CLAIMS CHECKLIST FOR MOTOR INSURANCE

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INSURED	THIRD PARTY (TP)	RECOVERY
A. PARTIAL LOSS/TOTAL LOSS Claimant’s Incident Report (COCOGEN form to be accomplished by the Insured) Pictures of Damage Police Report and/or Driver’s Affidavit Registration Certificate and OR Driver’s License and OR Stencils of Motor and Serial No. Copy of Insurance Policy Copy of OR or Proof of Premium Payment	A. VEHICLE TP Claimant Repair Estimate Pictures of Damage Certificate of No Claim or CTPL Policy Registration Certificate and OR Insured Registration Certificate and OR Driver’s License and OR Driver’s Affidavit	A. FOR RECOVERY PURPOSES NOTE: If Insured was reportedly bumped by a third party, Insured has to provide the following documents of party at fault: Driver’s License and OR Registration Certificate and OR Copy of Insurance Policy Copy of TIN and SSS ID Contact Number
B. CARNAP Certificate of Non-Recovery Alarm Sheet Complaint Sheet Police Report Registration Certificate and OR Driver’s License and OR Copy of Policy Copy of OR of Premium Payment	B. PROPERTY DAMAGE TP Claimant Quotation of Repair Estimate Pictures of Damage Insured Registration Certificate and OR Driver’s License and OR Driver’s Affidavit	B. RECOVERY OF OTHER INSURANCE COMPANY NOTE: Insurance company has to submit their claim documents: Release of Claim Payment Voucher Policy of Adverse Party Registration Certificate and OR Driver’s License and OR Pictures of Damage Repair Estimate / Computation of Liability Letter of Authority
C. BODILY INJURY Note: In addition to item A above Original Medical Receipts /OR Medical Certificate	C. BODILY INJURY TP Claimant Original Medical Receipts /OR Medical Certificate Insured Registration Certificate and OR Driver’s License and OR Driver’s Affidavit

INSURED

THIRD PARTY (TP)

RECOVERY

A. PARTIAL LOSS/TOTAL LOSS

Claimant’s Incident Report (COCOGEN form to be accomplished by the Insured)
Pictures of Damage
Police Report and/or Driver’s
Affidavit
Registration Certificate and OR
Driver’s License and OR
Stencils of Motor and Serial No.
Copy of Insurance Policy
Copy of OR or Proof of Premium Payment

A. VEHICLE
TP Claimant

Repair Estimate
Pictures of Damage
Certificate of No Claim or CTPL Policy
Registration Certificate and OR

Insured

Registration Certificate and OR
Driver’s License and OR
Driver’s Affidavit

A. FOR RECOVERY PURPOSES
NOTE: If Insured was reportedly bumped by a third party, Insured has to provide the following documents of party at fault:

Driver’s License and OR
Registration Certificate and OR
Copy of Insurance Policy
Copy of TIN and SSS ID
Contact Number

B. CARNAP

Certificate of Non-Recovery
Alarm Sheet
Complaint Sheet
Police Report
Registration Certificate and OR
Driver’s License and OR
Copy of Policy
Copy of OR of Premium Payment

B. PROPERTY DAMAGE
TP Claimant

Quotation of Repair Estimate
Pictures of Damage

Insured

Registration Certificate and OR
Driver’s License and OR
Driver’s Affidavit

B. RECOVERY OF OTHER INSURANCE COMPANY
NOTE: Insurance company has to submit their claim documents:

Release of Claim
Payment Voucher
Policy of Adverse Party
Registration Certificate and OR
Driver’s License and OR
Pictures of Damage
Repair Estimate / Computation of Liability
Letter of Authority

C. BODILY INJURY
Note: In addition to item A above

Original Medical Receipts /OR
Medical Certificate

C. BODILY INJURY
TP Claimant

Original Medical Receipts /OR
Medical Certificate

Insured

Registration Certificate and OR
Driver’s License and OR
Driver’s Affidavit

CLAIMS CHECKLIST FOR FIRE INSURANCE

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Documentary Requirements in case of Fire and Allied Perils
Basic Documents: Formal Claim against COCOGEN Fire Department Report / Affidavit of Loss (for fire loss) Photographs

	Additional Documents for Building: Detailed repair estimate Declaration of Real Property DFloor Plan / Construction Plan Building Permit Lease Contract (if lot belongs to other than insured) Transfer Certificate of Title Appraisal Report (if any

Additional Documents for Stocks, Household Furniture, Fixture, Fittings and Personal Effects, Machinery, Equipment and Accessories Detailed inventory of all stocks and property risk whether damaged or undamaged Purchase / Sales Invoice Income Tax Return / Financial Statements Business License Registration of Business Appraisal Report

