Dear Valued Client: Please be informed that Republic Act 9160, otherwise known as the Anti-Money Laundering Act

(AMLA), requires that insurance companies keep basic information of all assureds. To comply with this, all member companies of the Philippine Insurers & Reinsurers Association (PIRA) have adopted common Know Your Client (KYC) forms for individual and corporate clients. In this regard, may we please request you to fill out the attached KYC form? Please be assured that all information will be held in strict confidence. The KYC form shall be valid for five (5) years unless there are changes in the declared information. Please disregard this letter if you have already filled out a KYC form. 1. 2. For your convenience, we are providing you with the following options in returning the KYC form: Send to any Mapfre Insular branch c/o The Branch Manager; Send through your servicing agent or broker; or 3. Fax to (632)876-4344 c/o The Compliance Officer. For your reference, we have enclosed a copy of the pertinent implementing rules of the AMLA. Thank you for your cooperation and we look forward to receiving your KYC form. Very truly yours, MAPFRE INSULAR INSURANCE CORP. Client Information Sheet : Client information is mandated under the Philippines Anti-Money Laundering Act. Complete information required before a policy is issued. For Individual Client Complete Name: Daryl Leus Del Rosario Manzo Present Address: 45J Langka St. Balingasa, Balintawak, Quezon City Permanent Address: 45J Langka St., Balingasa, Balintawak, Quezon City
Nationality: Filipino TIN: Date of Birth: Sept 18, 1989 SSS/GSIS No:34-2638861-7 Business Tel. No. Residence Tel. No. 3666471 Mobile No. Place of Birth: Manila, Philippines E-mail: daryl_leus@yahoo.com

Nature of Work: Self-Employed Name of Employer: Nature of Self-employment / Business: Names of Beneficiaries, if applicable: Erlinda Manzo Source of Funds:

For Corporate Client Business Name: Principal Business Address: Nature of Business: List of Board of Directors / Partners: TIN Contact Nos.

List of Principal Stockholders owning at least 2% of the capital stock:

Beneficial owners, if any: Name & Signature of Insured/Corporate representative: ______________________ Position & Contact No.:

_______________________
(for Corporate Client only)

Date Signed: ____________________

Policy No.:

______________________________ (For individual client: Please attach photocopy of any valid government issued ID; For corporate client: