Private Car Policy

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PRIVATE CAR POLICY

AUTHORIZED DRIVER

Any of the following:

(a) The Insured

(b) Any person driving on the Insured’s order or with his permission.

Provided that the person driving is permitted, in accordance with the licensing law or other regulations, to
drive the Scheduled Vehicle, or has been permitted and is not disqualified by order of a Court of Law or by
reason of any enactment or regulation in that behalf, provided that for Sections I and II only of this Policy, an
authorized driver shall include a duly licensed driver but whose license at the time of the accident had expired.

LIMITATIONS AS TO USE

Use only for social, domestic and pleasure purposes, and for the Insured’s business or profession.

This policy does not cover:

(1) Use for the hauling and/or carrying of logs, lumber, sand, gravel, bottled beverages, gasoline
products and/or other inflammable articles or materials.

(2) Use for racing, pacemaking, reliability trial or speed testing.

N.B. Provided that limitations (1) and (2) above may be deleted and the risks named therein covered
by this Policy upon agreement by, and payment of 20% additional premium to the Company.

(3) Use for the carriage of PASSENGERS or for hire or reward.

(4) Use for any purpose in connection with the Motor Trade.

SECTIONS I and II of this Policy cover THIRD PARTY liability arising from bodily injury and/or death in
amounts set forth under the Schedule of Indemnities.

IN WITNESS WHEREOF, the Company has caused this Policy to be signed by its duly authorized officer/
representative at ……………………………………………………………... Philippines, this ……………… day of
………………………………... 20 ….....................

Documentary Stamps to the value stated above have been affixed and property cancelled on the office copy
of this Policy

Prudential Guarantee and Assurance, Inc.

COYIUTO HOUSE, 119 C. Palanca St., Legaspi Village, Makati City, 1229 Philippines
Tel. Nos.: (632) 8810-4916 / 8878-3000 / 8651-9500 | Fax: (632) 8819-2991
[email protected] | www.prudentialguarantee.com
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IMPORTANT NOTICE

The Insurance Commissioner, with offices in Manila, Cebu and Davao is the Government official in-charge of
the faithful execution and enforcement of all laws relating to insurance and has supervision over
insurance companies. He is ready at all times to render assistance in settling any controversy between an
insurance company and a policyholder relating to insurance matters.

PRUDENTIAL GUARANTEE AND ASSURANCE, INC.

ANTHONY G. SY
President & CEO

WHEREAS THE INSURED, by his corresponding proposal and declaration, and which shall be the basis of
this Contract and deemed incorporated herein, has applied to the company for the insurance hereinafter
contained, subject to the payment of the Premium as consideration for such insurance.
NOW THIS POLICY WITNESSETH:

That, in respect of events occurring during the period of Insurance, and subject to the terms, exceptions and
conditions contained herein or endorsed hereon (hereinafter collectively referred to as the Terms of this Policy):

SECTION I – LIABILITY TO THE PUBLIC

1. The Company will pay all sums necessary to discharge liability of the Insured, arising from all
expenses and damages directly resulting from any bodily injury and/or death to any Third Party
(excluding all moral, exemplary and other incidental damages, expenses and loss of income) in an
accident caused by the use of the Scheduled Vehicle, provided that the Insured’s liability shall have
first been determined, but not exceeding in the aggregate ₱100,000 per occurrence or any one
occurrence, regardless of the number or individual-claims.

2. In terms of and subject to the limitations of this Policy, the Company will indemnify; -

(a) Any authorized Driver who is driving the Scheduled Vehicle, provided that he: -

(i) Observes, fulfills and be subject to the Terms of this Policy insofar as they can apply;

(ii) is not entitled to indemnity under any other policy subject, however, to Condition No. 8 of the
Conditions Applicable To All Sections;

(b) the insured whilst personally driving a motor car not belonging to him and not hired to him
under a hire purchase agreement.

3. In the event of the death of any person entitled to indemnity under this Policy the Company will, in
respect of the liability incurred to such person indemnify his personal representatives in terms of, and
subject to the terms and conditions hereof.
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4. In the event accident involving indemnity under this Policy to more than one person, the Limits of
Liability shall not exceed the aggregate amount so specified by Law to all persons to be indemnified.
Should indemnification both to liability of the Insured and that of another party (as provided under
Authorized Driver) be provable, the Insured’s shall have prior right thereto.

