Mortgagee's Copy

POLICY SCHEDULE
To : MetroBank Policy Number : FO-PCV-600038328

Address : Issue Date : 02/29/2024

Client Number : 1656665
Agent Number : 60000001
Referral Number :
Ext./Prev. Policy Number :
Insured : JED DARES PON-AN TONOGAN
From : March 11, 2024 12:00 PM
To : March 11, 2025 12:00 PM
Business : New Business (600038328) Days : 365
SUMMARY OF PREMIUM AND OTHER CHARGES
PREMIUM ................PHP 12,775.00 COC VF ................ PHP 0.00
Value Added Tax ................ PHP 1,533.00 Roadside Assistance Fee ................ PHP 100.00
Documentary Stamp Tax ................PHP 1,596.88
Local Government Tax ................ PHP 25.55
AMOUNT DUE .............. PHP 16,030.43
COVERAGE/S SUM INSURED PREMIUM
OWN DAMAGE / THEFT 740,000.00 8,140.00
ACTS OF NATURE 740,000.00 2,220.00
PERSONAL ACCIDENT 700,000.00 0.00
EXCESS BODILY INJURY 500,000.00 780.00
THIRD PARTY PROPERTY DAMAGE 500,000.00 1,635.00

DETAILS OF INSURANCE
Make Model : KIA STONIC EX A/T 1.4
Plate No. : FAJ2260 MV File No. : 0601-00001137374
Deductible : PHP 3,700.00
Model Year : 2022 Towing Fee : PHP 100.00
Motor/Engine No. : G4LCM1058993 AR Limit : PHP 3,800.00
Serial/Chassis : LJD4AA19BN0096369 Assignee : JED DARES PON-AN TONOGAN
Color : YELLOW-BLACK
COC / Auth No. : Mortgagee : METROBANK
RAP : Covered

Warranties and Clauses

MOTOR VEHICLE ACCESSORY ENDORSEMENT IMPORTATION CLAUSE LOSS OR DAMAGE, IF ANY IS PAYABLE TO

DRUNKEN DRIVER CLAUSE ACTS OF NATURE ENDORSEMENT METROBANK

PAIR & SET CLAUSE PERSONAL ACCIDENT INSURANCE FOR UNNAMED DRIVER/OCCUPANTS AS THEIR INTEREST MAY APPEAR, SUBJECT TO THE TERMS
AND CONDITIONS, CLAUSES AND WARRANTIES OF THIS
TERRORISM EXCLUSION CLAUSE
POLICY. IT IS HEREBY EXPRESSLY UNDERSTOOD THAT THIS
DATE RECOGNITION CLAUSE
OR ANY RENEWAL THEREOF SHALL NOT BE CANCELLED
Accessories Declared WITHOUT PRIOR WRITTEN NOTIFICATION TO AND
CONFORMITY OF
METROBANK

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.

Patricia E. Chilip Divinia D. Mitra

President Head - Risk Management Division
ADMINISTRATOR Original1
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.