LINE & SUBLINE PREMIUM 4,164.

64
MOTOR-CAR DOC STAMPS 520.50
LAND TRANSPORTATION OPERATORS POLICY PREMIUM TAX 499.76
FIRE SERVICE TAX
POLICY NO. LTO-ILO-20669 VALUE ADDED TAX
LOCAL GOV'T TAX 20.82
TERM FROM April 8, 2008 12:00 PM OTHER CHARGES
TO April 8, 2009 12:00 PM
AMOUNT DUE 5,205.72
ISSUE DATE April 8, 2008

INTERMEDIARY TANAGON CURRENCY PHILIPPINE PESO

ASSURED : MR. STEPHEN GUANCO

Avancena Street, Molo, Iloilo City

1 RECON MITSUBISHI FUSO JEEPNEY

PLATE NO. : FWK-341 COC NO. :
SERIAL NO. : LTO-RVI-0620-04-1913-C DEDUCTIBLE : 5,000.00
MOTOR NO. : 4DR5706339 TOWING : 500.00
COLOR : N/A REPAIR LIMIT: 5,500.00
SEATING CAP. : N/A
MORTGAGEE : DYNA SOURCE FINANCE CORPORATION
ACCESSORIES
N/A

SCHEDULE OF RATES AND PREMIUMS

COVERAGE SUM INSURED PREMIUM

SECTION I/II : Compulsory Third Party Liability

SECTION III : Loss and/or Damage 150,000.00 3,896.64
SECTION IV-A : Bodily Injury
SECTION IV-B : Property Damage 20,000.00 268.00
Personal Accident :

ITEM TOTAL 4,164.64

WARRANTIES AND CLAUSES AT THE TIME OF ISSUE :

IMPORTANT NOTICE
STANDARD REPAIR CLAUSE
MORTGAGEE CLAUSE

underw
IN WITNESS WHEREOF, the Company has caused this policy to be signed by its duly authorized officer/representative at Makati City on April 08, don’t for
2008. the date

UTILITY ASSURANCE CORPORATION

 Authorized Signature

Documentary Stamps to the value stated above have been affixed and properly cancelled on the office copy to the policy.
underwriting_2:
don’t forget to change
the date
Name and Address of Insured: S.A. No. : 73278
LBP ILOILO LC FMLY : WELCHIE & EMILY RAYMUNDO Date Issued : February 6, 2008
M.H. DEL PILAR ST., MALATE, MANILA Due Date : December 31, 2008
Line : FIRE POLICY

Policy No. : FI-NIL-HO-0000968 Premium : 16,789.64

Endt. No. : VAT :
From : 12/31/2007 04:00 PM TO : 12/31/2007 04:00 PM Doc. Stamps :
Sum Insured : PHP 4,695,000.00 Fire Service Tax :
Item : VARIOUS ITEMS Local Tax :
Premium Tax :
TSI PREMIUM Other Charges :
F/L 4,355,000.00 15,580.79
ESB 340,000.00 1,208.85 TOTAL AMOUNT DU : 16,789.64

UTILITY ASSURANCE CORPORATION

Prepared by : JGALANG
Received by :
Intermediary : LIBI
SUM INSURED RATE
4,695,000.00 1.00 16,789.64
1,625,000.00 34.6% 5,809.22 0.3574905% 5,809.22
220,000.00 4.7% 789.11 0.3586864% 789.11
720,000.00 15.3% 2,568.81 0.3567792% 2,568.81
1,059,000.00 22.6% 3,794.46 0.3583059% 3,794.46
558,000.00 11.9% 1,997.97 0.3580591% 1,997.97
165,000.00 3.5% 587.64 0.3561455% 587.64
340,000.00 7.2% 1,208.85 0.3555441% 1,208.85
8,000.00 0.2% 33.58 0.4197500% 33.58
16,789.64 16,789.64
LINE & SUBLINE PREMIUM -
MOTOR-CAR DOC STAMPS -
PREMIUM TAX -
FIRE SERVICE TAX
POLICY NO. VALUE ADDED TAX
LOCAL GOV'T TAX -
TERM FROM 12:00 PM OTHER CHARGES
TO 12:00 PM
AMOUNT DUE -
ISSUE DATE

INTERMEDIARY CURRENCY PHILIPPINE PESO

ASSURED :

1 AS PER ATTACHED SCHEDULE

PLATE NO. : COC NO. :
SERIAL NO. : DEDUCTIBLE :
MOTOR NO. : AS PER ATTACHED SCHEDULE TOWING :
COLOR : REPAIR LIMIT: -
SEATING CAP. :
MORTGAGEE :
ACCESSORIES
N/A