5. Unless the Insured objects, the Company shall; -

(a) arrange for representation at any inquest or investigation in respect of any death which may be
the subject of indemnity under this Section;

(b) undertake the defense in the Insurance Commission under Section 385 of the Insurance Code,
or in any court of law, for alleged offenses causing, or relating to, any event which may be the
subject to indemnity under this Section.

SCHEDULE OF INDEMNITIES FOR BODILY INJURY AND/OR DEATH

The following schedule of indemnities shall be observed in the settlement of claims for death, bodily injuries,
professional fees and hospital charges, for services rendered to, traffic accident victims under the
Compulsory Motor Vehicle Liability Insurance Coverage.

A. DEATH INDEMNITY

Burial and Funeral Expenses ₱ 70,000.00
30,000.00

B. BODILY INJURIES AND FRACTURES -

Types of Accommodation Services Rendered Maximum Reimbursable
or Professional Fees and/or Charges
Attendance Extended

1. Hospital Rooms Maximum of 45 days per ₱ 500.00/day

accident Laboratory 2,000.00
Examination fees, X-rays

2. Surgical Expenses Major Operation 7,500.00
Medium Operation 5,000.00
Minor Operation 1,500.00

3. Anesthesiologist’s Fees Major Operation 2,500.00

Medium Operation 2,000.00
Minor Operation 500.00

4. Operating Room Major Operation 1,500.00

Medium Operation 1,000.00
Minor Operation 500.00

5. Medical Expenses For daily visits of 400.00/day

Practitioner or Specialists

The total amount of medical

expenses must not exceed
(For a single period of confinement) 5,000.00

6. Drugs and Medicine Actual value of drugs and medicine
used but not to exceed 20,000.00

7. Ambulance Actual amount charged for ambulance 1,500.00
transport but not to exceed
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C. PERMANENT DISABLEMENT AMOUNT

Loss of or Loss of Use of:

Two Limbs ₱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 in being permanently bedridden 50,000.00
Any other injury causing permanent total 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
Hearing – one Ear 15,000.00

D. OTHER INCIDENTAL EXPENSES

The Company will pay all pertinent and reasonable expenses incurred in connection with the
accident not provided under this Schedule of Indemnities (A), (B), and (C), subject to a maximum
amount of P10,000.00 but in no case shall the company’s aggregate payment exceed the overall
Limits of Liability under Sections I and II.

SECTION II – NO FAULT INDEMNITY

The Company will pay any claim for bodily injury and/or death to any THIRD PARTY without the
necessity of proving fault or negligence of any kind, provided that,

(a) the total indemnity in respect of any one THIRD PARTY shall not exceed Fifteen Thousand
Pesos, subject to the foregoing Schedule of Indemnities in case of death or physical
injury, without prejudice to the claimant from pursuing his claim further, in which case he
shall not be required or compelled by the Company to execute any Quit Claim or document
releasing it from liability under the policy of insurance.

(b) The following proofs of loss, when submitted under oath, shall be sufficient evidence to
substantiate the claim; -

(i) Police report of accident or any evidence sufficient to establish the accident, and

(ii) Medical report and evidence of medical or hospital expenses and/ or;

(iii) Death Certificate and evidence sufficient to establish the proper payee.
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SECTION III – LOSS OR DAMAGE

1. The Company will, subject to the Limits of Liability, indemnify the Insured against loss of or damage
to the Scheduled Vehicle and its accessories and spare parts whilst thereon: -

(a) by accidental collision or overturning, or collision or overturning consequent upon mechanical

breakdown or consequent upon wear and tear;

(b) by fire, external explosion, self-ignition or lightning or burglary, housebreaking or carnapping, or

any unlawful taking of the car accessories or any part whilst thereon, but excluding those
committed by an employee of the insured or any person or persons to whom the scheduled
vehicle has been entrusted;

(c) by malicious act;

(d) whilst in transit (including the processes of loading and unloading) incidental to such transit by
road, rail, inland waterway, lift or elevator.

2. At its own option, the Company may pay in cash the amount of the loss or damage, or may repair,
reinstate or replace the Scheduled Vehicle or any part thereof or its accessories or spare parts. The
Liability of the Company shall not exceed the value of the parts lost or damaged and the reasonable
cost of fitting such parts or the value of Scheduled Vehicle at the time of the loss or damaged,
whichever is the less. The Insured’s estimate of value stated in the Schedule shall be the maximum
amount payable by the Company in respect of any claim loss or damage.

