Client's Copy

POLICY SCHEDULE
To : : DENMARK SIMBAJON MACALISANG Policy Number : PG-PCP-300991816

Issue Date : 05/23/2022

Address : P-4 BUTUAY,
JIMENEZ, MISAMIS OCCIDENTAL Client Number : 30353870
Agent Number : 30000223
Misamis Occ
Referral Number :
7204
Ext./Prev. Policy Number :
Insured : DENMARK SIMBAJON MACALISANG From : May 24, 2022 , 12:00 PM
To : May 24, 2023 , 12:00 PM
Business : New Business (300991816) Days : 365

SUMMARY OF PREMIUM AND OTHER CHARGES

PREMIUM ................... PHP 15,954.00 COC VF ...................PHP 0.00
Value Added Tax ................... PHP 1,914.48 ...................PHP
Roadside Assistance Fee 100.00
Documentary Stamp Tax ................... PHP 1,994.25
Local Government tax ................... PHP 79.77
AMOUNT DUE ................... PHP 20,042.50
COVERAGE/S SUM INSURED PREMIUM
OWN DAMAGE / THEFT 822,000.00 12,330.00
AON 822,000.00 1,644.00
EXCESS BODILY INJURY 300,000.00 585.00
THIRD PARTY PROPERTY DAMAGE 300,000.00 1,395.00

DETAILS OF INSURANCE
Make Model : MITSUBISHI MIRAGE GLX 1.2G CVT-2022MY (033)
Plate No. : B9Z537 MV File No. : NEW
Deductible : PHP 4,110
Model Year : 2022 Towing Limit PHP 100
Motor/Engine No.: 3A92UKX9718 AR Limit : PHP 4,210
Serial/Chassis : PAEA13RJNNA004757 Assignee : DENMARK SIMBAJON MACALISANG
Color : RED METALLIC
COC / Auth No. : Mortgagee :
RAP : Covered

Warranties and Clauses LOSS OR DAMAGE, IF ANY, IS PAYABLE TO

DEDUCTIBLE CLAUSE
PAIR & SET CLAUSE
ACTS OF NATURE ENDORSEMENT
MOTOR VEHICLE ACCESSORY ENDORSEMENT
Accessories Declared
WITH BUILT IN ACCESSORIES
TERRORISM EXCLUSION CLAUSE
DRUNKEN DRIVER CLAUSE AS THEIR INTEREST MAY APPEAR, SUBJECT TO THE TERMS
DATE RECOGNITION CLAUSE AND CONDITIONS, CLAUSES AND WARRANTIES OF THIS
IMPORTATION CLAUSE POLICY. IT IS HEREBY EXPRESSLY UNDERSTOOD THAT THIS
OR ANY RENEWAL THEREOF SHALL NOT BE CANCELLED
WITHOUT PRIOR WRITTEN NOTIFICATION TO AND
AOG DEDUCTIBLES-PS 15K PER ACCIDENT CONFORMITY OF

FREE PA FOR 5 PERSONS -PS 50K

FREE UPA TO AN UNNAMED INSURED-PS 100K
THE POLICY, POLICY SCHEDULE, SPECIFICATIONS AND ANY ENDORSEMENTS WILL BE READ AS ONE CONTRACT
Documentary Stamps to the value shown herein have been affixed/imprinted to the premium register of the company in compliance with Revenue Regulation No. 15-2001 dated October 16, 2001
In witness whereof, the company has caused this Policy to be signed by its duly authorized representative. This document with the e-sign of Standard Insurance Co. Inc.'s authorized representative is
system generated and serves as your official policy.

John B. Echauz Mark Ryan S. Bugarin

President Branch Head

ABALLE Original Copy

IMPORTANT REMINDER:
Please do not forget to check the correctness and accuracy of the details on the Policy Schedule. This will serve as the basis in the assessment and settlement of a claim. Any discrepancy or non-declaration
may cause inconvenience or even nullification of a claim. Should there be any correction/s or change/s, inform your agent or writing office IMMEDIATELY.
 Client's Copy

PREMIUM PAYMENT GUIDE

Dear Valued Customer,

Thank you for choosing Standard Insurance as your insurance provider.

We would like to remind you to pay your premium immediately to ensure that your policy is in-force. For your reference,
provided below are the details of your policy.

Policy Number PG-PCP-300991816 Summary of Premium Charges & Other Charges

Client Name DENMARK SIMBAJON MACALISANG Premium 15,954.00
VAT 1,914.48
Coverage Period May 24, 2022 - May 24, 2023 Documentary Stamp 1,994.25
Local Gov't Tax 79.77
Others 100.00
TOTAL AMOUNT DUE 20,042.50

PREMIUM PAYMENT FACILITIES

1. Bank Over-the-counter Payment
Visit the following banks (BDO, Metrobank, Union Bank, BPI, Bayad Center) and pay using the Bills Payment Form (bank payment) or
transaction form (Bayad Center)

o For check payment, please make the check payable to Standard Insurance Co., Inc. Please write the policyholder’s name and
policy number at the back of the check.

o Make sure to have a copy of your policy number

2. Standard Insurance Branches

Visit any branch of Standard Insurance located in key cities nationwide. You may pay in cash, check or via credit card swipe machine
(available in selected branches).

