PHILIPPINE AXA LIFE INSURANCE CORPORATION Customer Cara Hotlne +63 2 85816 202 - customer servce@axa.comh + ‘wn axa.com ph MOTOR CAR POLICY SCHEDULE Line MOTOR CAR Policy Period Subline PRIVATE VEHICLE From March 25, 2028 12:00:00 NOON Issue Date > March 29, 2023 To March 25, 2028 12:00:00 NOON Policy No. : MC+MPC-CA.23-0000084-00 PREMIUM PHP: 6,346.80 ‘Assured: KELVIN BRIAN RIEGO VILLEGAS Documentary Stamps 793.35 ‘Address: BILG CABALLERO COR PH1 SAN Expanded Vat 761.62 RAFAEL 1 SAN ANTONIO, ISLA Local Government Tax 38.08 VERDE, BATANGAS CITY, BATANGAS 4200, 24hr Assist 300.00 ‘AMOUNT DUE PHP 6230.88 RetPolNo, : MC-CA-2023-480 —_— Payment Reference No. : 9042300486849 Total Sum Insured NINE HUNDRED TWENTY-FIVE THOUSAND FOUR HUNDRED IN PHILIPPINE PESO (PHP 925,400.00) Mortgagee ‘ORI METRO LEASING & FINANCE CORP. INSURED Vehicle Insured 1-2017 TOYOTA VIOS 1.35 GAS MT ‘Acquired From ROAD ASSIST Model Year 2017 Make TOYOTA VIOS Type of Body 1.3) GAS MIT ‘Area of Operation NATIONWIDE Color THERMALYTE Plate No. Nop9487 LT File No. +120100000783305 MotorEngine No. ‘1NRXO053515 Unladen Weight 2,800 KGS. OR LESS. SerialiChassis No, PA‘B19F3664008171 Motor Type Description: LIGHT Vehicle Type SEDAN COC No 23 hem TSI PHP 925,400.00 Item Premium PHP 6,246.80 Perils ‘Sum Insured Premium (OWN DAMAGE PAP 275,400.00 PHP 3,308.80 THEFT PHE 275,400.00 PHP. 0.00 ACTS OF GOD PHP 278,400.00 PHP +3170 EXCESS BODILY INJURY PHP 200,000.00 PHP. 420.00 SRD PARTY PROP. DAMG PHE 200,000.00 PHP. 4,248.00 AUTO PASSENGER PHP 280,000.00 PHP 0.00 DEDUCTIBLES Deduetibiels| Amount Rate (%) Pests Deductible For OD/THEFT 2,000.00, 050 OWN DAMAGE Deductible for AOG 2,000.00 050 ACTS OF GOD Deductisios 2,000.00 Towing 1100.00 ‘Authorized Repair Limit 2,100.00‘tached to and forming part of MC-MPC-CA-23-0000084-00 Page 2 of 5 WARRANTIES AND CLAUSES PAYMENT OF DOCUMENTARY STAMP TAX WARRANTY PROPERTY DAMAGE CLARIFICATION CLAUSE WAR AND TERRORISM EXCLUSION CLAUSE AIRBAG CLAUSE BUILT-IN / STANDARD ACCESSORIES NON-CASA CLAUSE (for vehicles more than 36 months old) DRUNKEN DRIVER CLAUSE PAIR AND SET ENDORSEMENT ACTS OF GOD COVER ENDORSEMENT FOR PRIVATE CAR, TABLE OF PERMANENT DISABLEMENT BENEFIT AUTO UNNAMED PASSENGER PERSONAL ACCIDENT COVERAGE MORTGAGEE CLAUSE ‘SANCTION AND LIMITATION EXCLUSION CLAUSE NoLoss PAYMENT OF DOCUMENTARY STAMP TAX WARRANTY Itis hereby understood that upon the issuance ofthe policy, no Documentary Stamp Tax will be refunded as a result of the cancellation or endorsement of the palicy or reduction in the premium due for whatever reason outside of the month of the Issuance of the policy PROPERTY DAMAGE CLARIFICATION CLAUSE Clarification Agreement Property Damage covered under this Agreement shall mean physical damage to the substance of property. Physical damage due to the substance of property shall not include damage to data or software, in particular any detrimental change in dsta, software or computer programs that is caused by @ deletion, @ coruption ora deformation of tne original structure, Consequently, the following are excluded from this Agreement [A Loss or damage to date or software, in particular any detrimental change in data, sofware or computer programs thats caused by a deletion, a corruption or a deformation ofthe orginal structure and any business interuption losses, resulting from such loss or damage. Notwithstanding this exclusion, loss of or damage to data or sofware, which is the direct consequence of insured physical damage tothe substance of property shall be covered. B. Loss or damage resulting from an impairment inthe function, avalailly, range of use of accessiblly of data software or computer programs and any business interruption losses resulting from such loss or damage. WAR AND TERRORISM EXCLUSION CLAUSE Notwithstanding any provisions to the contrary within this Policy or any endorsement hereto attaches, itis agreed that his, Insurance exclides death injury, ilness, loss, damage, cost oof expense of whatsoever nature directly or ncreclly caused by, resulting from on