LAND TRANSPORTATION OPERATOR'S VEHICLE Client's Copy
CONFIRMATION OF COVER NO. 091L360040
AUTHENTICATION NO.: 091UUSVN1809 POLICY NO. GS-LTA-300546824 NAME AND ADDRESS OF INSURED BUSINESS DATE ISSUED TOMAS G. JAENA New Business 06/26/2018 AGENT'S CODE 30000129 PAID UNDER O.R. NO. Poblacion PERIOD OF INSURANCE Koronadal City S.Cotabato FROM 06/26/2018 TO 06/26/2019 SCHEDULED VEHICLE MAKE/MODEL/BODY TYPE SERIAL/CHASSIS NO. 2007 NISSAN URBAN SHUTTLE TVP4IEFE24A33703 PLATE NO. COLOR MOTOR NO. MV FILE NO. MVY556 GREEN TD27315259 130800000341411 THIRD PARTY LIABILITY / PASSENGER LIABILITY LIMIT OF LIABILITY 100,000 PER ACCIDENT (Subject to the Schedule Of Indemnities shown in the Master Policy) PREMIUMS This Confirmation of Cover is evidence of the policy of insurance required under insurance required under chapter VI - Compulsory Motor Vehicle Liability Insurance PREMIUM 880.00 RMA 230 of the Insurance Code amended by Presidential Decree No. 1814 PREMIUM TAX 105.60 Rev. 3-0 07/01/2009 DST 110.00 LGT 4.40 TOTAL 1,100.00 RMA 230 John B. Echauz Annabelle C. Obed AUTHENTICATION FEE 50.40 Rev. 3-2 President Manager/Branch Head 11/18/2016 TOTAL AMOUNT DUE 1,150.40
LAND TRANSPORTATION OPERATOR'S VEHICLE LTO Copy
CONFIRMATION OF COVER NO. 091L360040
AUTHENTICATION NO.: 091UUSVN1809 POLICY NO. GS-LTA-300546824 NAME AND ADDRESS OF INSURED BUSINESS DATE ISSUED TOMAS G. JAENA New Business 06/26/2018 AGENT'S CODE 30000129 PAID UNDER O.R. NO. Poblacion PERIOD OF INSURANCE Koronadal City S.Cotabato FROM 06/26/2018 TO 06/26/2019 SCHEDULED VEHICLE MAKE/MODEL/BODY TYPE SERIAL/CHASSIS NO. 2007 NISSAN URBAN SHUTTLE TVP4IEFE24A33703 PLATE NO. COLOR MOTOR NO. MV FILE NO. MVY556 GREEN TD27315259 130800000341411 THIRD PARTY LIABILITY / PASSENGER LIABILITY LIMIT OF LIABILITY 100,000 PER ACCIDENT (Subject to the Schedule Of Indemnities shown in the Master Policy) PREMIUMS This Confirmation of Cover is evidence of the policy of insurance required under insurance required under chapter VI - Compulsory Motor Vehicle Liability Insurance PREMIUM 880.00 of the Insurance Code amended by Presidential Decree No. 1814 PREMIUM TAX 105.60 DST 110.00 LGT 4.40 TOTAL 1,100.00 RMA 230 John B. Echauz Annabelle C. Obed AUTHENTICATION FEE 50.40 Rev. 3-2 President Manager/Branch Head 11/18/2016 TOTAL AMOUNT DUE 1,150.40