LAND TRANSPORTATION OPERATOR'S VEHICLE Client's Copy

CONFIRMATION OF COVER NO. 091L360040

AUTHENTICATION NO.: 091UUSVN1809 POLICY NO.
GS-LTA-300546824
NAME AND ADDRESS OF INSURED BUSINESS DATE ISSUED
TOMAS G. JAENA New Business 06/26/2018
AGENT'S CODE 30000129 PAID UNDER O.R. NO.
Poblacion PERIOD OF INSURANCE
Koronadal City
S.Cotabato FROM 06/26/2018 TO 06/26/2019
SCHEDULED VEHICLE
MAKE/MODEL/BODY TYPE SERIAL/CHASSIS NO.
2007 NISSAN URBAN SHUTTLE TVP4IEFE24A33703
PLATE NO. COLOR MOTOR NO. MV FILE NO.
MVY556 GREEN TD27315259 130800000341411
THIRD PARTY LIABILITY / PASSENGER LIABILITY LIMIT OF LIABILITY 100,000 PER ACCIDENT
(Subject to the Schedule Of Indemnities shown in the Master Policy) PREMIUMS
This Confirmation of Cover is evidence of the policy of insurance required under
insurance required under chapter VI - Compulsory Motor Vehicle Liability Insurance PREMIUM 880.00
RMA 230 of the Insurance Code amended by Presidential Decree No. 1814
PREMIUM TAX 105.60
Rev. 3-0
07/01/2009 DST 110.00
LGT 4.40
TOTAL 1,100.00
RMA 230
John B. Echauz Annabelle C. Obed AUTHENTICATION FEE 50.40
Rev. 3-2 President Manager/Branch Head
11/18/2016
TOTAL AMOUNT DUE 1,150.40

LAND TRANSPORTATION OPERATOR'S VEHICLE LTO Copy

CONFIRMATION OF COVER NO. 091L360040

AUTHENTICATION NO.: 091UUSVN1809 POLICY NO.
GS-LTA-300546824
NAME AND ADDRESS OF INSURED BUSINESS DATE ISSUED
TOMAS G. JAENA New Business 06/26/2018
AGENT'S CODE 30000129 PAID UNDER O.R. NO.
Poblacion PERIOD OF INSURANCE
Koronadal City
S.Cotabato FROM 06/26/2018 TO 06/26/2019
SCHEDULED VEHICLE
MAKE/MODEL/BODY TYPE SERIAL/CHASSIS NO.
2007 NISSAN URBAN SHUTTLE TVP4IEFE24A33703
PLATE NO. COLOR MOTOR NO. MV FILE NO.
MVY556 GREEN TD27315259 130800000341411
THIRD PARTY LIABILITY / PASSENGER LIABILITY LIMIT OF LIABILITY 100,000 PER ACCIDENT
(Subject to the Schedule Of Indemnities shown in the Master Policy) PREMIUMS
This Confirmation of Cover is evidence of the policy of insurance required under
insurance required under chapter VI - Compulsory Motor Vehicle Liability Insurance PREMIUM 880.00
of the Insurance Code amended by Presidential Decree No. 1814 PREMIUM TAX 105.60
DST 110.00
LGT 4.40
TOTAL 1,100.00
RMA 230
John B. Echauz Annabelle C. Obed AUTHENTICATION FEE 50.40
Rev. 3-2
President Manager/Branch Head
11/18/2016
TOTAL AMOUNT DUE 1,150.40