3. In the event of a claim being payable under Section III of this Policy for the cost of replacement parts,
the amount of settlement shall be the cost of brand new part(s) to replace the damaged part(s) of the
insured vehicle less the share of the Insured on the cost of the replacement parts computed based
on the following depreciation schedule:

Age of Vehicle Rate of Depreciation

(Share of the Insured)

Up to 3 years Nil
Over 3 years up to 4 years 20%
Over 4 years up to 5 years 25%
Over 5 years up to 6 years 30%
Over 6 years up to 7 years 35%
Over 7 years 40%
Batteries, Tires, Ball Joints, Tie Rods, and Shock 45%
Absorbers (for vehicles over three (3) years old)

It is further declared and agreed that in case of the total loss of the vehicle insured this Clause
shall not apply but the settlement shall be based on the provisions of Section III, Paragraph
No. 2 of the Policy.

4. If the Scheduled Vehicle is disabled by reason of loss or damage insured under this Policy, the
Company will, subject to the Limit of Liability for towing, bear the reasonable cost of protection
and removal to the nearest repairer.

5. The Insured may authorize the repair of the Scheduled Vehicle necessitated by damage for
which the Company may be liable under this Policy, provided that: -

(a) the estimated cost of such repair does not exceed the Authorized Repair Limit and;

(b) a detailed estimate of the cost is forwarded to the Company without delay.
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6. In the event of loss or damage to the Scheduled Vehicle or its accessories or spare parts
necessitating the supply of a part not obtainable from stocks held in the Philippines, or in the
event of the Company exercising the option under Paragraph 2 to pay in cash the amount of
the loss or damage, the liability of the Company in respect of any such part shall be limited to: -

(a) i) the price quoted in the latest catalogue or price list issued by Manufacturer or his Agents
for the Philippines or

ii) if no such catalogue or price list exists, the price last obtaining at the Manufacturer’s
Works plus the reasonable cost of transport other than by air, to the Philippines, and the
amount of the relative import duty, and;

(b) the reasonable cost fitting such part.

7. This policy shall be operative whilst the Scheduled Vehicle is being used for the purpose of
towing any one disabled mechanically propelled vehicle provided that –

(a) such towed vehicle is not towed for reward;

(b) the company shall not be liable in respect of damage to such towed vehicle or property
being conveyed thereby.

EXCEPTIONS TO SECTION III

The Company shall not be liable to pay for: -

1. Loss or Damage in respect of any claim or series of claims arising out of one event, the first amount
of each and every loss for each and every vehicle insured by this Policy, such amount being equal to
one half of one percent (0.50%) of the Insured’s estimate of Fair Market Value as shown in the Policy
Schedule with a minimum deductible amount of PHP 2,000.00;

2. Consequential loss, depreciation, wear and tear, mechanical or electrical breakdowns, failures
or breakages

3. Damage to tires, unless the Scheduled Vehicle is damaged at the same time;

4. Any malicious damage caused by the Insured, any member of his family or by a person in the
Insured’s service

SECTION IV – EXCESS LIABILITY INSURANCE

1. The Company will, subject to the Limits of Liability, reimburse the Insured for all sums actually
paid by the Insured to discharge liability in accordance with all the provisions of Section I
except the Limits of Liability for Section I but only in excess of: -

(a) The Limits of Liability for Sections I and II of this Policy, when such limits have been
exhausted or;

(b) The liability limits required for the Scheduled Vehicle under Section 377 of the Insurance
Code, as amended in the event no coverage exists as described in paragraph (a) above.
Coverage under this paragraph is not subject to the Schedule of Indemnities under
Section I.

2. The Company will, subject to the Limits of Liability, pay all sums necessary to discharge liability
of the Insured, in respect of damage to Third Party property in an accident caused by and
arising out of the use of the Scheduled Vehicle, or in connection with the loading or unloading
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of the Scheduled Vehicle, provided that the Insured’s liability shall have first been determined
either by final court judgment after actual trial, or by written agreement of the Insured, the
Claimant, and the Company. Provided, further, that the Company shall not be liable in respect
of damage to property belonging to the Insured, or held in trust by, or in the custody or control
of the Insured or any member of the Insured’s household, or being conveyed by the Scheduled
Vehicle.

For the purpose of this Paragraph, Scheduled Vehicle shall include any Private Car whilst being
personally driven by the insured not belonging to him and not hired to him under a hire purchase
agreement.

