‘Cemvaya, cipal CONFIRMATION OF COVER wis wstenroucvna. ora: : Issue date and time: ree 27 2023. 3-296" ei asTiael coe W. Coverage Premium as LORENA M, CAHULOGEN o2ra7y2023 - 06/27/2023 P $0 b 9 PHRSE 2 TENYAG TAGUIG CITY METRO MANILA PHILIPPINES Tiree a urges nuk | Sublimit of Php 10,000 Php s.000, Dest ane hp 10,000) Eerie metre pect Pheuseo Name of Insured: DAVE IAN M0 is cnfrmaton sorry he ers a condone of si Me Ply an alam lb aust a aoa cet ce fay mmm fe) DES for Aceidertal Death, Dismemberment &/ot cablement, Marder & Unprovoked Assault and Death Benefit. Maximum of five (8) COCs per household fo Ft cash Assistance Maximum of one (1} COC for Emergency Expense benefit. nave read and understood the terms and canitions of ProtectMax insurance plan and CebuanaLhuler Data Privacy Notice also certify that NO KNOWN LOSS INSURED prior tothe date an tet COC efectvy date ar esuancs of requested arene pole information Towew the terms andconctions,please vst wa ploneer.comfpregucts/¢ebvane Pull protectmas.Cebuan Lhe: Data Privacy Notice maybe [Simppriaeypolcy For wqures, please ys any Cebuana Branch near you o al us at (02) 87799860, Please present this COC when filing w cl Comyaecseget eames RA PIONEER Seat dat ww cebvanainuer Tis SuiPs row prorecrmax msURANCe PRODUCT EMERGENCY EXPENSE BENEFIT CLAIM [Behe condtion a dec result of Vouma/acient? Put checkmark (7) Ces Ne iFeehiclor accident, asthe sured he drier? Cl Yes CIN Date of out patent treatment if hospital confined, inclusive dates of confinement from ie Surgial operation performed (if applicable) Pry Name License No. — Name of Monga: Date Completed ‘Contac Number