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13. G.R. No.

L-16215 June 29, 1963


Section 5. Injury sustained by a stroke of lightning or by a cyclone. . . . . . . .
SIMEON DEL ROSARIO, plaintiff-appellee, P3,000.00
vs.
THE EQUITABLE INSURANCE AND CASUALTY CO., INC., defendant-appellant. xxx xxx xxx

Vicente J. Francisco and Jose R. Francisco for plaintiff-appellee. Part VI. Exceptions
K. V. Faylona for defendant-appellant.
This policy shall not cover disappearance of the Insured nor shall it cover
PAREDES, J.: Death, Disability, Hospital fees, or Loss of Time, caused to the insured:

On February 7, 1957, the defendant Equitable Insurance and Casualty Co., . . . (h) By drowning except as a consequence of the wrecking or
Inc., issued Personal Accident Policy No. 7136 on the life of Francisco del disablement in the Philippine waters of a passenger steam or motor vessel
Rosario, alias Paquito Bolero, son of herein plaintiff-appellee, binding itself in which the Insured is travelling as a farepaying passenger; . . . .
to pay the sum of P1,000.00 to P3,000.00, as indemnity for the death of the
insured. The pertinent provisions of the Policy, recite: A rider to the Policy contained the following:

Part I. Indemnity For Death IV. DROWNING

If the insured sustains any bodily injury which is effected solely through It is hereby declared and agreed that exemption clause Letter (h)
violent, external, visible and accidental means, and which shall result, embodied in PART VI of the policy is hereby waived by the company, and
independently of all other causes and within sixty (60) days from the to form a part of the provision covered by the policy.
occurrence thereof, in the Death of the Insured, the Company shall pay the
amount set opposite such injury: On February 24, 1957, the insured Francisco del Rosario, alias Paquito
Bolero, while on board the motor launch "ISLAMA" together with 33 others,
Section 1. Injury sustained other than those specified below unless including his beneficiary in the Policy, Remedios Jayme, were forced to
excepted hereinafter. . . . . . . . jump off said launch on account of fire which broke out on said vessel,
P1,000.00 resulting in the death of drowning, of the insured and beneficiary in the
waters of Jolo. 1äwphï1.ñët
Section 2. Injury sustained by the wrecking or disablement of a railroad
passenger car or street railway car in or on which the Insured is travelling as On April 13, 1957, Simeon del Rosario, father of the insured, and as the sole
a farepaying passenger. . . . . . . . heir, filed a claim for payment with defendant company, and on
P1,500.00 September 13, 1957, defendant company paid to him (plaintiff) the sum of
P1,000.00, pursuant to Section 1 of Part I of the policy. The receipt signed by
Section 3. Injury sustained by the burning of a church, theatre, public library plaintiff reads —
or municipal administration building while the Insured is therein at the
commencement of the fire. . . . . . . . RECEIVED of the EQUITABLE INSURANCE & CASUALTY CO., INC., the sum
P2,000.00 of PESOS — ONE THOUSAND (P1,000.00) Philippine Currency, being
settlement in full for all claims and demands against said Company as a
Section 4. Injury sustained by the wrecking or disablement of a regular result of an accident which occurred on February 26, 1957, insured under
passenger elevator car in which the Insured is being conveyed as a out ACCIDENT Policy No. 7136, causing the death of the Assured.
passenger (Elevator in mines excluded) P2,500.00
In view of the foregoing, this policy is hereby surrendered and On September 1, 1958, the trial court promulgated an Amended Decision,
CANCELLED. the pertinent portions of which read —

LOSS COMPUTATION xxx xxx xxx

Amount of Insurance P1,000.00 Since the contemporaneous and subsequent acts of the parties show that
__________ it was not their intention that the payment of P1,000.00 to the plaintiff and
vvvvv the signing of the loss receipt exhibit "1" would be considered as releasing
the defendant completely from its liability on the policy in question, said
On the same date (September 13, 1957), Atty. Vicente J. Francisco, wrote intention of the parties should prevail over the contents of the loss receipt
defendant company acknowledging receipt by his client (plaintiff herein), "1" (Articles 1370 and 1371, New Civil Code).
of the P1,000.00, but informing said company that said amount was not the
correct one. Atty. Francisco claimed — ". . . . Under the terms of this policy, defendant company agreed to pay
P1,000.00 to P3,000.00 as indemnity for the death of the insured. The insured
The amount payable under the policy, I believe should be P1,500.00 under died of drowning. Death by drowning is covered by the policy the pertinent
the provision of Section 2, part 1 of the policy, based on the rule of pari provisions of which reads as follows:
materia as the death of the insured occurred under the circumstances
similar to that provided under the aforecited section. xxx xxx xxx