3. Credit Card via Email (Payment Link)

To pay using credit card via email, please call the branch where your policy was issued and request for a credit card "Payment Link". We
accept Visa / Mastercard, AMEX, JCB credit cards and Union Pay.

4. Online Banking Payment (BDO, Metrobank, Union Bank, BPI)

For account holders, you may log-in to your online bank account and choose Standard Insurance Co., Inc. as biller company. (You may
required to enroll your policy number)

5. Bayad Center Mobile Application

To pay your insurance premium using the Bayad Center Mobile App, please choose Standard Insurance as biller company. Provide your
complete policy number – i.e. XXPCP100187264.

Important Note:
Under section 77 of the Insurance Code as amended, no policy is valid and binding unless and until the premium has been paid.

This is a system-generated form

 Producer's Copy

POLICY SCHEDULE
To : : FAST AUTOWORLD / ALAN LOBITANA (MITS. OZAMIS) Policy Number : PG-PCP-300991816

Issue Date : 05/23/2022

Address : PEREYRA VILLAGE, BRGY. MANINGCOL, OZAMIZ CITY
C/O SICI PAGADIAN BRANCH Client Number : 30353870
Agent Number : 30000223
Misamis Occ
Referral Number :
7200
Ext./Prev. Policy Number :
Insured : DENMARK SIMBAJON MACALISANG From : May 24, 2022 , 12:00 PM
To : May 24, 2023 , 12:00 PM
Business : New Business (300991816) Days : 365

SUMMARY OF PREMIUM AND OTHER CHARGES

PREMIUM ................... PHP 15,954.00 COC VF ...................PHP 0.00
Value Added Tax ................... PHP 1,914.48 ...................PHP
Roadside Assistance Fee 100.00
Documentary Stamp Tax ................... PHP 1,994.25
Local Government tax ................... PHP 79.77
AMOUNT DUE ................... PHP 20,042.50
COVERAGE/S SUM INSURED PREMIUM
OWN DAMAGE / THEFT 822,000.00 12,330.00
AON 822,000.00 1,644.00
EXCESS BODILY INJURY 300,000.00 585.00
THIRD PARTY PROPERTY DAMAGE 300,000.00 1,395.00

DETAILS OF INSURANCE
Make Model : MITSUBISHI MIRAGE GLX 1.2G CVT-2022MY (033)
Plate No. : B9Z537 MV File No. : NEW
Deductible : PHP 4,110
Model Year : 2022 Towing Limit PHP 100
Motor/Engine No.: 3A92UKX9718 AR Limit : PHP 4,210
Serial/Chassis : PAEA13RJNNA004757 Assignee : DENMARK SIMBAJON MACALISANG
Color : RED METALLIC
COC / Auth. No. : Mortgagee :
RAP : Covered

Warranties and Clauses LOSS OR DAMAGE, IF ANY, IS PAYABLE TO

DEDUCTIBLE CLAUSE
PAIR & SET CLAUSE
ACTS OF NATURE ENDORSEMENT
MOTOR VEHICLE ACCESSORY ENDORSEMENT
Accessories Declared
WITH BUILT IN ACCESSORIES
TERRORISM EXCLUSION CLAUSE
DRUNKEN DRIVER CLAUSE AS THEIR INTEREST MAY APPEAR, SUBJECT TO THE TERMS
DATE RECOGNITION CLAUSE AND CONDITIONS, CLAUSES AND WARRANTIES OF THIS
IMPORTATION CLAUSE POLICY. IT IS HEREBY EXPRESSLY UNDERSTOOD THAT THIS
OR ANY RENEWAL THEREOF SHALL NOT BE CANCELLED
WITHOUT PRIOR WRITTEN NOTIFICATION TO AND
AOG DEDUCTIBLES-PS 15K PER ACCIDENT CONFORMITY OF

FREE PA FOR 5 PERSONS -PS 50K

FREE UPA TO AN UNNAMED INSURED-PS 100K
THE POLICY, POLICY SCHEDULE, SPECIFICATIONS AND ANY ENDORSEMENTS WILL BE READ AS ONE CONTRACT
Documentary Stamps to the value shown herein have been affixed/imprinted to the premium register of the company in compliance with Revenue Regulation No. 15-2001 dated October 16, 2001
In witness whereof, the company has caused this Policy to be signed by its duly authorized representative. This document with the e-sign of Standard Insurance Co. Inc.'s authorized representative is
system generated and serves as your official policy.

John B. Echauz Mark Ryan S. Bugarin

President Branch Head

ABALLE Original
IMPORTANT REMINDER:
Please do not forget to check the correctness and accuracy of the details on the Policy Schedule. This will serve as the basis in the assessment and settlement of a claim. Any discrepancy or non-declaration
may cause inconvenience or even nullification of a claim. Should there be any correction/s or change/s, inform your agent or writing office IMMEDIATELY.