Policy - MC PVC CBC 0012307

W
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G POLICY SCHEDULE
LINE & SUBLINE PREMIUM 28,335.00
AUTO INSURANCE DOC STAMPS 3,542.00
PRIVATE CAR PREMIUM TAX 0.00
FIRE SERVICE TAX 0.00
POLICY NO. MC-PVC-CBC-0012307 VALUE ADDED TAX 3,400.20
LOCAL GOV'T TAX 56.67
TERM FROM OCT 26, 2022 12:00 PM OTHER CHARGES 0.00
TO OCT 26, 2023 12:00 PM
ISSUE DATE NOV 14, 2022 AMOUNT DUE 35,333.87
INTERMEDIARY 0511571 CURRENCY PHILIPPINE PESO

INSURED : CERA, DARWIN VENTURA
L 11 PH 2 SITIO KNIGHTS OF COLUMBUS
BRGY SAN ROQUE ANTIPOLO CITY RIZAL
RENEWING POLICY NO. MC-PVC-CBF-0000810

1 2022 NISSAN URVAN 2.5L STANDARD 15 STR MT
PLATE NO. : F4T841 DEDUCTIBLE : 6,480.00
SERIAL NO. : JN1TC2E26Z0081194 TOWING : 100.00
MOTOR NO. : YD25105075B REPAIR LIMIT : 6,580.00
COLOR : GRANITE BLACK
SEATING CAP. : 5
MORTGAGEE : CHINABANK SAVINGS INC.
ACCESSORIES DESCRIPTION VALUE
AIRCONDITIONER FACTORY BUILT-IN
STEREO SYSTEM STD. FACTORY AUDIO SET-UP
ONE SET MAGWHEELS (5 PCS.) FACTORY BUILT-IN
A I P : ENROLLED
SCHEDULE OF RATES AND PREMIUMS :

COVERAGE SUM INSURED PREMIUMS
SEC III -OWN DAMAGE 1,296,000.00
THEFT 1,296,000.00
SEC IV-A-EXCESS BODILY INJURY 500,000.00
SEC IV-B-PROPERTY DAMAGE 500,000.00
AUTO PERSONAL ACCIDENT 500,000.00
MEDICAL REIMBURSEMENT 50,000.00
ACTS OF NATURE 1,296,000.00
RIOT, STRIKE, CIVIL COMMOTION 1,296,000.00
28,335.00
* - * - * - * - *
WARRANTIES AND CLAUSES AT THE TIME OF ISSUE:
ACTS OF NATURE
MORTGAGEE AND NON CANCELLATION CLAUSE
THIS IS COMPUTER GENERATED.
Prudential Guarantee and Assurance, Inc. COYIUTO HOUSE 119 C. Palanca St., Legaspi Village, Makati City, 1229 Philippines Tel. Nos.: (632) 8810-4916 / 8878-3000 / 8651-9500
Fax: (632) 8819-2991 customercare@prudentialguarantee.com | www.prudentialguarantee.com
POLICY SCHEDULE
ATTACHED TO AND FORMING PART OF POLICY NO. MC-PVC-CBC-0012307 Page 2 of 5
SECTIONS I & II DELETED

PAIR AND SET ENDORSEMENT
STRIKE, RIOT AND CIVIL COMMOTION
AUTO PERSONAL ACCIDENT ENDORSEMENT W/ MEDICAL REIMBURSEMENT
IN WITNESS WHEREOF, the Company has caused this policy to be signed by its duly
authorized officer/representative at Makati City on November 14, 2022.

POLICY SCHEDULE
ACTS OF NATURE
IN CONSIDERATION OF THE PAYMENT OF AN ADDITIONAL PREMIUM IT IS HEREBY UNDERSTOOD
AND AGREED THAT THE WORD "FLOOD, TYPHOON, HURRICANE, VOLCANIC ERUPTION, EARTHQUAKE
OR OTHER CONVULSION OF NATURE" IN THE GENERAL EXCEPTIONS OF THIS POLICY ARE DEEMED
DELETED.
IT IS UNDERSTODD THAT AON REFERS TO FLOOD, TYPHOON, HURRICANE, VOLCANIC ERUPTION,