Defendant company, upon receipt of the letter, referred the matter to the "Part I of the policy fixes specific amounts as indemnities in case of death
Insurance Commissioner, who rendered an opinion that the liability of the resulting from "bodily injury which is effected solely thru violence, external,
company was only P1,000.00, pursuant to Section 1, Part I of the Provisions visible and accidental means" but, Part I of the Policy is not applicable in
of the policy (Exh. F, or 3). Because of the above opinion, defendant case of death by drowning because death by drowning is not one resulting
insurance company refused to pay more than P1,000.00. In the meantime, from "bodily injury which is affected solely thru violent, external, visible and
Atty. Vicente Francisco, in a subsequent letter to the insurance company, accidental means" as "Bodily Injury" means a cut, a bruise, or a wound and
asked for P3,000.00 which the Company refused, to pay. Hence, a drowning is death due to suffocation and not to any cut, bruise or wound."
complaint for the recovery of the balance of P2,000.00 more was instituted
with the Court of First Instance of Rizal (Pasay City, Branch VII), praying for it xxx xxx xxx
further sum of P10,000.00 as attorney's fees, expenses of litigation and costs.
Besides, on the face of the policy Exhibit "A" itself, death by drowning is a
Defendant Insurance Company presented a Motion to Dismiss, alleging ground for recovery apart from the bodily injury because death by bodily
that the demand or claim is set forth in the complaint had already been injury is covered by Part I of the policy while death by drowning is covered
released, plaintiff having received the full amount due as appearing in by Part VI thereof. But while the policy mentions specific amounts that may
policy and as per opinion of the Insurance Commissioner. An opposition to be recovered for death for bodily injury, yet, there is not specific amount
the motion to dismiss, was presented by plaintiff, and other pleadings were mentioned in the policy for death thru drowning although the latter is,
subsequently file by the parties. On December 28, 1957, the trial court under Part VI of the policy, a ground for recovery thereunder. Since the
deferred action on the motion to dismiss until termination of the trial of the defendant has bound itself to pay P1000.00 to P3,000.00 as indemnity for
case, it appearing that the ground thereof was not indubitable. In the the death of the insured but the policy does not positively state any definite
Answer to the complaint, defendant company practically admitted all the amount that may be recovered in case of death by drowning, there is an
allegations therein, denying only those which stated that under the policy ambiguity in this respect in the policy, which ambiguity must be interpreted
its liability was P3,000.00. in favor of the insured and strictly against the insurer so as to allow greater
indemnity.
contract is selected with great care and deliberation by expert and legal
xxx xxx xxx advisers employed by, and acting exclusively in the interest of, the
insurance company" (44 C.J.S. 1174). Calanoc v. Court of Appeals, et al.,
. . . plaintiff is therefore entitled to recover P3,000.00. The defendant had G.R. No. L-8151, Dec. 16, 1955.
already paid the amount of P1,000.00 to the plaintiff so that there still
remains a balance of P2,000.00 of the amount to which plaintiff is entitled . . . . Where two interpretations, equally fair, of languages used in an
to recover under the policy Exhibit "A". insurance policy may be made, that which allows the greater indemnity will
prevail. (L'Engel v. Scotish Union & Nat. F. Ins. Co., 48 Fla. 82, 37 So. 462, 67
The plaintiff asks for an award of P10,000.00 as attorney's fees and expenses LRA 581 111 Am. St. Rep. 70, 5 Ann. Cas. 749).
of litigation. However, since it is evident that the defendant had not acted
in bad faith in refusing to pay plaintiff's claim, the Court cannot award At any event, the policy under consideration, covers death or disability by
plaintiff's claim for attorney's fees and expenses of litigation. accidental means, and the appellant insurance company agreed to pay
P1,000.00 to P3,000.00. is indemnity for death of the insured.
IN VIEW OF THE FOREGOING, the Court hereby reconsiders and sets aside its
decision dated July 21, 1958 and hereby renders judgment, ordering the In view of the conclusions reached, it would seem unnecessary to discuss
defendant to pay plaintiff the sum of Two Thousand (P2,000.00) Pesos and the other issues raised in the appeal.
to pay the costs.
The judgment appealed from is hereby affirmed. Without costs.
The above judgment was appealed to the Court of Appeals on three (3)
counts. Said Court, in a Resolution dated September 29, 1959, elevated the Padilla, Bautista Angelo, Labrador, Concepcion, Reyes, J.B.L., Barrera, Dizon
case to this Court, stating that the genuine issue is purely legal in nature. and Regala, JJ., concur.
Makalintal, J., reserves his vote.
All the parties agree that indemnity has to be paid. The conflict centers on G.R. No. L-21380 May 20, 1966
how much should the indemnity be. We believe that under the proven
facts and circumstances, the findings and conclusions of the trial court, are MISAMIS LUMBER CORPORATION, plaintiff and appellee,
well taken, for they are supported by the generally accepted principles or vs.
rulings on insurance, which enunciate that where there is an ambiguity with CAPITAL INSURANCE and SURETY CO., INC., defendant and appellant.
respect to the terms and conditions of the policy, the same will be resolved
against the one responsible thereof. It should be recalled in this connection, Achacoso, Nera and Ocampo for defendant and appellant.
that generally, the insured, has little, if any, participation in the preparation F. Capistrano, Jr. for plaintiff and appellee.
of the policy, together with the drafting of its terms and Conditions. The
interpretation of obscure stipulations in a contract should not favor the REYES, J.B.L., J.:
party who cause the obscurity (Art. 1377, N.C.C.), which, in the case at bar,
is the insurance company. Plaintiff-appellee Misamis Lumber Corporation, under its former name,
Lanao Timber Mills, Inc., insured its Ford Falcon motor car for the amount of
. . . . And so it has been generally held that the "terms in an insurance P14,000 with the defendant-appellant, Capital Insurance & Surety
policy, which are ambiguous, equivocal or uncertain . . . are to be Company, Inc. The pertinent provisions of the policy provided, as follows:
construed strictly against, the insurer, and liberally in favor of the insured so
as to effect the dominant purpose of indemnity or payment to the insured, 1. The Company will subject to the Limits of Liability indemnify the Insured
especially where a forfeiture is involved," (29 Am. Jur. 181) and the reason against loss or damage to the Motor Vehicle and its accessories and spare
for this rule is that the "insured usually has no voice in the selection or parts whilst thereon.
arrangement of the words employed and that the language of the
2. (a) by accidental collision or overturning or collision or overturning
consequent when mechanical breakdown or consequent upon wear and Since the defendant-appellant refused to pay for the total cost of to wage
tear. and repairs, suit was filed in the municipal court originally.