GENERAL EXCEPTIONS

The Company shall not be liable under any Section of this Policy in respect of: -

1. Any accident, or liability caused, or incurred

(a) outside the Republic of the Philippines.

(b) whilst the Scheduled Vehicle is:

(i) being used otherwise than in accordance with the limitations as to use;

(ii) being driven by any person other than an Authorized Driver;

(iii) on board a sea vessel on the inter-island transit;

2. Any liability which attached by virtue of an agreement but which would not have attached in
the absence of such agreement, except liability arising out of an on the spot agreement or
amicable settlement of minor accident to avoid impairing the flow of traffic.

3. Except in respect of claims arising under Sections I and II of this policy, any accident, loss,
damage or liability directly or indirectly, proximately or remotely occasioned by, contributed to
by, or traceable to, or arising out of, or in connection with flood, typhoon, hurricane, volcanic
eruption, earthquake or other convulsion of nature, invasion, the act of foreign enemies,
hostilities or warlike operations (whether war be declared or not), strike, riot, civil commotion,
mutiny, rebellion, insurrection, military or usurped power, or by any direct or indirect
consequences of any of the said occurrences and in the event of any claim hereunder, the
Insured shall prove that the accident, loss or damage or liability arose independently of, and
was in no way connected with, or occasioned by, or contributed to, any of the said
occurrences, or any consequence thereof, and in default of such proof, the Company shall not
be liable to make any payment in respect of such a claim.

4. Any sum which the Insured would have been entitled to recover from any party but for an
agreement between the Insured and such party.

5. Bodily injury and/or death to any person in the employ of the Insured arising out of and in the
course of such employment, or bodily injury and/or death to any member of the Insured’s
household who is riding the Scheduled Vehicle.

DEFINITIONS

1. MOTOR VEHICLE is any vehicles as defined in Section Three, paragraph (a) of Republic
Act – Numbered Four Thousand One Hundred Thirty-Six, otherwise known as the “Land
Transportation and Traffic Code”.
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2. THIRD PARTY is any person other than a PASSENGER as defined in the law and shall also
exclude a member of the household, or a member of the family within the second degree of
consanguinity or affinity, of a motor vehicle owner or his employee in respect of death, bodily
injury or damage to property arising out of and in the course of employment.

CONDITIONS APPLICABLE TO ALL SECTIONS

1. This Policy and the Schedule shall be read together, as one contract, and any word or
expression to which a specific meaning has been attached in any part of this Policy or of the
Schedule shall bear such specific meaning wherever it may appear.

2. Every notice or communication to be given or made under this Policy shall be delivered in
writing to the Company.

3. The Insured shall take all reasonable steps to safeguard the Scheduled Vehicle from loss or
damage and to maintain the Scheduled Vehicle in efficient condition, and the Company
shall have at all times free and full access to examine the Scheduled Vehicle or any part thereof or
any driver or employee of the Insured. In the event of any accident or breakdown, the
Scheduled Vehicle shall not be left unattended without proper precaution being taken to
prevent further loss or damage and if the Scheduled Vehicle be driven before the necessary
repairs are effected, any extension of the damage or any further damage to the Scheduled
Vehicle shall be excluded from the scope of the indemnity granted by this Policy.

4. In the event of any accident which may give rise to a claim under this Policy, the Insured
shall, as soon as possible, give notice thereof to the Company with full particulars. Every letter,
claim, writ, summons and process shall be notified or forwarded to the Company immediately
on receipt. Notice shall also be given to the Company immediately as soon as the Insured
shall have knowledge of any impending prosecution, inquest or fatal inquiry in connection with
any such occurrence. In case of carnapping or other criminal act which may give rise to a claim
under this Policy, the Insured shall give immediate notice to the Police and cooperate with the
Company in securing the conviction of the offender.

5. Without prejudice to No. 2 of the General Exceptions, no admission, offer, promise or payment
shall be made by or on behalf of the Insured without the written consent of the Company which
shall be entitled to take over the conduct in his name the defense or settlement of any claim,
or to prosecute in his name for its own benefit any claim for indemnity or damages or
otherwise, but shall not exercise any discretion prejudicial to the interest of the insured in the
conduct of any proceedings in the settlement of any claim, and the insured shall give all such
information and assistance as the Company may require. If the Company shall with the consent
of the Insured make any payment in settlement of any claim, and such payment includes any
amount not covered by this Policy, the Insured shall repay the Company the amount not so
covered.