CLAIMS CHECKLIST FOR MARINE INSURANCE

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Documentary Requirements in case of Marine Cargo Claim
Basic Documents: Formal Claim against COCOGEN Original copy of the Policy / Risk Note Original and /or duplicate copy of Bill of Lading (via Vessel) Original and /or duplicate copy of Airway Bill (via Aircraft) Original and/or duplicate copy of Commercial Invoice Original copy of Delivery Receipt Packing List Photographs Duly receipted formal claim against Vessel, Arrastre, Broker and Forwarder
	Documentary Requirements in case of Marine In Land / Truck Risk Claim
	Basic Documents: Police Report / Incident Report Invoices Registration Certificate and Official Receipt Driver’s License and Official Receipt Photographs Original copy of Delivery Receipt Original copy of Waybill, Delivery Receipt
Optional Document: Maintenance Record of the Vehicle (atleast six (6) months prior to loss)
		Documentary Requirements in case of Marine Hull Claim
	Basic Documents: Police Report / Incident Report Marine Note of Protest Coastwise License Repair estimate Photographs Survey Report Certificate of Ownership Certificate of Philippine Registry Minimum Safe Manning Certificate Crew List Cargo Ship Safety Certificate Original copy of Policy
Optional Document: Master Oath of Safe Departure

CLAIMS CHECKLIST FOR ENGINEERING INSURANCE

Documentary Requirements in case of Contractors/ Erection All Risk Claim
Basic Documents: Formal Claim against COCOGEN Police Report / Incident Report Photographs Estimate &/or Actual Repair Cost Technical Report/Assesment as to the cause of loss

	Optional Documents: Duly Accomplished and Signed Non-Waiver Agreement Invoices and/or Receipts Copy of Lease Copy of Contract
Documentary Requirements in case of Electronic Equipment Claim
Basic Documents: Formal Claim against COCOGEN Police Report / Incident Report Photographs Estimate and/or Actual Repair Cost / Invoices / Receipts Technical Report/Assesment as to the cause of loss
	Optional Documents: Proof of Purchase (Equipment)
		Documentary Requirements in case of Third Party Property Damage Claim
Basic Documents: Formal Claim against COCOGE Photographs of Damaged Units Detailed Estimate Police Report / Affidavit of Loss Accomplished Sworn Statement of claim Accomplished Non Waiver Agreement Demand Letter of the Third party claimant Real Property Tax Declaration Supporting documents of the unit cost/ price per invoice
	Optional Documents: Repair Invoice (if damage is already repaired) Floor Lay-out Copy of Lease Copy of Lease Contract
		Additional Documents for Motor: Ceritificate of No Claim (for damaged vehicle Formal Claim of Third Party against Insured Driver's License of the owner of the vehicle for identity purposes Original Copy of Certificate of No Claim from their insurer
Documentary Requirements in case of Third Party Bodily Injury / Illness or Health/Death Claim
Basic Documents: Formal Claim against COCOGE Original Copy of Official Receipt of medical expenses Death certificate (for Death Claim) Police Report / Affidavit of Loss Birth Certificate (for Death Claim) Hospital Bill/Statement of Account (if hospitalized)
	Optional Documents: Statement of Account (if hospitalized) Copy of driver’s license (if due to vehicular accident) Doctor’s prescription Admitting history & Physical Examination Vital signs chart Nurse’s daily progress notes
		Additional Documents for Motor: Medical Certificate Post Mortem Certificate

CLAIMS CHECKLIST FOR BONDS INSURANCE

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Documentary Requirements in case of Performance Bond Claims
Basic Documents for Obligee: Formal Statement of Claim to Surety with details and breakdown of claim The name(s) of individuals and entities involved in the notification. Job titles of all individuals involved. The date of first awareness by the insured of the circumstance or claim being notified Overview of the claim against the individual(s) and/or entity(ies) including – The factual background; The allegations being made against the individual(s) and/or entity(ies); The nature of action; The nature and amount of redress sought by the claimant, including the amount of damages (if any) The names, addresses and contact details of any external law firm(s) engaged by individuals or the entity in relation to the Circumstances notified and who they will be representing. The names of the individual lawyers who will be invloved in the defense, and their proposed hourly rate. A copy of the engagement letter once a law firm is engaged.
Additional Document/Information to be provided: Once expenses have been incurred, a breakdown should be provided to show that such expenses were part of the costs to defend the Insured (e.g. Time charges should be broken down into the no. of hours a particular Lawyer has worked and the particulars of the case worked on). Also, any expenses should be substantiated with an Official Receipt and any pertinent documents that directly relate such expenses to the case Merits of the case and litigation budget. Updates/developments on the case if any

