STANDARD INSURANCE CO.. INC.

(A Cooperative Partner of the Zurrch lnsurance Group)

Batangas Branch: G/F A.A. Panganiban Building, Pa locan Wefc, Batangas City
Tel. Nos.: (043) 300-4248 I f23 5315 Manrla Line: (02) 782'5382' Te efax No,; (043) 7)3-1637
'
Website: rwvw,standard-insurance.com '
E-matl: inquiqr@standard-lnsurance.com

P oL CY SCHE E DUL
To : GLENN JOSE M. GALVEZ PolicyNumber : BT-PCV-298011000909
lssue Da'.e i 611412018
Address : 816 L56 PELICAN ST. VALLEJO PLACE Client Number : 298011000635
PASONG BUAYA IMUS CAVITE Agent Nurnber : 20000586
Cavite Referral Number :

41 03 Other Reference No. :

lnsured : GLENN JOSE M. GALVEZ

: June 14,2018, 12:00 PM
: June 14,2019, 12:00 PM
Business : NEW BUSINESS
: 365
SUMMARY OF PREMIUM AND OTHER CHARGES
PREMIUM ................ PHP 19,515.00 COC VF
Value Added Tax ................ PHP 2,341 .80
Documentary Stamp Tax................ PHP 2,439.38
Local Government Tax ................ PHP 29.27

AMOUNT DUE ............... PHP 24,325.45

COVERAGE/S SUM INSURED PREMIUM

:.a OWN DAMAGE/THEFT 825,000 00 14,025.00 s
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ACTS OF NATURE 825,000,00 4,125.00
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: PERSONAL ACCIDENT 350,000.00 0.00 e
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EXCESS BODILY INJURY 100,000.00 270.00 l
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THIRD PARTY PROPERTY DAMAGE 100,000,00 1,095.00
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E DETAILS OF INSURANCE !
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-o Make Model : SUZUKI ERTIGA GL 1,41 M/T
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G0T068 c00000 o
sF Model Year : 2018 Deductible : PllP 4,125.00 -
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No.
Motor/Engine : K148T1279646 Towing Limit : FHi) 100.00
Chassis
Serial : MHYZESl S1 KJ30OOO2 ARLimit : PHP 4,225.00
Color : MDIANT RED Assignee : GLENN JOSE M. GALVEZ
COC No. i Auth. No.:
RAP Number i srctBRN00311823 Mortgagee : LUZON DEVELOPMENT BANK
Risk No. 1 :

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

ACTS OF NATURE ENDORSEMENT PAIR AND SET ENDORSEMENT LUZON DEVELOPMENT BANK
STANDARD WARRANTIES & CLAUSE AS THEIR INTEREST MAY APPEAR, SUBJECT TO THE TERMS
DATE RECOGNITION CLAUSE
AND CONDITIONS, CLAUSES AND WARRANTIES OF THIS
DEDUCTIBLE CLAUSE ROADSIDE ASSISTANCE PROGRAM
POLICY. IT IS HEREBY EXPRESSLY UNDERSTOOD THAT THIS
DRUNKEN DRIVER CLAUSE TERRORISM AND SABOTAGE EXCLU
OR ANY RENEWAL THEREOF SHALL NOT BE CANCELLED
PAI CERTIFICATE FOR UNNAMED DRIVER WITHOUT PRIOR WRITTEN NOTIFICATION TO AND

Accessories Declared
FREE UPA PlOO,OOO FOR NAMED DEVELOPMENT BANK
Built-in accessories. I

TINT ATEMNDER CALANOC JR

FIP
IN-HoUsE IN-mTirrEE
THE READ AS ONE CONTRACT
Documentary Stamps to the value shown herein have been afflx, SUZUKI AUTO STA with Revenuo Regulation Nop.15-2001 dated October 16,2001
in witness whereof, the company has caused this policy to be sig
ROSA -sign of Standard-lnsurance Co.lnc's authorized representative is
PIS I_OOK FOR:
system generated and serues as your official policy. NER| DELA CF UZ
0956-257-4853
; 0 91.2_6725_147

suzukiasr Original Copy

IMPORTANT REMINDER:

may Guse inconvenience or even nullifiction of a claim.Should there be any correction/s or changes/i, intorm your Fgent or witing office l[4lvlED|ATELY.
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Batangas Branch: G/F A.A, Panganiban Building, Pal{ocan West, Batangas City
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Tel. Nos.: (043) 300-4248 I 723-531 5 . Manila Line: (02) 787-5387 . Telefax No.: (043) f23-1637
Website: www.standard-insurance.com . E-mail: inquirT@standard-insurance.com

nttached to and forming part of srcr rolicy Number : BT-Pcv-298011000909

rt is hereby declared and agreed that effective incept'ion date the following warranties and clauses are
deemed included:
ROADSIDE ASSISTANCE PROGRAM
PERSONAL ACCIDENT INSURANCE COVER FOR UNN,{MED DRIVER AND PASSENGER
php 5OOOO EACH WITH 10% MEDICAL REIMBURSEMENT

STANDARD MOTOR VEHICLE ATTACHMENT

FREE UPA P1OOOOO FOR NAMED INSURED
*+*+++**r.+*************************************+*****n******+
rt is hereby further agreed and understood that the coverage under this rolicy'is suspended and shall be
considered null and void when the scheduled veh'icle is used or converted to the following:
negular .raxi
ai rport Tax'i
\ Tourist service :
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hn uv Express
s-
Transport Network vehicle system (GRAB and UBER ET AL.) $
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L ri4poRTANT REMTNDER:(For accessories being added to the unit insured) o'
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rhe shall not be liab"le to pay for any loss &/or damage in respect of any c'laim on any
company o
.-o a accessory/ accessories being added to the unit insured subsequent to poliey issuance in the Q-
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event the nssured fails to confer necessary declaratJon for thej inclusion of said accessory/accessories
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IMPORTANT NOTICE
please be advised that the standard motor car policy coverage is suspended whilst the subject motor car
is on board sea-faring vessels sailing inter-island within the ehilippines.
tt is therefore recommend that you secure a marine cargo policy to cover your motor car aga'inst
loss or damage occuring during the above-mentioned transit.
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rindly inform your insurer on any changes made on your insured unit,

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