in connection with any of the following regardless of any other cause or event contributing concurrently rin any ather sequence tothe loss: Dy War, invasion, act of foreign enemies, hostites or warlke operations (whether war be declared or not) civil war, rebelion, mutiny, rot, miltary of popular rising, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising miliary or usurped power, martial law or stale of siege or any events or cause which determine the proclamation or maintenance of martial law ar state of siege: 2) Any act of terrorism For the purpose of this endorsement an act of terrorism means and act, including but not limited fo the use of force or Violence and/or the treat thereof, of any person or group(s) or persons, whether acting alone or on behalf of or in connection with any organization(s) or governments), commited for plieal, religious, ideological or similar purposes including the intention fo influence any government andior to put the public, or any section to the public, in fear, This endorsement also excludes death, inury, illness, loss, damage, cost or expanse of whatsoover nature drecly of Indirectly caused by, resulting rom or in connection with any action taken in controling, preventing, suporessing an any way relating to (1) andlor (2) above. If the Insurer allege that by reason ofthis exclusion, any loss, damage, cost or expense isnot covered by this insurance, the burden of proving the contrary shall be upon the Insured. Ifthe event any portion ofthis endorsement is found to be invalid or unenforceable, the remainder shall remain in fll force and effect‘tached to and forming part of MC-MPC-CA-23-0000084-00 Page 3 of 5 AIRBAG CLAUSE The Company will pay andlor replace the artbags including the cost of reinstallation folowing its deployment or discharge consequent upon a sudden and accidental impact tothe insured vehicle provided that due fo such impact the said vehicle sustained damages that are compensable under Section Il ofthe policy Tne Company, however, will not pay for claims in respect of damage to the alrbags nor forthe cost of its re-installation as a result of the following a Fully () design, (l) manufacture, or (i) installation regardless of whether the scheduled vehicle fs damaged at the same time; b. Discharge or deployment of airaags while the scheduled vehicle is undergoing repairs. BUILTIN / STANDARD ACCESSORIES. Itis hereby declared and agreed that notwithstanding anything contained herein tothe contrary the insurance under Section Il (Loss or Damage) of this Policy shal include lass or damage to built-in / standard accessories only. Add-on accessories, are not covered unless declared and noted inthe Policy with Inalvdual sums insured applicable to each item. NON-CASA CLAUSE (for vehicles more than 36 months old) tis hereby declared and agreed that in case of damage to the Scheduled Vehicle, including loss or damage to is accessories insured hereon, claim settlement shall be based on the reasonable cost of repair and installation of the same ‘at any non-dealer ar non-casa repair shop accredited with Charter Ping An Insurance Corporation (Formerly: Philippine Charter Insurance Corp. DRUNKEN DRIVER CLAUSE Except in case of claims arising under Sections | and Il ofthis Polcy tis hereby declared and agroed thatthe Company shall not be lable in respect of any accident or liability caused or incurred by a DRUNKEN AUTHORIZED DRIVER or any AUTHORIZED DRIVER who is under the influence of iguor atthe time ofthe accident. This is further subject tothe terms and conditions ofthe Policy.” PAIR AND SET ENDORSEMENT Itis hereby understood and agreed that inthe event of loss or damage to any accessory or accessories, spare part or spare parts forming part ofa pai or se, the measure of loss or damage to Such accessory or spare part shall be is reasonable {nd fair proportion to the total value ofthe pair or set, giving consideration tothe importance of said accessories or spare Paris, but no event shall such loss or damage be consirued to mean a total