Standard Insurance Head Office Claims

31/F Petron Megaplaza Bldg., Sen. Gil Puyat

Avenue Makati City
Trunk Line: (+632) 988-6388

LOA No. : 5000682143

LETTER OF AUTHORITY Claim No. : 2000456276
Branch LOA Trans No. : SI00000049027
SICI TTC (TECHNICAL TRAINING CENTER) Date & Time Issued : Dec. 07, 2021 02:36:38 PM
GOVERNOR'S DRIVE, BRGY. SABANG NAIC, CAVITE

CLAIM DETAILS
ASSURED ORIX RENTAL CORPORATION
THIRD PARTY
VEHICLE 2015 TOYOTA WIGO EMT
PLATE NO. ABR-1592 MOTOR NO. 1KR-A181021 SERIAL NO. MHKA4DE2F0J002148
POLICY NO. SI-PMF-500546059 EXTERNAL POLICY AGENT NAME TEAM 2 DIRECT PC..
DATE OF LOSS/ES NOV. 26, 2021

Gentlemen :
This authorizes you to proceed with the repair of the subject vehicle in accordance with the following approved repair valuation :
Approved Gross Repair Cost : Ps 28,114.80
less : Assured's Participation
****Policy Deductible : 8,000.00
****Depreciation / Betterment : 0.00
Company's Net Liability : Ps 20,114.80
**** To be collected by SICI TTC (TECHNICAL TRAINING CENTER) from the owner
/ representative upon completion of repair

This LOA is VALID for 30 days from the date of issuance. Repairs commencing after the 30-day validity period shall require
RE-VALIDATION of this LOA.

If the claimant failed to bring the vehicle to the above repair shop within the 30-day validity period, any price
increase/adjustment costs on part and/or labor included in this LOA's scope of repair shall be borne by the claimant.

If repair has been started within the 30-day validity period, any additional part/s for replacement, price and labor adjustment
or any changes to the scope of repair, prior approval of Standard Insurance is required. The Company's full and final liability
shall, however, be subject to validation upon completion of repairs.

Coordinate with the undersigned on the surrender of parts and/or replaced or remaining/excess parts of sets indicated in the attached
RVR/s, and wait/ask for Acknowledgement Receipt of Surrendered Parts (TD 116 form) duly accomplished and signed by our
Technical personnel.

Evaluated by : HERBERT V. VELASCO C#2000456276 R#4000951333 L#5000682143

Approved by : RODERICK L. BENIPAYO DTP12072021 18:23:25PM
System Generated. No Signature Required
Notes : NEW
--
TO BE ACCOMPLISHED BY WORKSHOP/REPAIRER'S AUTHORIZED PERSONNEL
Send an SMS to us when you RECEIVE (UNIT-IN) the subject unit :
Text UNT <space> SI683159 <space> [MM-DD-YYYY] <space> [your Job Order No. * ] <space> [Representative_name]
Send to 21584093 for Globe/TM and 225654093 for Smart/TNT/Sun
* if no J.O. has been created yet, just indicate NIL
** no need to send an update if you have previously sent one
Send an SMS to us for the update of the subject unit's repair status:
Text VRS <space> SI683159 <space> [your Job Order No.] <space> [repair_status_%*** ] <space> [est_days_repair *** ]
<space> [Representative_name]
Send to 21584093 for Globe/TM and 225654093 for Smart/TNT/Sun
*** repair status percentage from[0, 10, 25, 50, 75, 100]
**** estimated days of repair, just indicate NIL if not sure
- Sending information about the vehicle status will help us monitor, track and act immediately on our LOA claim payables.
- SMS is free of charge.

Standard Insurance Document Checklist for processing of payments:

Invoice Nos: Workshop Name: SICI TTC (TECHNICAL TRAIN..
Total Amt. of Invoices for this Claim only: Contact Person & Signature :
Duly Signed Release of Claim Contact Number:
Duly Signed Affidavit of Desistance (for Third Party Claim): Email Address:
Valid ID (please identify): Notes to Insurer (if any):
Valid Authorization / Undertaking for the Release of
Vehicle with ID (if representative)
TD 116 Form (Acknowledgement Receipt of Surrendered Parts)

Together with the accomplished portion above and the complete documentation will expedite the review and processing of the payment of your invoice.

