STERLING INSURANCE COMPANY, INC. IF Zeta ll Annex Bldg.. 191 Salcedo Street, Legaspi Vilage. Makati Cty ‘Trunk Lines: 759-2920 | 759-2921 / 759-3082 / 892-3792 / 893-0025 / 893-0026 ‘Emad. insure@stering-insurance com ph /info@sterling insurance com ph Fax Nos. 892-3784 / 759-2886 / 759-2399 TIN: 001-009-167-000, ENC NO: 692-20 CERTIFICATE OF NO CLAIM This is to certify that with Postal address at insured with us under Policy / COC No, cree, ONLY) from covering motor vehicle described as follows Make and Type Plate No. Motor No Chassis No. Fite No. We further certify that no claim has been filed against us, in relation / connection of vehicular accident that occurred on 2 The aforementioned assured, by asking for this certification of no claim has waived his/her right to whatever claim he/she may has under the aforecited policy for damages arising from the said motor accident. This certification is issued upon request of the assured for purpose of filing a third party damages claim Issued on. Prepaged by: Noted by: RHOZZVONNE MENDOZA Brangh Staff