QUOTATION DETAILS

To

RICO, ARMIE MAY

Address

Insured

RICO, ARMIE MAY

Business

New Business

PREMIUM
Value Added Tax
Documentary Stamp
Local Government Tax

..............
..............
..............
..............

PHP
PHP
PHP
PHP

AMOUNT DUE

...........

PHP

Quotation Number

1000067189

Issue Date
Client Number
Agent Number
Quotation Number
From
To
Days

:
:
:
:
:
:
:

12 October 2016
1000000
60000001
1000067189
12 October 2016
12 October 2017
365

SUMMARY OF PREMIUM AND OTHER

16,215.00
1,945.80
2,026.88
32.43
20,220.11

PERIL/S
OD/THEFT
ACTS OF NATURE
PERSONAL ACCIDENT
BODILY INJURY
PROPERTY DAMAGE

SUM INSURED
690,000.00
690,000.00
250,000.00
500,000.00
500,000.00

DETAILS OF INSURANCE
Plate
Make Model
Type of Body
Model Year
Motor/Engine
Serial/Chassi
Color

:
:
:
:
:
:
:

ALA4584
FORD FIESTA ECO BOOST SPORT HATCHBACK
HATCHBACK
2014
M1JGEU 34017
EU 34017
Phantom Purple

Warranties and Clauses

DATE RECOGNITION CLAUSE
TERRORISM EXCLUSION CLAUSE
PAIR AND SET ENDORSEMENT
DRUNKEN DRIVER CLAUSE

MV File No.
RAP Number
Deductible
Towing Fee
AR Limit
Assignee

:
:
: 3450
: 100
: 3550
:

DEDUCTIBLE CLAUSE
MOTOR VEHICLE ACCESSORY ENDORSEMENT
IMPORTATION CLAUSE
ACTS OF NATURE ENDORSEMENT

THE POLICY SCHEDULE, SPECIFICATIONS AND ANY ENDORSEMENTS WILL BE READ AS ONE
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
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
authorized representative is system generated and serves as your official policy.

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
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.