xxx xxx xxx The case before Us is now a direct appeal on a point of law from the
judgment of the Court of First Instance of Manila finding for the plaintiff and
3. At its option, the Company may pay in cash the amount of the loss or against the defendant-insurer in its Civil Case No. 51757. Per our resolution
damage or may repair, reinstate or replace the Motor Vehicle or any part on 13 February 1964, it was resolved to proceed with the case without the
thereof or its accessories or spare parts. The liability of the Company shall appellee's brief, which was filed late.
not exceed the value of the parts lost or damaged and the reasonable
cost of fitting such parts or the value of the Motor Vehicle at the time of the The defendant-appellant admits liability in the amount of P150, but not for
loss or damage whichever is the loss. The Insured's estimate of value stated any excess thereof.
in the schedule shall be the maximum amount payable by the Company in
respect of any claim for loss or damage.1äwphï1.ñët The lower court did not exonerate the said appellant for the excess
because, according to it, the company's absolution would render the
xxx xxx xxx insurance contract one-sided and that the said insurer had not shown that
the cost of repairs in the sum of P302.27 is unreasonable, excessive or
4. The Insured may authorize the repair of the Motor Vehicle necessitated padded, nor had it shown that it could have undertaken the repairs itself at
by damage for which the Company may be liable under this policy less expense.
provided that:
The above reasoning is beside the point, because the insurance policy
(a) the estimated cost of such repair does not exceed the authorized stipulated in paragraph 4 that if the insured authorizes the repair the liability
Repair Limit. of the insurer, per its sub-paragraph (a), is limited to P150.00. The literal
meaning of this stipulation must control, it being the actual contract,
(b) a detailed estimate of the cost is forwarded to the Company without expressly and plainly provided for in the policy (Art. 1370, Civil Code; Young
delay. vs. Midland Textile Ins. Co., 30 Phil. 617; Ty vs. First Nat. Surety & Assur. Co.,
Inc., L-16138-45, 29 April 1961).
and providing also that the authorized repair limit is P150.00.
The lower court's recourse to legal hermeneutics is not called for because
At around eleven o'clock in the evening of 25 November 1961, and while paragraph 4 of the policy is clear and specific and leaves no room for
the above-mentioned insurance policy was in force, the insured car, while interpretation. The interpretation given is even unjustified because it
traveling along in Aurora Boulevard in front of the Pepsi-Cola plant in opposes what was specifically stipulated. Thus, it will be observed that the
Quezon City, passed over a water hole which the driver did not see policy drew out not only the limits of the insurer's liability but also the
because an oncoming car did not dim its light. The crankcase and flywheel mechanics that the insured had to follow to be entitled to full indemnity of
housing of the car broke when it hit a hollow block lying alongside the repairs. The option to undertake the repairs is accorded to the insurance
water hole. At the instance of the plaintiff-appellee, the car was towed company per paragraph 2. The said company was deprived of the option
and repaired by Morosi Motors at its shop at 1906 Taft Avenue Extension at because the insured took it upon itself to have the repairs made, and only
a total cost of P302.27. notified the insurer when the repairs were done. As a consequence,
paragraph 4, which limits the company's liability to P150.00, applies.
On 29 November 1961, when the repairs on the car had already been
made, the plaintiff-appellee made a report of the accident to the The insurance contract may be rather onerous ("one-sided", as the lower
defendant-appellant Capital Insurance & Surety Company. court put it), but that in itself does not justify the abrogation of its express
terms, terms which the insured accepted or adhered to and which is the
law between the contracting parties.

