Insurance Brokers Inc. 43° Floor, BDO Corporate Center, 12 ADB Avenue, Ortigas Center 1550, Mandaluyong City ‘Numbers (02) #702-4000 or 02) 240-7000, oe, 308) narciva marvanefbde.com.oh (6-838.2364) dons refibdo co 8 n MALL TENANTS INSURANCE PROGRAM (CAR! CSL) (Coverage for Construction Works Within the M ‘Contractor's Nam Contact Person: Office Tite: Malling Address: Direct, Trunktine: Email Address BDO Account Name: Policy Term: From TIN: Store/Trade Name: Registered Owner: contact Person: office Tite: Department: Fax # Mobile # [BDO Account Name: [BDO Branch of Account Location at Mi Mall Branch: ‘Section |: MATERIAL DAMAGE ‘Amour tree (2area on Contact Pre) Kindly provide a copy of ANY o the following: Nace To Proceed IT), Purchase Order (P.O) or Project Contract ‘Section: THIRD PARTY LIABILITY (TPL) ‘Arount nseed "2% of he Materal Damage cover minimu of Php $90,000.00 ‘SCOPE OF WORK: Irsallaten! smanting of Dropdown Fazade Banner (CCL) (Pleaee pv} ‘Corstton of Store out Sematton of Store cute (CSL) ores “Pleat tate note of eur-No paynent, No booking poly Inception af Insurance wl be based an your payment dae or upon completion of IVC raqarererts whthaver als Pramam Computation wil be proves upon submesion of duly aecolshed Appleaton Form within SS woneng cys. 18001 Data Privacy Consent Form In compliance wah the requirements ofthe Dala Privacy Act hereby give my consent o BDO Unban, Ie. adits sutssares (techy fefred fo a8 "B00 Group osrocess lore. sos or share my personal formaton or sensitive personal formato obaineg Wom me inthe course of my transactions tm 800, I contm tat | understand ane agree that these norton may be Seckaos raved win ‘he BOO Greup fr erosssalng purposes io for and provide New o elatoa products ane sarvcos oft BDO Group. Furor | hereby ‘ve my congent to any rember of he BDO Grup fo process, cae, use, sore, sare a cose my personal Iormaton of Sanat Personglifomaton aang hemseies oe ha parts, | confi that understand a agree thal my ivomaton may continue fo be processed, collected. ued, sores. or dsclsed for en (10) yoars rom my ast traction date wih any member of ®e BDO G-cup oF url te expraton ofthe retention mis set by apeicabe Ewe, ‘ivehove comes late" \nereby acknowledge and understan thal should wsh to withdraw my consent t eceve information about new of rested produc and terest ef he 800 Grup fe sce, ute, coven! stan pure Sta at sls ht fam | May communal ret) 300 irate Brokers, rs Data Plcion Oe tough da ted es edaeancentncans | othe snoige {ag urcertand tha ay access and vew BDO Insurance Boxes, e's Data Privacy Stale at ibs bdo can ghBDO! Prac aly 9 oblan a opy eraof fom BDO Insurance Brokers, Ina's tarch offen. signature over Printed Name Bala —pesignation —