GROUPPERSONALACCIDENTINSURANCEPOLICYSCHEDULE PolicyNo: GPAHO003527

IssuingOffice: DateIssue: November/09/2015 ReplacingPolicyNo:

NAMEANDADDRESS: Premium : 31,435.12

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KENNARDSECURITYAGENCY DocumentrayStamps : 79.00
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CEBUCITY,CEBU PremiumTax : 628.70
(BURIALASSISTPLANB) xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
LGT(LocalGov.Tax) : 157.18
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TotalAmountDue : 32,300.00
PolicyPeriod: PolicyPeriod:

From: 12:00o'clocknoon October27,2015 To: 12:00o'clocknoon October27,2016 AgentCode : T182 /

NUMBEROFPERSONS : 129

COVERAGE LIABILITY
AccidentalDeath/Disablement 50,000.00 /PERSON
BurialAssistanceDuetoAccident 50,000.00 /PERSON
Total 100,000.00

1.
2.ACCIDENTBURIALEXPENSEBENEFIT
3.AggregateLimitofIndemnity
4.DOCUMENTARYSTAMPSADVISORY
5.POLITICALRISKEXCLUSIONCLAUSE
6.TERRORISMEXCLUSIONCLAUSE
7.WARANDTERRORISMEXCLUSIONENDORSEMENT

VISAYANSURETYANDINSURANCECORPORATION

RACHELM.LACUESTA
BranchManager