Finally, to require the insurer to prove that the cost of the repairs ordered by
the insured is unreasonable, as the appealed decision does, when the
insurer was not given an opportunity to inspect and assess the damage
before the repairs were made, strikes Us as contrary to elementary justice
and equity.

For the foregoing reasons, the appealed decision is hereby modified by


ordering the defendant-appellant Capital Insurance & Surety Company,
Inc. to pay not more than P150.00 to the plaintiff-appellee Misamis Lumber
Corporation. Each party shall bear its own costs and attorney's fees.

Bengzon, C.J., Bautista Angelo, Concepcion, Barrera, Dizon, Regala,


Makalintal, Bengzon, J.P., and Sanchez, JJ., concur.
Zaldivar, J., took no part.
14. G.R. No. 76452 July 26, 1994 sufficient in form and substance, and requested that a hearing thereon be
conducted.
PHILIPPINE AMERICAN LIFE INSURANCE COMPANY and RODRIGO DE LOS
REYES, petitioners, Petitioner De los Reyes, in his letter to respondent Commissioner dated June
vs. 6, 1986, reiterated his claim that private respondent's letter of May 16, 1986
HON. ARMANDO ANSALDO, in his capacity as Insurance Commissioner, did not supply the information he needed to enable him to answer the
and RAMON MONTILLA PATERNO, JR., respondents. letter-complaint.

Ponce Enrile, Cayetano, Reyes and Manalastas for petitioners. On July 14, a hearing on the letter-complaint was held by respondent
Commissioner on the validity of the Contract of Agency complained of by
Oscar Z. Benares for private respondent. private respondent.