loss ofthe pair or set Excopt as herein stated, all other terms and condllions remain unaltered. ACTS OF GOD COVER ENDORSEMENT FOR PRIVATE CAR Itis hereby declared and agreed that in consideration of the payment of adeitional premium, effective (date), the words. "FLOOD, TYPHOON, HURRICANE, VOLCANIC ERUPTION, EARTHQUAKE OR OTHER CONVULSION OF NATURE" Under item 3 of the General Exceptions ofthis Policy are deemed deleted All other terms and conditions remain unaltered DEDUCTIBLE CLAUSE (PC) - ACTS OF GOD Itis hereby declared and agreed that deductible of this Policy for Acts of God (AOG) related claims shall be 0.5% of sum ingured, minimum of Ps2,000.00. ‘Allother terms and consitions ofthis Policy remain unaltered, ‘TABLE OF PERMANENT DISABLEMENT BENEFIT Description of Disablement - Percentage of Principal Sum Loss ofthe Limbs - 100% Loss of both hands, oral fingers and thumbs of both hand - 100% Loss of both feat - 100% Loss of sight of both eyes - 100% Injures resulting in being permanently becridden - 100% ‘Any other Inury causing permanent ‘otal cisablement- 100% Loss of arm at or above elbow - 70% Loss of arm between elbow & writ - 50% Loss of hand - 42.5% Loss of four fingers and thumb of one hand - 42.5% Loss of four fingers - 35% Loss of thumb - 15% Loss of index finger- 10% Loss of middle fnger- 6% Loss of ring finger - 5%‘tached to and forming part of MC-MPC-CA-23-0000084-00 Page 4 of 5 Loss of tle finger ~ 49% Loss of metacarpale-fist or second (addlional)- 39% Third, fourth or fifth (adational)- 2% Loss of fg at or above knee - 80% Loss of eg below knee- 50% Loss of one foot- 40% Loss of toes - all of one foot - 15% Loss of big toe - 5% Loss of any toe other than big toe, each - 1% Loss of sight of one eyes - 30% Loss of hearing - both ears - 50% Loss of One ear 25% The aggregate of all percentages payable in respect of any one accident shall nol exceed 100% Total Permanent Iss of the use of a member shall be treated as loss of such member. The loss ofthe first joint ofthe thumb or any other finger or of any toe shall be considered as equal to the lass of one-half of. the thumb oF finger or te and the benett shall be one-half ofthe bereft above specified for loss ofthe limbs or fager oF toe The loss of more than one phalange ofthe thumb or of any ther finger or of any toe shall be treated as loss ofthe entire thumb oF finger or tos, Where, however, thre is lose of two or more pats ofthe hand the percentage payable shall not be more than the loss of the whole hand, Where, the disablement isnot specified the Company will adopt a percentage, which in its opinion isnot inconsistent with the provisions of this table NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR CHANGE ANY OF THE TERMS, CONDITIONS OF THE POLICY, EXCEPT AS HEREIN OTHER WISE PROVIDED. [AUTO UNNAMED PASSENGER PERSONAL ACCIDENT COVERAGE ‘AUTO UNNAMED PASSENGER PERSONAL ACCIDENT COVERAGE This form is par of the Motor Car Policy to which tis attached and valid only if the form number, benefits and appropriate premium is indicated on the application for sai policy or is endorsed thereon. IT IS HEREBY DECLARED AND AGREED THAT: 1. "Covered Vehicle" wherever used inthis policy, shall mean the vehicle fully licensed for road use, as indicated under the schedule or as described herein 2, “Life Insured" wherever used in this policy shall mean each passenger or operator (driver) ofthe covered vehicle indicated on the application or described herein. 3. “Injury” wherever used inthis policy means accidental bodily injury occurring while this polcy isin force as to life Insured whose Injury is @ basis of claims and resulting drecly and independent of all causes walle rding, boarding, or alighting {rom the covered vehicle indicate on the policy application or as descrived herein. 4. This insurance shall provide the specific benefits shown in the Table of Benefits for Loss of Life, Disablement. Accident Burial Expense of Medical Expenses sustained as a result of badly injury caused by accident while a car oceupant is ‘operating, riding boarding in or aighting fram the covered vehicle as deserbed herein. 