Standard Insurance Head Office Claims 31/F Petron Megaplaza Bldg. Sen Gil Puyat Ave Makati City. (02)988-6388
 Standard Insurance Head Office Claims
31/F Petron Megaplaza Bldg., Sen. Gil Puyat
Avenue Makati City
Trunk Line: (+632) 988-6388

Repair Valuation Report RVR Date: Dec. 07, 2021

ASSURED ORIX RENTAL CORPORATION

THIRD PARTY
POLICY NO. SI-PMF-500546059 EXTERNAL POLICY:
AGENT NAME TEAM 2 DIRECT PC

Referral No. RVR No. Requested By

4000951333 4000951333-RI-1-G HERBERT V. VELASCO
Inspected at Date & Time Inspected Inspected by
UNIT IN TTC Dec. 06, 2021 11:32 AM CDM
KMR: NP FMV: Stencils: Motor [No] Serial [No]
Vehicle Plate No Motor No. Serial No.
2015 TOYOTA WIGO EMT ABR-1592 1KR-A181021 MHKA4DE2F0J002148

ACCIDENT - G
PARTS TO BE REPLACED: TYPE AMOUNT

SCOPE OF WORKS: AMOUNT

DISMANTLE ALL NECESSARY PARTS TO GIVE WAY FOR REPAIRS AND

1,500.00
RE-INSTALLATION :

REPAINT, RUBDOWN & SIMONIZED REPARED AREAS :

Rh rear door panel 2,100.00
Rh quarter panel 2,400.00
Color: White

ELECTRICAL WORKS :
Remove & install :
Rh tail lamp assy 150.00
to give way for repair
Fix and secure electrical wiring connections.

NOTES :
No clear info gathered.
Please refer to previous RVR 4000949949 for your reference.
***** FIVE STAR SHOP LABOR RATES USED *****

ESTIMATED REPAIR SUMMARY

Total Parts
Tinsmith Labor 1,500.00
Painting Labor 4,500.00
Mechanical Works
Glassman Works
Upholstery Works
Aircon Works
Outside Works
Reprocessing
Electrical Works 150.00
Shop Materials 3,825.00
R-VAT 1,197.00
Total Cost of Repair 11,172.00
 Standard Insurance Head Office Claims
31/F Petron Megaplaza Bldg., Sen. Gil Puyat
Avenue Makati City
Trunk Line: (+632) 988-6388

Repair Valuation Report RVR Date: Dec. 07, 2021

ASSURED ORIX RENTAL CORPORATION

THIRD PARTY
POLICY NO. SI-PMF-500546059 EXTERNAL POLICY:
AGENT NAME TEAM 2 DIRECT PC

Referral No. RVR No. Requested By

4000951333 4000951333-RI-1-H HERBERT V. VELASCO
Inspected at Date & Time Inspected Inspected by
UNIT IN TTC Dec. 06, 2021 11:32 AM CDM
KMR: NP FMV: Stencils: Motor [No] Serial [No]
Vehicle Plate No Motor No. Serial No.
2015 TOYOTA WIGO EMT ABR-1592 1KR-A181021 MHKA4DE2F0J002148

ACCIDENT - H
PARTS TO BE REPLACED: TYPE AMOUNT

SCOPE OF WORKS: AMOUNT

DISMANTLE ALL NECESSARY PARTS TO GIVE WAY FOR REPAIRS AND

1,200.00
RE-INSTALLATION :

REPAINT, RUBDOWN & SIMONIZED REPARED AREAS :

Lh running board panel 1,650.00
Color: White

NOTES :
No clear info gathered.
Please refer to accident G for your reference.
***** FIVE STAR SHOP LABOR RATES USED *****

