CHARTER PING AN INSURANCE CORPORATION 11/12/2019 7.

33 AM

Under the Trade Name of AXA Philippines, Philippine AXA and AXA October 31 2019
29th Floor GT Tower International, 6813 Ayala Ave. cor. H.V. Dela Costa St., Makati City 1227 Philippines
P.O. Box 1893 MCPO 1258 Makati City · VAT Reg. TIN 000-487-306-0000
Customer Care Hotline +63 2 85815 292 · customer.service@axa.com.ph · www.axa.com.ph

STATEMENT OF ACCOUNT

Name : JUNIO, ABIGAIL AGUAS - 10799 / 111G34-O Term : 90D

BLK 29 LOT 2, SHERWOOD ST., CHESTER PLACE,

DASMARIÑAS

Term of Insurance Policy No. Assured Bill No. Amount Due (Gross)
08-30-2019 / 08-30-2020 MC-MPC-CV-18-0000711-01 JUANITO REDUBLO ESGUERRA CV-34521-1 PHP 11,096.47

Total CURRENT PHP 11,096.47

10-25-2018 / 10-25-2019 MC-MPC-CV-18-0000848-00 GLADYS ASELA D. ZAMORA CV-28580-1 PHP 11,863.72

Total OVER 90 DAYS PHP 11,863.72

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 Total Amount Due PHP 22,960.19

PAST DUE
SUMMARY CURRENT 1-30 DAYS 31-60 DAYS 61-90 DAYS OVER 90 DAYS TOTAL

11,096.47 0.00 0.00 0.00 11,863.72 22,960.19

Kindly make payments on or before the due date to avoid cancellation of policy.

Note: 1. Please examine this statement immediately. If no discrepancy is reported within 14 days from this statement date, the contents of this
statement will be considered correct.
2. We reserve the right to cancel policies still unpaid beyond the given credit term.
3. The corresponging documentary stamps for cancelled policies due to unpaid premiums shall be charged to the insured/agent/broker.
4. If any payment has been made, please provide us copy of official receipt and its pertinent details for verification
For any inquiry on this statement, please get in touch with NIKKI RAMOS or LORIE MANANSALA of our Collection Department at Telephone No. (046) 424-2479; (046) 424-
2480 or email us at veronica.ramos@axa.com.ph or loreta.manansala@axa.com.ph

Conforme:

Signature over printed name and date

This is a computer-generated form and does not require any signature if it has been issued without any alteration.
Permit No.: 1703_0125_PTU_CBA_000077Date of Issue: March 7, 2017

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