Client's Copy

RENEWAL SCHEDULE
To : : PATRICK HASCOET Policy Number : DU-PCV-400703317

Issue Date : 07/09/2019

Address : THALATTA RESORT, MALUAY
ZAMBOANGUITA Client Number : 40260667
Agent Number : 40000263
Negros Or
Referral Number :
6218
Ext./Prev. Policy Number :
Insured : PATRICK HASCOET From : July 15, 2019 , 12:00 PM
To : July 15, 2020 , 12:00 PM
Business : Renewal Days : 366

SUMMARY OF PREMIUM AND OTHER CHARGES

PREMIUM ................... PHP 14,195.40 COC VF ................... PHP 0.00
Value Added Tax ................... PHP 1,703.45 ................... PHP
Roadside Assistance Fee 100.00
Documentary Stamp Tax ................... PHP 1,774.43
Local Government tax ................... PHP 70.98
AMOUNT DUE ................... PHP 17,844.26
COVERAGE/S SUM INSURED PREMIUM
OWN DAMAGE / THEFT 712,800.00 10,692.00
ACTS OF NATURE 712,800.00 2,138.40
PERSONAL ACCIDENT 250,000.00 0.00
EXCESS BODILY INJURY 100,000.00 270.00
THIRD PARTY PROPERTY DAMAGE 100,000.00 1,095.00

DETAILS OF INSURANCE
Make Model : MITSUBISHI STRADA GLX-V 2WD 2.5 A/T
Plate No. : ABN3584 MV File No. : 070100000185976
Deductible : PHP 3,564
Model Year : 2015 Towing Limit PHP 100
Motor/Engine No.: 4D56UAA8686 AR Limit : PHP 3,664
Serial/Chassis : MMBJYKK30FH002317 Assignee : PATRICK HASCOET
Color : -
COC / Auth No. : Mortgagee :
RAP Number : SICIBRN402986

Warranties and Clauses LOSS OR DAMAGE, IF ANY, IS PAYABLE TO

DEDUCTIBLE CLAUSE DRUNKEN DRIVER CLAUSE
TERRORISM EXCLUSION CLAUSE IMPORTATION CLAUSE AS THEIR INTEREST MAY APPEAR, SUBJECT TO THE TERMS
DATE RECOGNITION CLAUSE PAIR & SET CLAUSE AND CONDITIONS, CLAUSES AND WARRANTIES OF THIS
PAI FOR UNAMED DRIVER/OCCUPANTS EMERGENCY PROTECT POLICY. IT IS HEREBY EXPRESSLY UNDERSTOOD THAT THIS
MOTOR VEHICLE ACCESSORY ENDORSEMENT OR ANY RENEWAL THEREOF SHALL NOT BE CANCELLED
Accessories Declared WITHOUT PRIOR WRITTEN NOTIFICATION TO AND
BUILT-IN, STEPBOARD, & TINT CONFORMITY OF

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.

John B. Echauz Flordeliz Temblor-Olivar

President Manager/Branch Head

ALAGASI Original Copy

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.
 Client's Copy

PREMIUM PAYMENT GUIDE

Dear Valued Customer,

Thank you for choosing Standard Insurance as your insurance provider.

We would like to remind you to pay your premium immediately to ensure that your policy is in-force. For your reference,
provided below are the details of your policy.

Policy Number DU-PCV-400703317 Summary of Premium Charges & Other Charges

Client Name PATRICK HASCOET Premium 14,195.40
VAT 1,703.45
Coverage Period July 15, 2019 - July 15, 2020 Documentary Stamp 1,774.43
Local Gov't Tax 70.98
Others 100.00
TOTAL AMOUNT DUE 17,844.26

PREMIUM PAYMENT FACILITIES

1. Over the counter - Pay through any BPI, BDO, Maybank branch, any participating Bayad Center. For check payment, please
make check payable to Standard Insurance Co., Inc.
2. Branch Payment - Pay at any Standard Insurance Branches nationwide. For list of branches, visit www.standard-insurance.com

3. Credit Card (Visa or Mastercard) - Call your Standard Insurance servicing branch to request for credit card payment link or call
(02) 8451111.
4.Online Payment - For BPI account holders, log in at www.bpiexpressonline.com and choose BPI Payment.

5.Check Payment - Make the check payable to Standard Insurance Co., Inc. Please write the policyholder’s name and policy number
at the back of the check

Important Note:
Under section 77 of the Insurance Code as amended, no policy is valid and binding unless and until the premium has been paid.

This is a system-generated form

Attached to and forming part of SICI Policy Number : DU-PCV-400703317

FREE PA RIDER OF Ps. 50K EACH FOR 1 UNNAMED DRIVER UP TO SEATING CAPACITY.
FREE UPA OF Ps. 100K TO NAME INSURED NOT MORE THAN 65 YEARS OLD (Death /Disablement Only).
FREE AMBULANCE SERVICE
Attached to and forming part of SICI Policy Number : DU-PCV-400703317

EMERGENCY PROTECT

FREE EMERGENCY PROTECT COVER

The Emergency Protect Program provides benefits for ambulance assistance including payment of actual ambulance
costs, emergency medical evacuation and emergency medical repatriation arising out of death, illness or accident
It is a condition of cover that the Insured Vehicle is maintained in a mechanically sound condition by the dealer
Individual Comprehensive Private Motor Car policyholders have been automatically registered for FREE under

the Emergency Protect Program of Standard Insurance.You may register an additional four (4) beneficiaries for FREE
by logging on to our website
www.standard-insurance.com/emergencyprotect.

Corporate Comprehensive Private Motor Car policyholders will need to register in

www.standard-insurance.com/emergencyprotect.
An additional four (4) beneficiaries may be registered for FREE per policyholder.

For more details regarding the Emergency Protect Program benefits and Terms and Conditions:
please visit http://bit.ly/29g0jAe.