QUIASON, J.: In said hearing, private respondent was required by respondent


Commissioner to specify the provisions of the agency contract which he
This is a petition for certiorari and prohibition under Rule 65 of the Revised claimed to be illegal.
Rules of Court, with preliminary injunction or temporary restraining order, to
annul and set aside the Order dated November 6, 1986 of the Insurance On August 4, private respondent submitted a letter of specification to
Commissioner and the entire proceedings taken in I.C. Special Case No. 1- respondent Commissioner dated July 31, 1986, reiterating his letter of April
86. 17, 1986 and praying that the provisions on charges and fees stated in the
Contract of Agency executed between Philamlife and its agents, as well as
We grant the petition. the implementing provisions as published in the agents' handbook, agency
bulletins and circulars, be declared as null and void. He also asked that the
The instant case arose from a letter-complaint of private respondent amounts of such charges and fees already deducted and collected by
Ramon M. Paterno, Jr. dated April 17, 1986, to respondent Commissioner, Philamlife in connection therewith be reimbursed to the agents, with
alleging certain problems encountered by agents, supervisors, managers interest at the prevailing rate reckoned from the date when they were
and public consumers of the Philippine American Life Insurance Company deducted.
(Philamlife) as a result of certain practices by said company.
Respondent Commissioner furnished petitioner De los Reyes with a copy of
In a letter dated April 23, 1986, respondent Commissioner requested private respondent's letter of July 31, 1986, and requested his answer
petitioner Rodrigo de los Reyes, in his capacity as Philamlife's president, to thereto.
comment on respondent Paterno's letter.
Petitioner De los Reyes submitted an Answer dated September 8, 1986,
In a letter dated April 29, 1986 to respondent Commissioner, petitioner De stating inter alia that:
los Reyes suggested that private respondent "submit some sort of a 'bill of
particulars' listing and citing actual cases, facts, dates, figures, provisions of (1) Private respondent's letter of August 11, 1986 does not contain any of
law, rules and regulations, and all other pertinent data which are necessary the particular information which Philamlife was seeking from him and which
to enable him to prepare an intelligent reply" (Rollo, p. 37). A copy of this he promised to submit.
letter was sent by the Insurance Commissioner to private respondent for his
comments thereon. (2) That since the Commission's quasi-judicial power was being invoked with
regard to the complaint, private respondent must file a verified formal
On May 16, 1986, respondent Commissioner received a letter from private complaint before any further proceedings.
respondent maintaining that his letter-complaint of April 17, 1986 was
In his letter dated September 9, 1986, private respondent asked for the session ruled as it is hereby ruled to deny the Motion to Quash
resumption of the hearings on his complaint. Subpoena/Notice for lack of merit (Rollo, p. 109).

On October 1, private respondent executed an affidavit, verifying his letters Hence, this petition.
of April 17, 1986, and July 31, 1986.
II
In a letter dated October 14, 1986, Manuel Ortega, Philamlife's Senior
Assistant Vice-President and Executive Assistant to the President, asked that The main issue to be resolved is whether or not the resolution of the legality
respondent Commission first rule on the questions of the jurisdiction of the of the Contract of Agency falls within the jurisdiction of the Insurance
Insurance Commissioner over the subject matter of the letters-complaint Commissioner.
and the legal standing of private respondent.
Private respondent contends that the Insurance Commissioner has
On October 27, respondent Commissioner notified both parties of the jurisdiction to take cognizance of the complaint in the exercise of its quasi-
hearing of the case on November 5, 1986. judicial powers. The Solicitor General, upholding the jurisdiction of the
Insurance Commissioner, claims that under Sections 414 and 415 of the
On November 3, Manuel Ortega filed a Motion to Quash Subpoena/Notice Insurance Code, the Commissioner has authority to nullify the alleged illegal
on the following grounds; provisions of the Contract of Agency.