ESTIMATED REPAIR SUMMARY

Total Parts
Tinsmith Labor 1,200.00
Painting Labor 1,650.00
Mechanical Works
Glassman Works
Upholstery Works
Aircon Works
Outside Works
Reprocessing
Electrical Works
Shop Materials 1,402.50
R-VAT 510.30
Total Cost of Repair 4,762.80
 Standard Insurance Head Office Claims
31/F Petron Megaplaza Bldg., Sen. Gil Puyat
Avenue Makati City
Trunk Line: (+632) 988-6388

Repair Valuation Report RVR Date: Dec. 07, 2021

ASSURED ORIX RENTAL CORPORATION

THIRD PARTY
POLICY NO. SI-PMF-500546059 EXTERNAL POLICY:
AGENT NAME TEAM 2 DIRECT PC

Referral No. RVR No. Requested By

4000951333 4000951333-RI-1-I HERBERT V. VELASCO
Inspected at Date & Time Inspected Inspected by
UNIT IN TTC Dec. 06, 2021 11:32 AM CDM
KMR: NP FMV: Stencils: Motor [No] Serial [No]
Vehicle Plate No Motor No. Serial No.
2015 TOYOTA WIGO EMT ABR-1592 1KR-A181021 MHKA4DE2F0J002148

ACCIDENT - I
PARTS TO BE REPLACED: TYPE AMOUNT

SCOPE OF WORKS: AMOUNT

DISMANTLE ALL NECESSARY PARTS TO GIVE WAY FOR REPAIRS AND

1,200.00
RE-INSTALLATION :

REPAINT, RUBDOWN & SIMONIZED REPARED AREAS :

Lh rear door panel 2,100.00
Color: White

NOTES :
No clear info gathered.
Please refer to accident G for your reference.
***** FIVE STAR SHOP LABOR RATES USED *****

ESTIMATED REPAIR SUMMARY

Total Parts
Tinsmith Labor 1,200.00
Painting Labor 2,100.00
Mechanical Works
Glassman Works
Upholstery Works
Aircon Works
Outside Works
Reprocessing
Electrical Works
Shop Materials 1,785.00
R-VAT 610.20
Total Cost of Repair 5,695.20
 Standard Insurance Head Office Claims
31/F Petron Megaplaza Bldg., Sen. Gil Puyat
Avenue Makati City
Trunk Line: (+632) 988-6388

Repair Valuation Report RVR Date: Dec. 07, 2021

ASSURED ORIX RENTAL CORPORATION

THIRD PARTY
POLICY NO. SI-PMF-500546059 EXTERNAL POLICY:
AGENT NAME TEAM 2 DIRECT PC

Referral No. RVR No. Requested By

4000951333 4000951333-RI-1-J HERBERT V. VELASCO
Inspected at Date & Time Inspected Inspected by
UNIT IN TTC Dec. 06, 2021 11:32 AM CDM
KMR: NP FMV: Stencils: Motor [No] Serial [No]
Vehicle Plate No Motor No. Serial No.
2015 TOYOTA WIGO EMT ABR-1592 1KR-A181021 MHKA4DE2F0J002148

ACCIDENT - J
PARTS TO BE REPLACED: TYPE AMOUNT

SCOPE OF WORKS: AMOUNT

DISMANTLE ALL NECESSARY PARTS TO GIVE WAY FOR REPAIRS AND

1,200.00
RE-INSTALLATION :

REPAINT, RUBDOWN & SIMONIZED REPARED AREAS :

Lh quarter panel 2,400.00
Color: White

ELECTRICAL WORKS :
Remove & install :
Lh tail lamp assy 150.00
to give way for repair
Fix and secure electrical wiring connections.

NOTES :
No clear info gathered.
Please refer to accident G for your reference.
***** FIVE STAR SHOP LABOR RATES USED *****

ESTIMATED REPAIR SUMMARY

Total Parts
Tinsmith Labor 1,200.00
Painting Labor 2,400.00
Mechanical Works
Glassman Works
Upholstery Works
Aircon Works
Outside Works
Reprocessing
Electrical Works 150.00
Shop Materials 2,040.00
R-VAT 694.80
Total Cost of Repair 6,484.80