5, "Accident Medical Expense Beneft" pays the actual cost, up to maximum benefit amount indicat inthe table of benefits {for medical or surgical treatment, including trained nurses and hospitalization, incurred with 52 weeks fom the date of accident, 6. “Accident Burial Expense Benefit pays the actual cost up to maximum bor in the event of death due tothe injuries sustained from the accident. ‘amount as shown inthe Table of Beneft, 7. This insuranco shall effective only ifthe Unnamed Authorized Driver is duly iconsed to drive the motor vehicle as Goscribed herein or is permitted in accordance with te licensing or other laws or regulations to drive or has been permitted ‘and is not aisqualifie by order of law or by reason of any enactment ar regulations in that behal 8. "Aggregate Limit of Indemnity" Inthe event thatthe actual number of passengers (including driver) atthe time of the accident exceeds the maximum seating capacity dectared the Company shal be lable only fr that proportion ofthe Indemnity otherwise payable that the maximum seating capacity bears to the actual numiver of passenger (ncluding drver) ‘and shall notin the agoregate exceed the sum af Ps 250,000.00 / 50,000.00 per passenger during any one period of insurance. 9, Payment of benefits under ths policy shall be made tothe Policy halderiOvner of the covered vehicle as designated in the application under schedule for cistibution tothe Life Insurance whoso injury is the basis of claim, orto his hers in case cof death of incapacity. Payment to the Policynolder/Owner ofthe covered vehicle shall discharge the Company of lablity‘tached to and forming part of MC-MPC-CA-23-0000084-00 Page 5 of 5 Under this policy, 10. This insurance does not cover death, disablement, or bodly injury caused by: bacterial infection, suicide, disease, war lor act of war, service inthe Armed Force, medical or surgical treatment not resulting rom accident, dental care surgery except to natural teeth as occasioned by injury, murder or assault, ls sustained by any insurance passengers (including ver) while the covered vehicle is being used for racing, peacemaking, tral or spees testing, get-away car in any robbery, holdup, smuggling ar attempting the performance of an unlawful act, Insured Unnamed Authorized Driver is driving or ‘operating under the influence of hquar andlor drugs ‘SCHEDULE OF BENEFIT PER ACCIDENT ‘Accidental Death Ps 50,000.00 per passenger. Permanent Disablement Ps 50,000.00 per passenger. Medical Reimbursement 10% of principal sum maximum of Ps §,000.00 whichever is less. ‘Accident Burial Expense 10% of principal sum Maximum of Ps 8,000.00 whichever is less. MORTGAGEE CLAUSE LOSS &/0R DAMAGE, if any under this policy is payable to ORIX METRO LEASING & FINANCE CORP. as ther interest may appear, subject lo the terms and conditions, clauses and warranties ofthis policy. IT ISHEREBY DECLARED AND AGREED THAT, this policy or renewal thereof shall not be cancelled without prior writen rotifcation and conformity by ORIX METRO LEASING & FINANCE CORP. ‘SANCTION AND LIMITATION EXCLUSION CLAUSE No insurer shall be deemed to provide cover and no insurer shal be lable to pay any claim or provide any benefit hereunder to the extent thatthe provision of such cover, payment of such claim or provision of such beneft would expose that insurer to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America ‘The insured is ented to a return of the premium if no part oftheir interest inthe thing insured be exposed to any of the perils insured against No Loss Warranted no oss as of date of Issuance, {800-451B01-0A / 10306-OMLF18 PHILIPPINE AXA LIFE INSURANCE CORPORATION PAR No. Mo-cA-23-001137- 00 Cred. Br. cA Policy 1D 4549507 Bernardo Rafael Serrano Lopez President and Chie? Executive Officer Ifyou are not the intended recipient of tis message, kindly inform AXA Philipines through our hotline and delete this message. Wie apologize for the inconvenience.