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Certification

GSIS certification of availability funds

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,.. Serle. ofl004.

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No.

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,.."-CERTIFICATION ·OFAVAILABI.LITYOF FUNDS
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. , hereby'

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ctJrtify that funds:;:are .avanable to' pay prermums-on

" lnsurance qovsr;· for, the folfowfirg, pol/oJe,elbfl/e:

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Is further 'certified .that we:shall.· effect' pay·men~ of ~tie.above.',mentlcinecJ .Insurance' policies/bills -on a',ICASH-AND CARRY' basis,

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~ or wjthln the prescribed, sixty(~O) days from ,Inception 'or from the

date. of receipt of the' 'blU, whichever Is- lat~t. As ernbodled under
~ectiOri 7.7, lnsurance Code,'uno ,policy or contract of .lnsurancs
Issued by an lnsurance company' Isvaild"and ·blndlng unl~'ss and until
the premium: thereof has b~en paid." 'Therefore, non-payment of the,

premium' within the prescribed period wllfcause the ·GSfS to cancel, .
'. the pollcy.wtthout prior notice. f
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Done' this ...;,.._ day of __ , , 2004, ·In the City of Pasay,
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. Philippines.
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(Authorized Signatory), .

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(Office)

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Address/Tet. No,

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