Client's Copy

POLICY SCHEDULE
To : : MA. THERESA D. MAGALLANES Policy Number : VA-PCV-301098874

Issue Date : 03/29/2023

Address : DANGCAGAN
BUKIDNON Client Number : 30394670
Agent Number : 30000343
Bukidnon
Referral Number :
8719
Ext./Prev. Policy Number :
Insured : MA. THERESA D. MAGALLANES From : March 29, 2023 , 12:00 PM
To : March 29, 2024 , 12:00 PM
Business : New Business (301098874) Days : 366

SUMMARY OF PREMIUM AND OTHER CHARGES

PREMIUM ................... PHP 24,345.00 COC VF ...................PHP 0.00
Value Added Tax ................... PHP 2,921.40 ...................PHP
Roadside Assistance Fee 100.00
Documentary Stamp Tax ................... PHP 3,043.13
Local Government tax ................... PHP 121.73
AMOUNT DUE ................... PHP 30,531.26
COVERAGE/S SUM INSURED PREMIUM
OWN DAMAGE / THEFT 1,260,000.00 17,640.00
AON 1,260,000.00 5,040.00
EXCESS BODILY INJURY 200,000.00 420.00
THIRD PARTY PROPERTY DAMAGE 200,000.00 1,245.00

DETAILS OF INSURANCE
Make Model : MITSUBISHI STRADA GLS 2.4D
Plate No. : LAJ7559 MV File No. : 1101000013296
Deductible : PHP 6,300
Model Year : 2022 Towing Limit PHP 100
Motor/Engine No.: 4N15UJB4903 AR Limit : PHP 6,400
Serial/Chassis : MMBJLKK10NH066170 Assignee : MA. THERESA D. MAGALLANES
Color : WHITE DIAMOND
COC / Auth No. : Mortgagee : EASTWEST BANK
RAP : Covered

Warranties and Clauses LOSS OR DAMAGE, IF ANY, IS PAYABLE TO

DRUNKEN DRIVER CLAUSE MOTOR VEHICLE ACCESSORY ENDORSEMENT EASTWEST BANK
PAIR & SET CLAUSE IMPORTATION CLAUSE AS THEIR INTEREST MAY APPEAR, SUBJECT TO THE TERMS
TERRORISM EXCLUSION CLAUSE DATE RECOGNITION CLAUSE AND CONDITIONS, CLAUSES AND WARRANTIES OF THIS
PAI FOR UNAMED DRIVER/OCCUPANTS DEDUCTIBLE CLAUSE POLICY. IT IS HEREBY EXPRESSLY UNDERSTOOD THAT THIS
OR ANY RENEWAL THEREOF SHALL NOT BE CANCELLED
Accessories Declared WITHOUT PRIOR WRITTEN NOTIFICATION TO AND
CONFORMITY OF
EASTWEST BANK

THE POLICY, POLICY SCHEDULE, SPECIFICATIONS AND ANY ENDORSEMENTS WILL BE READ AS ONE CONTRACT
Documentary Stamps to the value shown herein have been affixed/imprinted to the premium register of the company in compliance with Revenue Regulation No. 15-2001 dated October 16, 2001
In witness whereof, the company has caused this Policy to be signed by its duly authorized representative. This document with the e-sign of Standard Insurance Co. Inc.'s authorized representative is
system generated and serves as your official policy.

John B. Echauz Freddie L. Catubo

President Manager/Branch Head

ALAGASI Original1
IMPORTANT REMINDER:
Please do not forget to check the correctness and accuracy of the details on the Policy Schedule. This will serve as the basis in the assessment and settlement of a claim. Any discrepancy or non-declaration
may cause inconvenience or even nullification of a claim. Should there be any correction/s or change/s, inform your agent or writing office IMMEDIATELY.
 Client's Copy

PREMIUM PAYMENT GUIDE

Dear Valued Customer,

Thank you for choosing Standard Insurance as your insurance provider.

We would like to remind you to pay your premium on time to ensure that your policy is in force. For your reference, provided below are
the details of your policy.

