Insurance Proposal

Motor Comprehensive Insurance

November 24, 2021

Policy Number Payment Reference Number
EXPIRY
LANDICHO, JENNY LYN CALILONG Expiry Date Sum Insured
230 BRGY MAUGAT 2/18/2022 Php 662,000.00
TANAUAN CITY Plate Number PN LOAN ACCT #: Mortgagee
BATANGAS B8H100 800200010159226 CBSI
Vehicle Type
2020 MITS MIRAGE G4 GLX 1.2G MT/ MAJESTIC RED/
LANDICHO JENNY LYN CALILONG`
Serial Motor Color
PAEA13MJLLA012980 3A92UJT6429 PLEASE
Dear Valued Client, ADVISED

This has reference to the insurance coverage of your mortgaged vehicle described above.

We wish to remind you that the insurance policy for the above-described unit will soon expire. Under your Promissory Note and
Chattel Mortgage, the said unit is to be continuously covered by a comprehensive insurance until the loan obligation is fully paid.

As the Bank’s subsidiary broker, we are tasked to assist you with your insurance needs should you require help on the renewal of
your insurance policy.

We are pleased to offer you the annual premium for your consideration.

PREMIUM COMPUTATION
COVERAGE LIMIT PREMIUM
Own Damage / Theft Php 662,000.00 Php 11,916.00
Bodily Injury 500,000.00 780.00
Property Damage 500,000.00 1,635.00
Passenger Accident 250,000.00 FREE
Acts of Nature 662,000.00 INCLUDED
Fixed Participation 2,000.00 -

Premium Before Taxes 14,331.00

Documentary Stamps Tax 1,791.38
EVAT 1,719.72
Local Gov’t Tax 28.66
Total Premium Php 17,870.76

If you’ll be handling your insurance requirements yourself, please submit the following to China Bank Savings on or before the
expiry date of your existing policy: Original copy of your New Motor Insurance Policy/ Original copy of Official Receipt of premium
payment/Endorsement of the Policy to China Bank Savings.

For submission, please look for:

Mr. John Mark O. Valenzuela
Address: 11th Flr. Chinabank Savings Head Office Buendia, Makati City

If you wish to insure with us, Please signify your conformity by signing on the space provided.

Should you have any questions regarding the renewal of your insurance policy, please feel free to call Chinabank
Insurance Brokers, Inc. at 8885-5759 / 8885 – 5555 loc.6094 and look for JEZALYN TOLOSA / ANJO SAURO or email us
your confirmation at assauro@chinabank.ph

Very truly yours,

CHINABANK INSURANCE BROKERS, INC

RENEWAL INSTRUCTIONS

1. RENEW my policy and deliver to this address:

Contact Numbers: Work: Home: Mobile: E-mail:

2. (Please Check)  ADD /  DELETE the following accessories (provide sales invoice)

CONFORME: PAYMENT OPTIONS

(Please bring this letter when paying your premium)

___________________________________________________ 1. Pay in CASH or CHECK at:

LANDICHO, JENNY LYN CALILONG  Any Chinabank Savings or Chinabank Branch
(Please Sign Over Printed Name) IMPORTANT: Use the BILLS PAYMENT SLIP FORM
 Chinabank Insurance Brokers, Inc. Office
Date: ________________________________
2. For check payments, please make the check payable to:
CHINABANK INSURANCE BROKERS, INC.