This document is an endorsement for an insurance policy for Ludy Quimbo Datol, covering a Mitsubishi Xpander with an insured amount of 1,216,000.00. The policy is effective from September 27, 2024, to September 27, 2025, with no additional premium charged. All other terms and conditions remain unchanged except for the specified coverage and premium adjustments.
This document is an endorsement for an insurance policy for Ludy Quimbo Datol, covering a Mitsubishi Xpander with an insured amount of 1,216,000.00. The policy is effective from September 27, 2024, to September 27, 2025, with no additional premium charged. All other terms and conditions remain unchanged except for the specified coverage and premium adjustments.
This document is an endorsement for an insurance policy for Ludy Quimbo Datol, covering a Mitsubishi Xpander with an insured amount of 1,216,000.00. The policy is effective from September 27, 2024, to September 27, 2025, with no additional premium charged. All other terms and conditions remain unchanged except for the specified coverage and premium adjustments.
This document is an endorsement for an insurance policy for Ludy Quimbo Datol, covering a Mitsubishi Xpander with an insured amount of 1,216,000.00. The policy is effective from September 27, 2024, to September 27, 2025, with no additional premium charged. All other terms and conditions remain unchanged except for the specified coverage and premium adjustments.
ENDORSEMENT : CBS-01236833 ENDORSEMENT DATE : SEP. 30, 2024 INSURED NAME/ADDRESS LINE OF BUSINESS POLICY NO. AMOUNT INSURED DATOL, LUDY QUIMBO MotorCar-CV CBS-CV-2024-00003192 1,216,000.00 EXPIRY DATE PREMIUM BLK36, LOT1 FATIMA ST. DAANGHARI NAVOTAS NCR September 27, 2025 ADDITIONAL RETURN THIRD DISTRICT 1485 MODEL : 2025 MAKE : : MITSUBISHI BODY TYPE : XPANDER GLS 1.5G 2WD AT PLATE NO. : GU197A SERIAL/CHASSIS : MK2LRNC1WSN011061 COLOR : RED METALLIC MOTOR NUMBER : 4A91KCL6033 MV FILE : T.I.N : ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- IT IS HEREBY DECLARED AND NOTED IN THE BOOKS OF THE COMPANY THAT THE CORRECT TERM OF INSURANCE AND ADDITIONAL ACTS OF GOD UNDER THIS POLICY SHOULD BE AS FOLLOWS AND NOT AS PREVIOUSLY STATED :
F R O M : SEP. 27, 2024
T O : SEP. 27, 2025 ADDITIONAL ACTS OF GOD
IN VIEW THEREOF, AN ADDITIONAL PREMIUM IN THE AMOUNT OF P0.00 INCLUSIVE OF
CHARGES IS HEREBY CHARGED TO THE ASSURED.
EXCEPT AS HEREIN VARIED ALL OTHER TERMS, CONDITIONS, CLAUSES AND WARRANTIES REMAIN THE SAME.
ADDITIONAL /(RETURN) CORRECT PREMIUM COMPUTATION
PERIL COVERAGE PREMIUM CHARGES PERIL COVERAGE PREMIUM CHARGES -------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- TPL 0.00 0.00 DS 0.00 TPL 0.00 0.00 DS 0.00 OWN DAMAGE 0.00 -4,547.23 EVAT 0.00 OWN DAMAGE 1,216,000.00 14,564.64 EVAT 0.00 THEFT (INCLUDED) LGT 0.00 THEFT 1,216,000.00 (INCLUDED) LGT 0.00 EBI 0.00 0.00 Others 0.00 EBI 200,000.00 510.00 Others 0.00 TPPD 0.00 0.00 TPPD 200,000.00 1,320.00 PA(5)@ 0.00 0.00 PA(5)@ 10,000.00 300.00 AON 0.00 4,547.23 AON 1,216,000.00 4,547.23 -------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- Total Php 0.00 Php 0.00 Total Php 21,241.87 Php 5,236.13 TOTAL AMOUNT Php 0.00 TOTAL AMOUNT Php 26,478.00 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Nothing herein contained shall be held to vary, alter, waive or change of the terms, limit or conditions except as herein above set fort.
Conforme:_______________________________ Assured NOTE: Only the following items may be corrected/altered by this endorsement. 1. Name of Assured 7. Location of Property Insured 2. Change/Correct Address 8. Change/Correct Mortagagee 3. Period of Cover 9. Correct Boundaries EDWARD PHILIP E. DELA CRUZ 4. Cancellation 10. Correct Premium/Rate VICE PRES-CORP.AFFAIRS, SALES & MKTG 5. Reduction/Additional Coverage 11. Correct Serial/Motor/Plate Number 6. Description of Property Insured