6. At any time after the happening of any event giving rise to a claim or series of claims under
this Policy, the Company may pay to the Insured and the Third Party claimant jointly the full
amount of the Company’s liability and relinquish the conduct of any defense, settlement or
proceedings, and the Company shall not be responsible for any damage alleged to have been
caused to the Insured in consequence of any alleged action or omission of the Company in
connection with such defense, settlements or proceedings or of the Company relinquishing
such conduct, nor shall the Company be liable for any costs or expenses whatsoever incurred
by the Insured or any claimant or other person after the Company shall have so relinquished.

7. The Company may cancel this Policy in accordance with Sections 64, 65, and 380 of the
Insurance Code, in which case, the Company shall thereupon return to the Insured premiums
paid less the pro rata portion thereof for the period when the Policy has been in force. The
Insured may, at any time, cancel the Policy by surrendering it to the Company and (provided
no claim has arisen during the then current period of Insurance) the insured shall be entitled
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to a return of the premium at the Company’s Short Period Rates for the period when the policy
has been in force. However, in respect of Sections I and II, the cancellation made by the
Insured shall not be effective unless he has secured a similar policy of insurance or surety bond
to replace the policy to be cancelled or make a cash deposit in sufficient amount with the
Commissioner and without any gap file within five (5) working days from the date of
cancellation the required documentation with the Bureau of Land Transportation in accordance
with Section 381 of the Insurance Code.

8. If, at the time any claim arises under this Policy, there is any other insurance covering the same
loss, damage or liability, the Company shall not be liable to pay or contribute more than its
ratable proportion of any loss, damage, compensation, costs or expenses. Provided always
that nothing in this Condition shall impose on the Company any liability from which, but for this
Condition it would have been relieved under proviso (ii) of Section 1-2 of this Policy.

9. Except in case of claims arising under Sections I and II of this Policy, if any difference or
dispute shall arise with respect to the amount of the Company’s liability under this Policy, the
same shall be referred to the decision of a single arbitrator, to be agreed upon by both parties
or, failing such agreement of a single arbitrator, to the decision of two arbitrators, one to be
appointed in writing by each of the parties within one calendar month after having been
required in writing to do so by either of the parties and, in case of disagreement between the
arbitrators, to the decision of an umpire who shall have been appointed in writing by the
arbitrators, before entering on the reference, and the costs of and expenses incidental to the
reference shall be dealt with in the award. And it is hereby expressly stipulated and declared
that it shall be a condition precedent to any right of action or suit upon this Policy that the
award by such arbitrators or umpire of the amount of the Company’s liability hereunder, if
disputed, shall be first obtained. If a claim be made and rejected, and an action or suit be not
commenced within twelve months after such rejection, or in case of an arbitration taking place
as provided herein, within twelve months after the arbitrator or arbitrators or umpire shall have
made their award, then the claim shall, for all purposes, be deemed to have been abandoned
and shall not hereafter be recoverable hereunder. Provided, however, that in case of any
dispute in the enforcement of the provisions of Section I and Section II of this Policy, the
adjudication of such dispute shall be within the original and exclusive jurisdiction of the
Insurance Commissioner, subject to the limitations provided in Section 416 of the Insurance
Code, as emended.

10. The due observance and fulfillment of the Terms of this Policy, insofar as they relate to anything
to be done or not to be done by the Insured, and the truth of the statements and answer in
the proposal, shall be conditions precedent to any liability of the Company to make any
payment under this Policy.

11. In the event that the Company should pay or be held liable pay any claim or claims under the
“No Fault” provisions of the Insurance Code, the Insured shall reimburse the Company all such
sums, whenever the Insured or his authorized driver or representative has committed a breach
of any of the warranties, clauses or conditions of the Policy, or whenever the circumstances fall
under any of the EXCEPTIONS listed in the Policy, for which the Company would not have
been liable were it not for the application of the “No-Fault” provision of the Insurance Code.

NUCLEAR EXCLUSIONS CLAUSE

1. This Policy does not cover; -

(a) Loss or destruction of, or damage to any property whatsoever or any loss or expense
whatsoever resulting or arising therefrom, or any consequential loss;

(b) Any legal liability of whatsoever nature, directly or indirectly caused, by or contributed to
by, or arising from, ionizing radiations or contamination by radioactivity from nuclear fuel,
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or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this
exclusion only combustion shall include any self-sustaining process of nuclear fission.