SCHEDULE OF RATES AND PREMIUMS

COVERAGE SUM INSURED PREMIUM

SECTION I/II :
SECTION III : TOTAL LOSS ONLY - -
SECTION IV-A :
SECTION IV-B :
Personal Accident :

ITEM TOTAL -

WARRANTIES AND CLAUSES AT THE TIME OF ISSUE :

IMPORTANT NOTICE
STANDARD REPAIR CLAUSE

underw
IN WITNESS WHEREOF, the Company has caused this policy to be signed by its duly authorized officer/representative at Makati City on don’t for
the date

UTILITY ASSURANCE CORPORATION

 Authorized Signature

Documentary Stamps to the value stated above have been affixed and properly cancelled on the office copy to the policy.
underwriting_2:
don’t forget to change
the date
ATTACHED TO AND FORMING PART OF POLICY NO. MOTOR- Page 9 of 11

1
PLATE NO. : N/A COC NO. :
SERIAL NO. : N/A DEDUCTIBLE :
MOTOR NO. : N/A TOWING :
COLOR : N/A REPAIR LIMIT: -

SCHEDULE OF RATES AND PREMIUMS :

COVERAGE SUM INSURED PREMIUMS

TOTAL LOSS ONLY

ITEM TOTAL -

2
PLATE NO. : N/A COC NO. :
SERIAL NO. : N/A DEDUCTIBLE :
MOTOR NO. : N/A TOWING :
COLOR : N/A REPAIR LIMIT: -

SCHEDULE OF RATES AND PREMIUMS :

COVERAGE SUM INSURED PREMIUMS

TOTAL LOSS ONLY

ITEM TOTAL -

3
PLATE NO. : N/A COC NO. :
SERIAL NO. : N/A DEDUCTIBLE :
MOTOR NO. : N/A TOWING :
COLOR : N/A REPAIR LIMIT: -

SCHEDULE OF RATES AND PREMIUMS :

COVERAGE SUM INSURED PREMIUMS

TOTAL LOSS ONLY

ITEM TOTAL -

4
PLATE NO. : N/A COC NO. :
SERIAL NO. : N/A DEDUCTIBLE :
MOTOR NO. : N/A TOWING :
COLOR : N/A REPAIR LIMIT: -

SCHEDULE OF RATES AND PREMIUMS :

COVERAGE SUM INSURED PREMIUMS

TOTAL LOSS ONLY

ITEM TOTAL -
 Page 10 of 11

5
PLATE NO. : N/A COC NO. :
SERIAL NO. : N/A DEDUCTIBLE :
MOTOR NO. : N/A TOWING :
COLOR : N/A REPAIR LIMIT: -

SCHEDULE OF RATES AND PREMIUMS :

COVERAGE SUM INSURED PREMIUMS

TOTAL LOSS ONLY

ITEM TOTAL -

6
PLATE NO. : N/A COC NO. :
SERIAL NO. : N/A DEDUCTIBLE :
MOTOR NO. : N/A TOWING :
COLOR : N/A REPAIR LIMIT: -

SCHEDULE OF RATES AND PREMIUMS :

COVERAGE SUM INSURED PREMIUMS

TOTAL LOSS ONLY

ITEM TOTAL -

7
PLATE NO. : N/A COC NO. :
SERIAL NO. : N/A DEDUCTIBLE :
MOTOR NO. : N/A TOWING :
COLOR : N/A REPAIR LIMIT: -

SCHEDULE OF RATES AND PREMIUMS :

COVERAGE SUM INSURED PREMIUMS

TOTAL LOSS ONLY

ITEM TOTAL -

8
PLATE NO. : N/A COC NO. :
SERIAL NO. : N/A DEDUCTIBLE :
MOTOR NO. : N/A TOWING :
COLOR : N/A REPAIR LIMIT: -

SCHEDULE OF RATES AND PREMIUMS :

COVERAGE SUM INSURED PREMIUMS

TOTAL LOSS ONLY

 ITEM TOTAL Page 11 of 11 -

9
PLATE NO. : N/A COC NO. :
SERIAL NO. : N/A DEDUCTIBLE :
MOTOR NO. : N/A TOWING :
COLOR : N/A REPAIR LIMIT: -

SCHEDULE OF RATES AND PREMIUMS :

COVERAGE SUM INSURED PREMIUMS

TOTAL LOSS ONLY

ITEM TOTAL -

10
PLATE NO. : N/A COC NO. :
SERIAL NO. : N/A DEDUCTIBLE :
MOTOR NO. : N/A TOWING :
COLOR : N/A REPAIR LIMIT: -

SCHEDULE OF RATES AND PREMIUMS :

COVERAGE SUM INSURED PREMIUMS

TOTAL LOSS ONLY

ITEM TOTAL -