Reference No.

22-1004503-2-R
Date November 21, 2022

* This LOA is valid only up to 30 days from date of issue. Should the
assured/claimant fail to bring the vehicle to the repair shop within the said
AMC HAMMER ALANA MOTORS CORP period, any increase in the cost of repair shall be for the account of the
SOUTH DIVERSION ROAD, DOMOIT Lucena City assured/claimant. Prices of the parts are subject to change without prior
QUEZON Philippines 4301 notice. Any increase int the cost of parts may be subject to a corresponding
increase in the assured's share in depreciation charges, if any.
8975426
jianalana@gmail.com

Attention : MR. JIAN CARLO ALANA

Gentlemen :

Assured : ELIZALDE, MARIA NOEMI ALFONSO

Third Party : N/A
Motor and Type : 2012 HYUNDAI ACCENT
Plate No. : TVO330
Loss Date : October 19, 2022
Policy No. : 1002201007503
Claim No. : 100221000002639

This will authorize you to proceed with the repairs of the above described vehicle based on the following:

Add : Parts P 38,850.00

Labor 24,675.00
VAT 2,961.00
Total Cost 66,486.00

Deductible 2,000.00
Depreciation (40%) 0.00
Others 0.00

Net Amount Due P 64,486.00

It is understood that no additional amount shall be incurred without our prior written approval. Should you have questions regarding the above evaluation,
please get in touch with DAVID, MARK DEAN DAVID our in-house adjuster.

Please have the vehicle OWNER or his authorized representative bearing the OWNER'S written authorization sign the enclosed Release of Claim ( and
Affidavit of Desistance, in case of Third Party claim ) and forward the same to us together with your final repair bill, a copy of this letter, all replaced parts,
and owner's written authorization to enable us to process payment.

ASSURED'S CONFORME MAPFRE INSULAR INSURANCE CORPORATION

This is a computer generated form. If printed without alterations, letter is valid and need not be signed.
 CLAIMS ADJUSTMENT REPORT

Date Evaluated January 5, 2023 Eval No. 22-1004503-2-R

Claim No. 100221000002639 Model 2012 HYUNDAI ACCENT
Assured ELIZALDE, MARIA NOEMI ALFONSO Plate No. TVO330
TP Claimant Elizalde, Maria Noemi Alfonso Motor No. G4FABU689130
Policy No. 1002201007503 Chassis No. KMHCT41CBCU138903

DESCRIPTION PRICE TINSMITH PAINTING

PARTS
FRT BUMPER CLIPS (Replacement) 350.00
FRT BUMPER COVER (Surplus) (For Retrieval) 6,500.00
RH FENDER LIGHT (Surplus) 850.00
RH FENDER LINER (Surplus) 1,950.00
RH FENDER PANEL (Surplus) (For Retrieval) 5,500.00
RH FOG LAMP COVER (Surplus) 600.00
RH FRT BUMPER SUPPORT (Replacement) 1,800.00
RH HEADLIGHT ASSY (Surplus) (For Retrieval) 8,500.00
STEERING GEAR ASSY (Surplus) (For Retrieval) 8,500.00

ADDITIONAL PARTS :
RH FRT LOWER ARM (Replacement) 4,300.00

SCOPE OF WORK
TINSMITH 4,000.00

REMOVE/RE-INSTALL NECESSARY PARTS TO GIVE WAY FOR REPAIRS.

STRAIGHTEN/REFORM/ALIGN THE FOLLOWING:

• RH FENDER APRON
• RH FRT DOOR PANEL
• FRT BUMPER REINFORCEMENT
• HOOD PANEL

REPLACE ABOVE MENTIONED PARTS

ELECTRICAL WORKS 375.00

REPLACE DAMAGED ELECTRICAL PARTS.
CHECK/FIX/SECURE AFFECTED ELECTRICAL WIRINGS & CONNECTIONS.
MECHANICAL WORKS 3,500.00
REPLACE ABOVE MECHANICAL PARTS.
PERFORM WHEEL AND CAMBER ALIGNMENT.

ADDITIONAL MECHANICAL WORKS 1,800.00

REPLACE ABOVE MECHANICAL PARTS.
PERFORM WHEEL AND CAMBER ALIGNMENT.

PAINTING/SHOP MATERIALS 15,000.00

REPAINT/RUBDOWN/SIMONIZE/RUSTPROOF THE FOLLOWING:

• RH FENDER APRON
• RH FRT DOOR PANEL
• RH FENDER PANEL (Surplus)
• FRT BUMPER REINFORCEMENT
• FRT BUMPER COVER (Surplus)
• HOOD PANEL

***Nothing follows***

Remarks : THIS IS A REVISED EVALUATION SUPERSEDING ALL PREVIOUSLY ISSUED EVALUATIONS.

Processor LERIN, JOSHUA JOHN A. Total Parts 38,850.00

Evaluation Posted By DAVID, MARK DEAN DAVID Labor/Shop Materials 24,675.00
Preferred Shop AMC HAMMER ALANA MOTORS CORP 12% VAT 2,961.00
Inspected by DAVID, MARK DEAN DAVID Total 66,486.00
Date Inspected 10/28/2022 Less: Deductible ( 2,000.00 )
Place of Inspection BASED ON PICTURES Depreciation (40%) ( 0.00 )
Others ( 0.00 )
NET DUE 64,486.00
Supplied Parts 0.00
Outside Works 0.00
12% VAT 0.00
Consequential Loss 0.00

NOT VALID WITHOUT A LETTER OF AUTHORITY