2. The indemnity provided by this Policy shall not apply to nor include any loss, destruction,
damage or legal liability directly or indirectly caused by contributed to, by, or arising from,
nuclear weapons material.

CIVIL CODE ARTICLE 1250 WAIVER CLAUSE

IT IS HEREBY DECLARED AND AGREED that the provision of Article 1250 of the Civil Code of the
Philippines (Republic Act No. 386) which reads: -

“In case of extraordinary inflation or deflation of the currency stipulated should supervene, the value
of the currency at the time of the establishment of the obligation shall be the basis of payment….”
shall not apply in determining the extent of liability under the provisions of this Policy.

SHORT PERIOD RATE SCALE

It is hereby agreed, in the event this Policy is surrendered by the Insured for cancellation, the Company shall
retain a premium in accordance with the following scale for the time the Policy has been in force: -

No. of Month/s 1 2 3 4 5 6 7 8 9 10 11

Percentage 20 30 40 50 60 70 75 80 85 90 95
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Dear Auto Insurance Policy Holder,

Introducing the Prudential Guarantee Auto Insurance Roadside Assistance Program.

For roadside assistance, Prudential Guarantee’s Auto Insurance Roadside Assistance Program is there
to extend the following special privileges for FREE, 24 hours a day, exclusively for all privately-use vehicles
insured under Prudential Guarantee’s Comprehensive Auto Insurance.

FREE TOWING SERVICE

In the event of breakdown or accident involving the insured vehicle, Prudential Guarantee will provide towing
services to transport the insured vehicle to the nearest accredited repair facility.

FREE VEHICLE RETRIEVAL

In the event of an accident, insured vehicle fell into a ravine or canal. Prudential Guarantee will arrange its
removal up to an agreed limit of FIFTEEN THOUSAND PESOS (PHP 15,000.00) and bring the vehicle to the
nearest accredited shop.

FREE VEHICLE BREAKDOWN SERVICE

In event of breakdown involving the insured vehicle, Prudential Guarantee will provide minor on-site repairs
such as changing of tires, battery boosting, jump start, car lockout, fuel delivery (cost of fuel not included) &
delivery of spare key.

SPECIAL TOWING
Prudential Guarantee will cover towing for a Covered Vehicle with an expired Comprehensive Motor Insurance
Policy provided that the date of the accident happened during the effectivity period of the enrolled Covered
Unit. This benefit is only valid when towing is within one hundred eighty (180) calendar days from the expiry
date of Policy of the Covered Vehicle.

SECONDARY TOWING
Service by which a vehicle, which cannot be driven, is transported from a location other than the place of
breakdown to the nearest repair shop.

TOWING ASSISTANCE TO THIRD PARTY

In the event that the Covered Vehicle is confirmed to be at fault in an accident/collision with another vehicle as
indicated in a Police Report or Affidavit, the Service Provider will extend the towing assistance of the involved
Third Party Vehicle up to an agreed limit of FIVE THOUSAND PESOS (PHP 5,000.00) to the nearest accredited
repair facility.

FREE AMBULANCE COORDINATION SERVICE

In the event of an accident involving the Covered Vehicle and upon request of the Beneficiary or any of the
passengers of the Covered Vehicle, Prudential Guarantee will arrange for an ambulance service to transport
the injured passengers from the place of accident to the nearest medical facility. Cost of ambulatory service
shall be for account of Insured except for the TWO THOUSAND (PHP2,000.00) which may be reimbursed.

FREE ALTERNATIVE TRANSPORT TO DESTINATION

In the event of breakdown or accident involving the insured vehicle outside Metro Manila, where immediate
repair is not feasible WITHIN 24 HOURS, or alternative transport is not immediately available, Prudential
Guarantee will provide upon request of the client the appropriate vehicle to bring the insured to the desired
destination.

Prudential Guarantee and Assurance, Inc.

COYIUTO HOUSE, 119 C. Palanca St., Legaspi Village, Makati City, 1229 Philippines
Tel. Nos.: (632) 8810-4916 / 8878-3000 / 8651-9500 | Fax: (632) 8819-2991
[email protected] | www.prudentialguarantee.com
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FREE ALTERNATIVE OVERNIGHT ACCOMODATION

In the event of breakdown or accident involving the insured vehicle, outside Metro Manila, where immediate
repair is not feasible WITHIN 24 HOURS, or alternative transport is not immediately available, Prudential
Guarantee will provide for the client an appropriate hotel overnight accommodation (standard room only).