EARTHQUAKE AND OTHER CONVULSIONS OF NATURE.
MORTGAGEE AND NON CANCELLATION CLAUSE

LOSS OR DAMAGE, IF ANY IS PAYABLE TO CHINABANK SAVINGS INC. AS THEIR
INTEREST MAY APPEAR SUBJECT TO THE TERMS AND CONDITIONS, CLAUSES AND
WARRANTIES OF THIS POLICY. IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT
THIS POLICY OR ANY RENEWAL THEREOF SHALL NOT BE CANCELLED WITHOUT ANY
PRIOR WRITTEN NOTIFICATION TO AND CONFORMITY BY CHINABANK SAVINGS INC.
PAIR AND SET ENDORSEMENT

It is hereby declared and agreed that the above-mentioned policy is amended as
follows:
Pair and Set Endorsement
It is understood and agreed that in the event of loss or damage to any accessory
or accessories, spare part or spare parts forming part of a pair or set, the
measure of loss or damage to such accessory or spare part shall be its reasonable
and fair proportion to the total value of the pair or set, giving consideration to
the importance of said accessories or spare parts, but in no event shall such loss
or damage be construed to mean a total loss of the pair or set.
Except as herein stated, all other terms and conditions remain unaltered.
STRIKE, RIOT AND CIVIL COMMOTION

In consideration of the payment of an additional premium, it is hereby declared
and agreed that the indemnity provided by this policy shall be extended to cover
loss or damage due to strike, riot and civil commotion which for the purpose of
this endorsement shall mean loss of or damage to the property insured directly
caused by:
a. The act of any person taking part together with others in any disturbance of
the public peace (whether in connection with a strike or lock-out or not)
b. The action of any constituted authority in suppressing or attempting to
suppress any such disturbance or in minimizing the consequences of any such
disturbance
c. The willful act of any striker or locked-out worker done in furtherance of a
POLICY SCHEDULE
strike or in resistance to a lockout; and

d. The action of any lawful constituted authority in preventing or attempting
to prevent any such act or in minimizing the consequences of any such act.
Provided further that the Company shall not be liable for loss, damage or
liability occasioned directly or indirectly by through or in consequence of any of
the following occurrences namely:
1. War, invasion, act of foreign enemy, hostilities or war-like operations

(whether war be declared or not), civil war
2. Mutiny, civil commotion assuming the proportion of or amounting to a popular
uprising, insurrection, rebellion, revolution, military or usurped power;
and
3. Acts of persons operating on behalf of or in connection with any political
organization, martial law or stage of siege or any events, which determine
the proclamation of martial law or state of siege.
4. Acts of terrorism committed by a person or persons acting on behalf of or in
connection with any organization.
For this purpose, an act of terrorism shall mean an act, including but not
limited to the use of force or violence and/or the threat thereof, of any
person or group(s) of persons, whether acting alone or on behalf of or in
connection with any organization(s) or government(s), committed for
political, religious, ideological, or similar purposes including the
intention to influence any government and/or to put the public, or any
section of the public, in fear.
This also excludes loss, damage, cost or expense of whatsoever nature

directly or indirectly caused by, resulting from or in connection with any
action taken in controlling, preventing, suppressing or in any way relating
to any act of terrorism.
AUTO PERSONAL ACCIDENT ENDORSEMENT W/ MEDICAL REIMBURSEMENT

IN CONSIDERATION OF THE PAYMENT OF AN ADDITIONAL PREMIUM IT IS HEREBY UNDERSTOOD
AND AGREED THAT THE COMPANY UNDERTAKES TO PAY COMPENSATION ON THE SCALE PROVIDED
BELOW FOR BODILY INJURY AS HEREINAFTER DEFINED SUSTAINED BY
ONE (1) AUTHORIZED DRIVER
FOUR (4) PASSENGERS
IN THE MOTOR VEHICLE HEREIN INSURED WHILE DRIVING, MOUNTING INTO, DISMOUNTING FROM
OR TRAVELLING IN THE MOTOR VEHICLE, AND CAUSED BY VIOLENT ACCIDENTAL EXTERNAL AND
VISIBLE MEANS WHICH INDEPENDENTLY OF ANY OTHER CAUSE (EXCEPTING MEDICAL OR
SURGICAL TREATMENT CONSEQUENTLY UPON SUCH INJURY) SHALL WITHIN THREE CALENDAR
MONTHS OF THE OCCURRENCE OF SUCH INJURY RESULT IN:
SCALE OF
POLICY SCHEDULE
COMPENSATION
(1) DEATH --------------------------------------------------- P 100,000.00/PERSON
(2) TOTAL AND IRRECOVERABLE LOSS OF ALL SIGHT IN BOTH EYES -- P 100,000.00/PERSON
(3) TOTAL LOSS BY PHYSICAL SEVERANCE AT OR ABOVE THE WRIST