Policy Number : VA-PCV-301098874 Summary of Premium & Other Charges

Client Name : MA. THERESA D. MAGALLANES Premium 24,345.00
VAT 2,921.40
Coverage Period : March 29, 2023 - March 29, 2024 Documentary Stamp 3,043.13
Local Gov't Tax 121.73
Others 100.00
TOTAL AMOUNT DUE 30,531.26

Premium Payment Facilities

Online Facilities

1. Standard QR Code – for motorcar and property policies, pay using the Standard QR code found at the upper
right-hand corner of your policy. Scan the QR code and pay using a credit card, GCash, or Maya.
2. Standard Payment Link – for all policies, pay via the Standard Payment Link. Please call your servicing
Standard Insurance branch to get your Payment Link via email. You can pay using a credit card, GCash, or Maya.
3. GCash, Maya, and Bayad – Use your mobile wallets to pay your premium for all types of policies.
4. Online Banking – using the bills payment facility, mobile banking, and online banking facility, you can pay in BDO,
BPI, Metrobank, and UnionBank.

Over-the-Counter Facilities

1. Bank Branches – using the Bills Payment Form, you may pay over-the-counter in BDO, BPI, Metrobank and Union Bank.
2. Standard Insurance Branches – visit the more than 65 branches of Standard Insurance and pay using cash, credit card,
debit card and check.
3. Bayad Center – visit any Bayad Center branches and pay using cash.

*For credit card payment, we offer straight payment for all credit cards and installment offers of up to six (6) months
for BDO, Metrobank, BPI, HSBC, and RCBC credit cards.
**Some banks may require enrollment in the bills payment facility for Online Banking. Make sure you have your
complete and correct Policy Number.
***For check payment, please make the check payable to Standard Insurance Co., Inc. and write the Policyholder’s
Name on the back of the check.

This is a system-generated form

 CONFIRMATION OF COVER

This is to confirm that the Insurance Policy, with the following details, was issued by Standard Insurance Co., Inc.:

Assured : MA. THERESA D. MAGALLANES

Policy No : VA-PCV-301098874
Policy Period : 29 March 2023 to 29 March 2024
Make / Model : 2022 MITSUBISHI STRADA GLS 2.4D
Plate No : LAJ7559
Engine No : 4N15UJB4903
Chassis No : MMBJLKK10NH066170

Coverage

Own Damage/Theft/
Acts of Nature : Php 1,260,000.00
Excess Bodily Injury : Php 200,000
Third Party Property
Damage : Php 200,000

Mortgagee : EASTWEST BANK

This document is being issued upon the request of the Assured. As such, said Policy shall be in full force and effect
for the above-stated period, notwithstanding non-presentation of Official Receipt during its term. The Company is therefore
liable for all losses and/or damage that the Insured property may incur, subject, however, to pertinent provisions of the law,
limits of liability, and the terms and conditions of the policy in force.

Issued this 29th day of March 2023.

For and in behalf of

Standard Insurance Co., Inc.

Freddie L. Catubo
Manager/Branch Head

This is a system-generated form

Attached to and forming part of SICI Policy Number : VA-PCV-301098874

WITH BUILT-IN/STANDARD ACCESSORIES. ADD-ON ACCESS. ARE NOT COV. UNLESS DECLARED & VALUED IN THE POLICY
WITH FREE PERSONAL ACCIDENT ON NAME INSURED @100,000.00 (MUST BE 18-65YRS OLD)
(Medical Reimbursement @10% of the amount coverage per person. 10% of 100,000.00 is P10,000.00)
WITH FREE PA FOR UNNAMED DRIVER & UNNAMED RIDERS @100,000.00 PER PERSON UP TO SEATING CAPACITY
(Medical Reimbursement @10% of the amount coverage per person. 10% of 100,000.00 is P10,000.00)
WITH ACTS OF NATURE ENDORSEMENT ATTACHED
WITH 24/7 EMERGENCY ROADSIDE ASSISTANCE
RAP HOTLINE - 8845-1111 press 1
Mobile No. 0998-545-1111
 Mortgagee's Copy

POLICY SCHEDULE
To : : EASTWEST BANK Policy Number : VA-PCV-301098874

Issue Date : 03/29/2023

Address : VALENCIA CITY
BUKIDNON Client Number : 30394670
Agent Number : 30000343
Referral Number :
Ext./Prev. Policy Number :
Insured : MA. THERESA D. MAGALLANES From : March 29, 2023 , 12:00 PM
To : March 29, 2024 , 12:00 PM
Business : New Business (301098874) Days : 366

