PREMIUM PAID
LOGO
ALPHA INSURANCE CENTRE
1025 San Marcelino St., Ermita, Manila
Trunkline 525-1301 / Fax No. 522-6131
TIN 321-000-433-024-VAT
CONFIRMATION OF COVER
NON-LAND TRANSPORTATION OPERATIORS VEHICLE
(CLIENT COPY)
COC No.
AUTHENTICATION CODE:
POLICY NO.
-
NAME AND ADDRESS OF INSURED
BUSINESS/PROFESSION
AGENT ID:
DATE ISSUE
OFFICIAL RECIEPT NO
FROM 12:00 Noon
TO 12:00 Noon
MODEL
MAKE
TYPE OF BODY
COLOR
MV FILE NO.
PLATE NO.
SERIAL/CHASSIS NO.
MOTOR NO.
AUTHORIZED CAPACITY
-
UNLADEN WEIGHT
-
SECTION I/II
THIRD PARTY LIABILITY
SUBJECT TO THE SCHEDULE OF IMDEMNITIES BELOW
AMOUNTS
LIMIT OF LIABILITY
PASSENGER LIABILITY
This confirmation of Cover is evidence of the policy of Insurance required under
Chapter VI Compulsory Motor Vehicle Liability Insurance, of the Insurance
Code, as amended by Presidential Decree No. 1814
Chapter VI Compulsory Motor Vehicle Liability Insurance, of the Insurance
Code, as amended by Presidential Decree No. 1814
SIGNATURE
RAYMOND O. MORALES
AUTHORIZED SIGNATURE
✂
|
A. DEATH INDEMNITY
Burial and Funeral Expenses
|
Ps 70,000.00 30,000.00 |
B. BODILY INJURIES AND FRACTURES
| Type of Accom. or Professional Attendance |
Service Rendered | Max Reimbursable Fees/and or Charges |
|---|---|---|
| 1. Hospital Rooms | Maximum of 45 days per accident Laboratory Examinations fees, X-Rays |
P 500.00 / day 2,000.00 |
| 2. Surgical Expenses | Major Operation Medium Operation Minor Operation |
7,500.00 5,000.00 1,500.00 |
| 3. Anesthesiologist’s Fee | Major Operation Medium Operation Minor Operation |
2,500.00 2,000.00 500.00 |
| 4. Operating Room | Major Operation Medium Operation Minor Operation |
1,500.00 1,000.00 500.00 |
| 5. Medical Expenses |
For Daily visits of Practitioner or specialist. The total amount of medical expenses must not exceed (for one period of confinement) |
400.00/day 5,000.00 |
| 6. Drugs and Medicine | Actual value of drugs and medicine but not exceed | 20,000.00 |
| 7. Ambulance | Actual amount charged for ambulance transport but not exceed | 1,500.00 |
|
C. PERMANENT DISABLEMENT
Loss of or the Loss of Use of:
Two Limbs P 50,000.00
Both Hands, or All Fingers & Both Thumbs 50,000.00
Both Feet 50,000.00
One Hand and One Foot 50,000.00
Sight of Both Eyes 50,000.00
Injuries resulting being permanently bedridden 50,000.00
Any other injury causing permanent disablement 50,000.00
Arm at or above elbow 20,000.00
Arm between elbow and wrist 15,000.00
Hand 15,000.00
Four Fingers and thumb of one Hand 15,000.00
Four Fingers 12,000.00
Leg at or above knee 20,000.00
Leg below knee 15,000.00
One foot 15,000.00
All toes of one foot 10,000.00
Thumb 8,000.00
Index Finger 6,000.00
Sight of one eye 20,000.00
Hearing – both Ears 30,000.00
|
COC No.
ALPHA INSURANCE CENTRE
1025 San Marcelino St., Ermita, Manila
Trunkline 525-1301 / Fax No. 522-6131
TIN 321-000-433-024-VAT
CONFIRMATION OF COVER
NON-LAND TRANSPORTATION OPERATIORS VEHICLE
(CLIENT COPY)