ASSISTANCE REPATRIATION OF MORTAL REMAINS OF BENEFICIARY

In the event of death of Insured (caused by road accident with the Covered Vehicle), the SERVICE PROVIDER
will arrange for the repatriation of the mortal remains to the usual place of residence for burial.

ARRANGEMENT FOR FUNERAL SERVICES

Upon request of the Insured or his/her immediate family member, Prudential Guarantee shall arrange for the
funeral services of the Insured or deceased passenger/s of the Covered Vehicle, through its accredited
mortuary service providers. Cost of mortuary services shall be for the account of the Insured or his/her
immediate family.

APPOINTMENT WITH HEALTH PROFESSIONALS

In the event that the Insured needs medical attention of follow-up consultations for any health related
concerns even those not involving the use of the Covered Vehicle. PRUDENTIAL GUARANTEE shall arrange the
preferred schedule and appointment to the medical doctor or medical facility of their choice. Costs of the
services shall be for the account of the Insured.

TAXI SERVICES
In the event that the Insured requires taxi services, Prudential Guarantee will arrange and dispatch the taxi
service (including Uber and Grab) within Metro Manila. Cost of this service shall be for the account of the
Insured.

MINOR ON SITE REPAIR

• Fuel Delivery
If the covered Vehicle runs out of fuel, Insured may request Prudential Guarantee to provide up to an
agreed number of liters the Insured will pay for the cost of fuel.

• Battery Boosting/Jumpstarting
If the Covered Vehicle does not start due to battery problem, the Service Provider will take care of battery
boosting or jumpstarting thru an accredited technician.

• Locksmith Service
If the Insured cannot access the Covered Vehicle due to the keys being locked inside the vehicle, Prudential
Guarantee will send a locksmith to open the vehicle door and will pay for the locksmith’s charges and travel
expenses.

• Tire Replacement
If the Covered Vehicle has punctured tire, The Service Provider will send an accredited technician to replace
it with spare.

• Delivery of Spare key

If the Insured cannot access the Covered Vehicle due to the keys being locked inside, stolen or lost,
defective or malfunctioning, Prudential Guarantee shall pick-up the Covered Vehicle Spare Key in the
Beneficiary’s Home or Office subject to approval and coordination with the Insured with the spare key
keeper, for the Prudential Guarantee to deliver it onsite.

FREE EMERGENCY MESSAGE RELAY SERVICE

Upon client’s request, Prudential Guarantee will provide services to convey urgent messages concerning the
vehicle breakdown or accident.
 Auto Insurance Policy
Page 3 of 3

FREE INFO SERVICE

• 24/7 Traffic Information and Road Condition

• Nearest Gasoline Station
• Emergency Numbers (Police, Hospitals, Fire Station, etc.)
• Weather Information
• Basic Claims Information
• Directory Assistance
• Driving Direction Assistance

Prudential Guarantee Auto Insurance Program is another quality service from the country’s leading insurer
always with your safety and convenience in mind.

For emergency assistance, please call our hotline no. (02) 8459-4734.

For breakdown/ non-accident related cases, the insured is entitled to avail these benefits but not exceeding
3 times per policy year.

Very truly yours,

ANTHONY G. SY
President & CEO

rma/adp
 Traffic Accident Situation Form
Page 1 of 3

TRAFFIC ACCIDENT SITUATION FORM

NOTE: This Form is NOT a substitute for the Police Report

IMPORTANT NOTICE

This Form shall be accomplished and signed by the parties involved in a vehicular accident without waiting
for the traffic investigator (especially if the vehicles are obstructing the flow of traffic). This Form when
accomplished and signed by the parties must be binding upon them and should be recognized by the
Insurers of the vehicles involved. After the completion of this Form, the vehicles involved may be moved and
parked where they will not obstruct the flow of traffic.

Date of Accident: _________________________________________________________________________________

Time: ____________________________________________________________________________________________

Location of Accident: _____________________________________________________________________________

VEHICLES INVOLVED IN ACCIDENT

Vehicle 1
Make / Type / Model: Reg. Cert. No.:
Plate No.: Official Receipt No.: Date:
Owner: Tel. No.:
Address:

Driver: Tel. No.:

License No.: Official Receipt No.: Date:
Insurance Company: Policy No.:

Vehicle 2
Make / Type / Model: Reg. Cert. No.:
Plate No.: Official Receipt No.: Date:
Owner: Tel. No.:
Address:

Driver: Tel. No.:

License No.: Official Receipt No.: Date:
Insurance Company: Policy No.:

Prudential Guarantee and Assurance, Inc.