SUMMARY OF PREMIUM AND OTHER CHARGES

PREMIUM ................... PHP 24,345.00 COC VF ...................PHP 0.00
Value Added Tax ................... PHP 2,921.40 ...................PHP
Roadside Assistance Fee 100.00
Documentary Stamp Tax ................... PHP 3,043.13
Local Government tax ................... PHP 121.73
AMOUNT DUE ................... PHP 30,531.26
COVERAGE/S SUM INSURED PREMIUM
OWN DAMAGE / THEFT 1,260,000.00 17,640.00
AON 1,260,000.00 5,040.00
EXCESS BODILY INJURY 200,000.00 420.00
THIRD PARTY PROPERTY DAMAGE 200,000.00 1,245.00

DETAILS OF INSURANCE
Make Model : MITSUBISHI STRADA GLS 2.4D
Plate No. : LAJ7559 MV File No. : 1101000013296
Deductible : PHP 6,300
Model Year : 2022 Towing Limit PHP 100
Motor/Engine No.: 4N15UJB4903 AR Limit : PHP 6,400
Serial/Chassis : MMBJLKK10NH066170 Assignee : MA. THERESA D. MAGALLANES
Color : WHITE DIAMOND
COC / Auth. No. : Mortgagee : EASTWEST BANK
RAP : Covered

Warranties and Clauses LOSS OR DAMAGE, IF ANY, IS PAYABLE TO

DRUNKEN DRIVER CLAUSE MOTOR VEHICLE ACCESSORY ENDORSEMENT EASTWEST BANK
PAIR & SET CLAUSE IMPORTATION CLAUSE AS THEIR INTEREST MAY APPEAR, SUBJECT TO THE TERMS
TERRORISM EXCLUSION CLAUSE DATE RECOGNITION CLAUSE AND CONDITIONS, CLAUSES AND WARRANTIES OF THIS
PAI FOR UNAMED DRIVER/OCCUPANTS DEDUCTIBLE CLAUSE POLICY. IT IS HEREBY EXPRESSLY UNDERSTOOD THAT THIS
OR ANY RENEWAL THEREOF SHALL NOT BE CANCELLED
Accessories Declared WITHOUT PRIOR WRITTEN NOTIFICATION TO AND
CONFORMITY OF
EASTWEST BANK

THE POLICY, POLICY SCHEDULE, SPECIFICATIONS AND ANY ENDORSEMENTS WILL BE READ AS ONE CONTRACT
Documentary Stamps to the value shown herein have been affixed/imprinted to the premium register of the company in compliance with Revenue Regulation No. 15-2001 dated October 16, 2001
In witness whereof, the company has caused this Policy to be signed by its duly authorized representative. This document with the e-sign of Standard Insurance Co. Inc.'s authorized representative is
system generated and serves as your official policy.

John B. Echauz Freddie L. Catubo

President Manager/Branch Head

ALAGASI Original1
IMPORTANT REMINDER:
Please do not forget to check the correctness and accuracy of the details on the Policy Schedule. This will serve as the basis in the assessment and settlement of a claim. Any discrepancy or non-declaration
may cause inconvenience or even nullification of a claim. Should there be any correction/s or change/s, inform your agent or writing office IMMEDIATELY.
Attached to and forming part of SICI Policy Number : VA-PCV-301098874

WITH BUILT-IN/STANDARD ACCESSORIES. ADD-ON ACCESS. ARE NOT COV. UNLESS DECLARED & VALUED IN THE POLICY
WITH FREE PERSONAL ACCIDENT ON NAME INSURED @100,000.00 (MUST BE 18-65YRS OLD)
(Medical Reimbursement @10% of the amount coverage per person. 10% of 100,000.00 is P10,000.00)
WITH FREE PA FOR UNNAMED DRIVER & UNNAMED RIDERS @100,000.00 PER PERSON UP TO SEATING CAPACITY
(Medical Reimbursement @10% of the amount coverage per person. 10% of 100,000.00 is P10,000.00)
WITH ACTS OF NATURE ENDORSEMENT ATTACHED
WITH 24/7 EMERGENCY ROADSIDE ASSISTANCE
RAP HOTLINE - 8845-1111 press 1
Mobile No. 0998-545-1111