCORPORATED PRIVATE CAR TIP-PC-2737683 BRANCH BDO-QC TFSPH LSD TO: SAHARA VILLA MALABANAN SANO. 4791059 ENTRY DATE June 26, 2021 | BEVSNE ESE) ISS i ‘32F GT TOWER INTL AYALA AVE COR HV DELA COSTA ST., june 25, Perret ‘SALCEDO VILL MAKATI CITY METRO MANILA 1226 RENEWING POLICY NO. ee a =e ee ieee ED erie So -Te ict eas ee ee jeer oe diy coe Sse sammie TFT NUDED, MCLEE, ancmeniservoui eur Riot, Strike and Civil Commotion RSCG. ‘000 0.00 ARS ETARARD) BUILTIN SECTIONIVA™ Excess Soul njury SS aoe [ge STERSOLSTNSAOS BUILTIN ‘SECTION IV-B - Property Damage = PD 200,000.00 1,245.00 DED 2 \. “tuna BORE RePaRneT PHILIPPINE 10 Deni de ist bene TOVDTAENANCLAL SERIES PHILIPPINES CORP. os hr ares may appear subj he ems condos causes and warrants of| hs pol: aaron tht tha poy oan enw hee all tbe aed uation ond eras by TOYOTA PRANGIAL SERVICES PILES MORTGAGEE TOYOTA FINANCIAL ih ‘cust no: sooossaa7s VsiNo: AsoAot7515, MP: JANET FRANCESCO MOBILE: 0973085602 Forms and endorsements OVERA PREMIUM fete che Ci resin 1D 851,000.00 10,434.58 THe INCLUDED INCLUDED 851,000.00 4,255.00 Paneamenenanumenemmes RS AND Ps 851,000.00 “TOTAL 2,227,000.00 16,354.59 Subject to Auto PA for 1 unnamed driver and 4 unnamed yaT 1,962.55 assengers @ Ps 25,000.00 each. Medical Reimbursement LGT 24.54 pf 2,500.00 each. DOC STAMPS. 2,044.32 OTHERS 0.00 INCODED BY Ruby Tibay AUTO ASSIST Covered 0.00 INTED BY Ruby Tibay AUTHENTICATION 0.00 \GENT TBK _TOTAL AMOUNT DUE 20,386.00 Documentary Stamps fo the value stated ‘above have been afixed propery anceled on the offen copy of te re Vie Worcaidene 5/2612 1# 9-34AM#O00001 AUTHORIZED SIGNATURE 117th Floor, Security Bank Cantre, 6776 Ayala Avenue, Makali City, Philippines - Tel. Nos.: 8891-1329 to G7 « Fax Nos.: 6891-1826; 8815-2299; 8891-1181STRONGHOLD INSURANCE COMPANY, INCORPORATED en ieonie | PRIVATE CAR TIP-PC-2737682 i BRANCH 8D0-ac TF: ‘SPH LSD TO: SAHARA VILLA MALABANAN SRNO, Froxton ENTRY DATE June 26, 2021 Bipiey bare © June 38; 2034 Eemnoon 32F GTTOWER INTL AYALA AVE COR HV DELA COSTA ST. lune 25, é ‘SALCEDO VILL MAKATI CITY METRO MANILA 1228 RENEWING POLICY NO. TS55F SCHEDULED VERTICES Mare Farora SCTio, Seas i Tipeor cone ViOs 13 xLE ovT-Ek 000 MOTORNG. Threxroove9 ALUMINA JADE METALLIC CHASSISNO. PATBI8P31I4145775, COVERAGE PREMIUM ACCESSORIES ‘AMOUNT REMARKS | SECTIONI/N- Thin Party Lablity TPL ‘ea,con.ce 120543 TION M-insured’s Estimated Tacey caste Te excuW0ed,» EXCLUDED. ‘Strike and Civil Commotion SCC 0 2.00 W-A-Excass Bodily jury Bi 0.00 ‘8.00 IN-B-Property Damage PD 0.00 0.00 PA 0.00 TOTAL ——_ 100,000.00 1285.43 oeDucTILE Towgg AUTHORIZED REPAIR LBA MORTGAGEE 57 NO: so00ssa2T4 NO: ASOAOT7S15 MP: JANET FRANCESCO MOBILE: 09773083602 _ Erna erzarees one mter toy aye TPL SD THEFT ‘AON Rscc 8 PD PA AUTHORIZED SIGNATURE 47th Ficor, Security Bank Contre, 6776 Ayala Avenue, Makati City, Phiiopines + Tel. Nos.: 8891-1929 to 87 « Fax Nos.: 8891-1926; 6615-2283; 8801-1181