COYIUTO HOUSE, 119 C. Palanca St., Legaspi Village, Makati City, 1229 Philippines
Tel. Nos.: (632) 8810-4916 / 8878-3000 / 8651-9500 | Fax: (632) 8819-2991
[email protected] | www.prudentialguarantee.com
TIN-000-491-813
 Traffic Accident Situation Form
Page 2 of 3

Vehicle 3
Make / Type / Model: Reg. Cert. No.:
Plate No.: Official Receipt No.: Date:
Owner: Tel. No.:
Address:

Driver: Tel. No.:

License No.: Official Receipt No.: Date:
Insurance Company: Policy No.:

The Parties agree to the sketch / sketches of the accident overleaf.

For Vehicle I
Name / Signature

For Vehicle II
Name / Signature

For Vehicle III

Name / Signature

FRAUD NOTICE

Any person who presents or causes to be presented any fraudulent claim for the payment of a loss under a
contract of insurance, and fraudulently prepares, makes or subscribes any writing with intent to present or use
the same, or to allow it to be presented in support of any such claim, commits insurance fraud, which shall
merit a corresponding penalty, as provided under Section 251 of the Insurance Code, as amended.

DECLARATION

By transacting with Prudential Guarantee and Assurance, Inc. (PGAI), I hereby allow and authorize PGAI to
collect, use and process my personal data provided in this form and its attachments in accordance with
PGAI’s Privacy Notice and all applicable laws. I agree to be bound by the Data Privacy Act of 2012 and
related laws, rules and regulations. I understand that my personal data may be made available to PGAI’s
agents, affiliates, brokers, service providers, third-party companies and government bodies whenever
necessary. By freely and voluntarily providing personal data to PGAI, I am confirming that they are true
and correct. I understand that PGAI reserves the right to revise any decision made on the basis of the data
provided should the same be found untrue or incorrect. I hold PGAI, its agents and affiliates,
brokers, service providers and, where applicable, third-party companies free and harmless from any
liability which may arise as a result of the authorization herein given.

PGAI shall collect, process, use, store, record and update my personal data necessary for securing an
insurance contract and other related purposes. The same may be shared, disclosed, or transferred to
agents, affiliates, brokers, service providers of PGAI and government bodies authorized by law to receive
such information. PGAI shall retain all information provided for a period necessary to fulfill the aforesaid
purposes, unless a longer retention period is required or permitted by law. Such personal data shall be
treated with utmost confidentiality and shall be accessed by authorized personnel only. In accordance
with the Data Privacy Act of 2012, data subjects shall have the right to access their personal data to correct,
update or supplement any false, inaccurate or incomplete information. Should there be any question,
please contact the Data Protection Officer of PGAI through 8878-3000 loc. 7284.

Signature over Printed Name Date Signed

 Traffic Accident Situation Form
Page 3 of 3

POSITION OF VEHICLES INVOLVED IN ACCIDENT

Date of Accident: Time:

Location of Accident:

I. POSITION UPON IMPACT

(Position of the cars involved when the impact occurred)

II. POSITION AFTER IMPACT

(Position of the cars involved if they were pushed or drifted outside of the impact position)
 IMPORTANT NOTICE

Dear Insured:

We would like to remind all clients that all taxes should be paid immediately
upon receipt of the policy. This is in accordance with BIR Revenue Regulation
(RR) Number 9-2000 dated August 31, 2000, BIR Revenue Regulation (RR)
Number 15-2001 dated October 16, 2001 and Insurance Commission’s Circular
letter Number 7-2002 directed to insurance companies to remit taxes within the
month of issuance.

No refund of documentary stamps on flat or pro rata cancellation will be

entertained. Moreover, full payment of documentary stamps is required and
deemed payable for policies issued but not taken up.

For strict compliance.

Thank you for your continuous support and understanding.

Prudential Guarantee and Assurance, Inc.

COYIUTO HOUSE, 119 C. Palanca St., Legaspi Village, Makati City, 1229 Philippines
Tel. Nos.: (632) 8810-4916 / 8878-3000 / 8651-9500 | Fax: (632) 8819-2991
[email protected] | www.prudentialguarantee.com
TIN-000-491-813