OR ANKLE OF ONE HAND OR ONE FOOT TOGETHER WITH THE
TOTAL IRRECOVERABLE LOSS OF ALL SIGHT IN ONE EYE -------- P 100,000.00/PERSON

OR ANKLE OF BOTH HANDS OR FEET OR OF ONE HAND TOGETHER
WITH ONE FOOT ------------------------------------------- P 100,000.00/PERSON
(5) TOTAL IRRECOVERABLE LOSS OF ALL SIGHT IN ONE EYE -------- P 50,000.00/PERSON

OR ANKLE AT ONE HAND OR ONE FOOT ------------------------ P 50,000.00/PERSON
(7) MEDICAL EXPENSES PAYMENT --------------------------------- 10% OF DEATH

BENEFIT
PROVIDED ALWAYS THAT:
(A) COMPENSATION SHALL BE PAYABLE UNDER ONE ONLY OF ITEMS (1) TO (7) ABOVE IN
RESPECT OF ANY SUCH DRIVER ARISING OUT OF ANY ONE OCCURRENCE AND THE TOTAL
LIABILITY OF THE COMPANY SHALL NOT IN THAT AGGREGATE EXCEED THE SUM OF
P 100,000.00 DURING ANY ONE PERIOD OF INSURANCE.
(B) NO COMPENSATION SHALL BE PAYABLE IN RESPECT OF DEATH OR INJURY DIRECTLY OR

INDIRECTLY WHOLLY OR IN PART ARISING OR RESULTING FROM OR TRACEABLE TO (1)
INTENTIONAL SELF INJURY SUICIDE (WHETHER FELONIOUS OR NOT) OR ATTEMPTED
SUICIDE PHYSICAL DEFECT OR INFIRMITY OR (2) AN ACCIDENT HAPPENING WHILST SUCH
DRIVER IS UNDER THE INFLUENCE OF INTOXICATING LIQUOR OR DRUGS.
(C) SUCH COMPENSATION SHALL BE PAYABLE ONLY WITH THE APPROVAL OF THE INSURED AND
DIRECTLY TO THE INJURED DRIVER OR HIS LEGAL PERSONAL REPRESENTATIVES WHOSE
RECEIPT SHALL BE A FULL DISCHARGE IN RESPECT OF THE INJURY TO SUCH PERSON.
SUBJECT OTHERWISE TO THE TERMS AND CONDITIONS OF THE POLICY.


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INTERMEDIARY 0511571 CURRENCY PHILIPPINE PESO

RENEWING POLICY NO. MC-PVC-CBF-0000810

SCHEDULE OF RATES AND PREMIUMS :

SECTIONS I & II DELETED

THIS IS COMPUTER GENERATED.

IT IS UNDERSTODD THAT AON REFERS TO FLOOD, TYPHOON, HURRICANE, VOLCANIC ERUPTION,

MORTGAGEE AND NON CANCELLATION CLAUSE

PAIR AND SET ENDORSEMENT

Pair and Set Endorsement

STRIKE, RIOT AND CIVIL COMMOTION

strike or in resistance to a lockout; and

1. War, invasion, act of foreign enemy, hostilities or war-like operations

This also excludes loss, damage, cost or expense of whatsoever nature

AUTO PERSONAL ACCIDENT ENDORSEMENT W/ MEDICAL REIMBURSEMENT

(3) TOTAL LOSS BY PHYSICAL SEVERANCE AT OR ABOVE THE WRIST

(4) TOTAL LOSS BY PHYSICAL SEVERANCE AT OR ABOVE THE WRIST

(6) TOTAL LOSS BY PHYSICAL SEVERANCE AT OR ABOVE THE WRIST

(7) MEDICAL EXPENSES PAYMENT --------------------------------- 10% OF DEATH

(B) NO COMPENSATION SHALL BE PAYABLE IN RESPECT OF DEATH OR INJURY DIRECTLY OR

SUBJECT OTHERWISE TO THE TERMS AND CONDITIONS OF THE POLICY.

THIS IS COMPUTER GENERATED.

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