NOVEMBER 22, 2023

MR. CHRISTOPHER N. ARIAS

ADDRESS

Dear Valued Client,

Thank you for giving us the opportunity to quote on your motor insurance requirement. We are pleased to
submit our proposal for your review and consideration.

Vehicle’s Make and model 2016 FORD EVEREST

Plate Number or Conduction Sticker Number if PLEASE ADVISE
brand new
Serial Number PLEASE ADVISE
Motor Number PLEASE ADVISE
Color PLEASE ADVISE
MV File Number PLEASE ADVISE
Mortgagee PLEASE ADVISE, IF ANY
Classification Private Car

I. COMPREHENSIVE MOTORCAR INSURANCE

COVERAGE SUM INSURED PREMIUM

Section III OWN DAMAGE / THEFT 630,000.00 7,651.73

Acts of Nature 630,000.00 1,890.00

Section IV Excess Third Party Liability - Bodily Injury 200,000.00 420.00
Excess Third Party Liability - Property Damage 200,000.00 1,245.00
Unnamed Passenger Personal Accident 500,000.00 Free
(Php100,000/Person based on maximum seating capacity)
Net Premium 11,206.73

DST 1,400.84
VAT 1,344.81
LGT 22.41

Gross Premium 13,974.79

RAP CARD 100.00

TOTAL 14,074.79

Deductible: .50% of the Sum Insured or min. of Php 3,000.00 for each and every loss, whichever is
higher.
Basis of indemnity in respect of loss/damage to the insured vehicle is Standard Insurance Co., Inc.’s fair
market value at the time of the loss.

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This proposal includes the following:
1. FREE Auto Personal Passengers Accident based on authorized seating capacity
including driver
a. Accidental Death and Disablement (AD&D) limit of Php 100,000.00/person
b. Medical Reimbursement with a limit of 10% of the AD&D cover
2. Acts of Nature Cover (i.e. Flood, Typhoon, Earthquake, Hurricane, Volcanic Eruption,
Other Convulsions of Nature)
3. FREE Strike, Riot and Civil Commotion Cover - sum insured is based on the current Fair
Market Value

Extensions of Cover:
1. Unit model with a maximum of 12 years old up to present year will be accepted for CASA
repair including Third Party Property Damage (TPPD) claim.
2. Free 24-Hour Roadside Assistance Nationwide with additional benefits (Applicable to
PRIVATE CARS vehicles 15 years old and below only).
3. For Non-Accident Related – 24-Hour Emergency Roadside Assistance and three (3) service
calls in a year per vehicle such as Flat Tire Change, Dead Battery Service, Provision of Fuel,
Left Key, Mechanical Breakdown, etc. (Applicable to PRIVATE CARS vehicles 12 years old
and below only).
4. Automatic Extension of Period (30 days subject to pro-rata premium based on expiring
terms).
5. Units with no available parts shall be settled through cash settlement.
6. Accessories Clause – standard accessories / built-in accessories are automatically covered
in the Policy, whether declared or not, and the basis of valuation/indemnity is the Fair Market
Value. NOTE: Standard or Built-in accessory/ies means accessory/ies standard to the
model of the vehicle insured upon release from the dealer.
7. Waiver of depreciation on replacement parts (applicable to surplus only and original engine
materials).
8. Waiver of deductible and depreciation if unit will be repaired at Standard Insurance Co., Inc.
Technical and Training Center for multisourced parts. Depreciation will still be charged to the
client if they prefer brand new parts.

Table of Depreciation for Brand New Parts – Private Cars

Age of Vehicle Rate of Depreciation
Share of the Insured
Up to 3 years NIL
Over 3 years up to 4 years 20%
Over 4 years up to 5 years 25%
Over 5 years up to 6 years 30%
Over 6 years up to 7 years 35%
Over 7 years 40%
Batteries, Tires, Ball Joints,Tie Rods and Shock
45%
Absorbers (for vehicles over 3 years)

II. Compulsory Third Party Liability (CTPL)

As mandated by LTO for your vehicle registration

Php100, 000.00 coverage with a premium of _____________________________

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Should our proposal merit your approval, kindly provide us the following details and indicate your
conformity by signing the conforme below:

Full Name of Assured: JENNIFER BUELLA SINGSON

Mailing Address: PLEASE ADVISE
Home Number: PLEASE ADVISE
Mobile Number: PLEASE ADVISE
TIN number (if assured name is a company or organization):
E-mail Address: PLEASE ADVISE
Engine/Motor Number: UEJAHC21720
Serial/Chassis Number: MPBSXXMXXSH21720
Color: PLEASE ADVISE
Policy Period: ONE YEAR FROM INCEPTION DATE
Mortgagee /Name of bank if under loan: NIL
To be issued with CTPL (Y/N):

Please note that this proposal is valid 30 days from the receipt of the quotation. Coverage starts at 12:00
noon, warranted no loss on the date of acceptance of this quote. This quotation will not be valid if your
vehicle has been converted to public utility vehicle or used for transporting fare-paying passengers. The
liability of the Company extends to accessories that are specifically stated, otherwise, accessories are
presumed to be of standard type.

Likewise, we reserve the right to withdraw our quotation should you have secured prior quotation from
any of our branches and/or other intermediaries. If you wish to avail of our quotation, we will ask you to
sign a Broker of Record (BOR) and will just match the rate of the other source if the premium they
proposed is higher than what is indicated in this quotation.

Should you have questions, please do not hesitate to contact us.

Thank you and we look forward being of service to you soon.

Sincerely yours,
Standard Insurance Co., Inc.

NAME OF EMPLOYEE: RACHELL ANN M. OCAMPO

POSITION: ACCOUNT OFFICER

I understand and agree that, under Section 77 of the Insurance Code as amended, no policy is valid
and binding unless and until the premium thereof has been paid.

I allow Standard Insurance to collect, store and process my information to provide me certain services
declared in relation to the insurance policy/ies I am purchasing, in compliance with the Data Privacy Act
(DPA) of 2012*, and its Implementing Rules and Regulations (IRR) effective September 9, 2016.

CONFORME:

_______________________
Signature over printed name

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Date: __________________

Premium Payment Options:

I am paying the amount of P_________________

❑ Online Payment (Payment link will be sent to your email address. Please provide screenshot of reference number
after the transaction is done)
❑ Cash Deposit or Transfer
Bank Name: BDO Unibank, Inc.
Bank branch name: Pacific Star - Makati branch
Peso Account number: Checking Account no.3568-0230-23

Bank Name: BPI

Peso Account number: Savings Account 3721-0071-29 / 3721-0078-89

❑ Check Payment: Bank/Branch __________________________

Check Number: ____________________________________

Please make your check payable to STANDARD INSURANCE CO., INC. Indicate the Client Name and Policy
Number at the back of the check

We would appreciate if you could provide us the validated deposit slip, confirmation or any proof so we can
facilitate the proper application of your payment and for us to issue the official receipt. Please send a copy to:

Email: rocampo@standard-insurance.com