1. The Subpoena/Notice has no legal basis and is premature because: III

(1) No complaint sufficient in form and contents has been filed; The general regulatory authority of the Insurance Commissioner is described
in Section 414 of the Insurance Code, to wit:
(2) No summons has been issued nor received by the respondent De los
Reyes, and hence, no jurisdiction has been acquired over his person; The Insurance Commissioner shall have the duty to see that all laws relating
to insurance, insurance companies and other insurance matters, mutual
(3) No answer has been filed, and hence, the hearing scheduled on benefit associations and trusts for charitable uses are faithfully executed
November 5, 1986 in the Subpoena/Notice, and wherein the respondent is and to perform the duties imposed upon him by this Code, . . .
required to appear, is premature and lacks legal basis.
On the other hand, Section 415 provides:
II. The Insurance Commission has no jurisdiction over;
In addition to the administrative sanctions provided elsewhere in this Code,
(1) the subject matter or nature of the action; and the Insurance Commissioner is hereby authorized, at his discretion, to
impose upon insurance companies, their directors and/or officers and/or
(2) over the parties involved (Rollo, p. 102). agents, for any willful failure or refusal to comply with, or violation of any
provision of this Code, or any order, instruction, regulation or ruling of the
In the Order dated November 6, 1986, respondent Commissioner denied Insurance Commissioner, or any commission of irregularities, and/or
the Motion to Quash. The dispositive portion of said Order reads: conducting business in an unsafe and unsound manner as may be
determined by the the Insurance Commissioner, the following:
NOW, THEREFORE, finding the position of complainant thru counsel tenable
and considering the fact that the instant case is an informal administrative (a) fines not in excess of five hundred pesos a day; and
litigation falling outside the operation of the aforecited memorandum
circular but cognizable by this Commission, the hearing officer, in open
(b) suspension, or after due hearing, removal of directors and/or officers A reading of the said section shows that the quasi-judicial power of the
and/or agents. Insurance Commissioner is limited by law "to claims and complaints
involving any loss, damage or liability for which an insurer may be
A plain reading of the above-quoted provisions show that the Insurance answerable under any kind of policy or contract of insurance, . . ." Hence,
Commissioner has the authority to regulate the business of insurance, which this power does not cover the relationship affecting the insurance
is defined as follows: company and its agents but is limited to adjudicating claims and
complaints filed by the insured against the insurance company.
(2) The term "doing an insurance business" or "transacting an insurance
business," within the meaning of this Code, shall include While the subject of Insurance Agents and Brokers is discussed under
(a) making or proposing to make, as insurer, any insurance contract; Chapter IV, Title I of the Insurance Code, the provisions of said Chapter
(b) making, or proposing to make, as surety, any contract of suretyship as a speak only of the licensing requirements and limitations imposed on
vocation and not as merely incidental to any other legitimate business or insurance agents and brokers.
activity of the surety; (c) doing any kind of business, including a reinsurance
business, specifically recognized as constituting the doing of an insurance The Insurance Code does not have provisions governing the relations
business within the meaning of this Code; (d) doing or proposing to do any between insurance companies and their agents. It follows that the
business in substance equivalent to any of the foregoing in a manner Insurance Commissioner cannot, in the exercise of its quasi-judicial powers,
designed to evade the provisions of this Code. (Insurance Code, Sec. 2[2]; assume jurisdiction over controversies between the insurance companies
Emphasis supplied). and their agents.

Since the contract of agency entered into between Philamlife and its We have held in the cases of Great Pacific Life Assurance Corporation v.
agents is not included within the meaning of an insurance business, Section Judico, 180 SCRA 445 (1989), and Investment Planning Corporation of the
2 of the Insurance Code cannot be invoked to give jurisdiction over the Philippines v. Social Security Commission, 21 SCRA 904 (1962), that an
same to the Insurance Commissioner. Expressio unius est exclusio alterius. insurance company may have two classes of agents who sell its insurance
policies: (1) salaried employees who keep definite hours and work under
With regard to private respondent's contention that the quasi-judicial the control and supervision of the company; and (2) registered
power of the Insurance Commissioner under Section 416 of the Insurance representatives, who work on commission basis.
Code applies in his case, we likewise rule in the negative. Section 416 of the
Code in pertinent part, provides: Under the first category, the relationship between the insurance company
and its agents is governed by the Contract of Employment and the
The Commissioner shall have the power to adjudicate claims and provisions of the Labor Code, while under the second category, the same is
complaints involving any loss, damage or liability for which an insurer may governed by the Contract of Agency and the provisions of the Civil Code
be answerable under any kind of policy or contract of insurance, or for on the Agency. Disputes involving the latter are cognizable by the regular
which such insurer may be liable under a contract of suretyship, or for courts.
which a reinsurer may be used under any contract or reinsurance it may
have entered into, or for which a mutual benefit association may be held WHEREFORE, the petition is GRANTED. The Order dated November 6, 1986 of
liable under the membership certificates it has issued to its members, where the Insurance Commission is SET ASIDE.
the amount of any such loss, damage or liability, excluding interest, costs
and attorney's fees, being claimed or sued upon any kind of insurance, SO ORDERED.
bond, reinsurance contract, or membership certificate does not exceed in
any single claim one hundred thousand pesos. Cruz, Davide, Jr. and Kapunan, JJ., concur.

Bellosillo, J,. is on leave.

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