CLAIMS CHECKLIST FOR LIABILITY INSURANCE

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Documentary Requirements in case of Directors and Officers Liability / Errors and Omission
Documentation/Information to be provided upon Notification: Basic Documents: Copies of any relevant correspondence, pleading or other court documents. The name(s) of individuals and entities involved in the notification. Job titles of all individuals involved. The date of first awareness by the insured of the circumstance or claim being notified Overview of the claim against the individual(s) and/or entity(ies) including – The factual background; The allegations being made against the individual(s) and/or entity(ies); The nature of action; The nature and amount of redress sought by the claimant, including the amount of damages (if any) The names, addresses and contact details of any external law firm(s) engaged by individuals or the entity in relation to the Circumstances notified and who they will be representing. The names of the individual lawyers who will be invloved in the defense, and their proposed hourly rate. A copy of the engagement letter once a law firm is engaged.
Additional Document/Information to be provided: Once expenses have been incurred, a breakdown should be provided to show that such expenses were part of the costs to defend the Insured (e.g. Time charges should be broken down into the no. of hours a particular Lawyer has worked and the particulars of the case worked on). Also, any expenses should be substantiated with an Official Receipt and any pertinent documents that directly relate such expenses to the case Merits of the case and litigation budget. Updates/developments on the case if any

CLAIMS CHECKLIST FOR MISCELLANEOUS INSURANCE

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Documentary Requirements in case of Third Party Property Damage Claim
Basic Documents: Formal Claim against COCOGEN Photographs of Damaged Units DetailedEstimate Police Report / Affidavit of Loss Accomplished Sworn Statement of claim Accomplished Non Waiver Agreement Demand Letter of the Third party claimant Real Property Tax Declaration Supporting documents of the unit cost/ price per invoice
Additional Documents for Motor: Ceritificate of No Claim (for damaged vehicle) Formal Claim of Third Party against Insured OR / CR of Motor Vehicles Driver's license of the owner of the vehicle for identity purposes Original copy of Certificate of No Claim from their insurer
Optional Documents: Repair Invoice (if damage was alreadyrepaired) Floor Lay-out Copy of Lease Copy of Lease Contract

Documentary Requirements in case of Bodily Injury / Illness or Health/Death Claim
Basic Documents: Formal Claim against COCOGEN Original Copy of Official Receipt of medical expenses Original/ Certified True Copy of Death Certificate (for Death Claim) Police Report / Affidavit of Loss Birth Certificate (for Death Claim) Hospital Bill/Statement of Account(if hospitalized)
Additional Documents: Medical Certificate Post Mortem Certificate
Optional Documents: Statement of Account (if hospitalized) Copy of driver’s license (if due to vehicular accident) Doctor’s prescription Admitting history & Physical Examination Vital signs chart Nurse’s daily progress notes

Documentary Requirements in case of Equipment Floater Claim / All Risks
Basic Documents: Formal Claim against COCOGEN Police Report / Affidavit of Loss/ Incident Report Quotation / Repair Estimates Duly Signed Notarized Claim forms Forklift Operation and Safety Certification Technical Report List of Damaged stocks Delivery Receipts Sales Invoice
Additional Documents: Photographs Disconnection Notice Memorandum of Agreement

Documentary Requirements in case of Burglary/ Robbery/ Hold-Up Claim
Basic Documents: Formal Claim against COCOGEN Police Report / Affidavit of Loss Audit Report & Breakdown of Loss
Additional Documents: Repair Estimates /Repair invoice (if damage is alreadyrepaired) Photos of forcible entry Sales & Collection Repor Inventory Report / Book of Accounts Business Permits

Documentary Requirements in case of Misloading
Basic Documents: Formal Claim against COCOGEN Police Report / Affidavit of Loss/Preliminary Loss Advise OR/CR of Motor Vehicles Driver’s License Original copy of Misloading Receipt Original copy of Towing Receip

Documentary Requirements in case of Fidelity Claim
Basic Documents: Audit Report showing discovery date & breakdown of loss Documents in support of Audit Report such as official receipts, invoices, sales & collection reports SSS / BIR / NBI / Personal Data Sheet (201 File) / Driver’s License No. of the Employee
Optional Documents: Company procedures as to duties of employees Action taken to recover loss such as filing of criminal case Duties and responsibilities of the involved employee

PERSONAL ACCIDENT CLAIM
Documentary Requirements in case of Medical Expenses Reimbursement
Basic Documents: Formal Claim against COCOGEN Affidavit or incident report Medical Certificate Doctor’s Prescription of Medicines Original copy of official receipts of medicine purchase Statement of Accounts (if hospitalized)
Optional Documents: Copy of driver’s license (if due to vehicular accident)

Documentary Requirements in case of Disability/ Death Claim
Basic Documents: Formal Claim against COCOGEN Affidavit or incident report Original/CertifiedTrue Copy of Death Certificate Original/Certified True Copy of Birth Certificate Marriage Contract (if married) Post-Mortem Certificate (if necessary) Clinical Records (if necessary) Vital signs chart (if necessary) Medical Certificate (if applicable) Admitting history (if available) Photos of affected body part/s Copy of driver’s license(if due to MCY accident) Proof/police certification that the Insured was wearing helmet at the time of loss(loss due to MCY)

Documentary Requirements in case of Educational Assistance Claim
Basic Documents: Certificate of enrollment from the school attended

Documentary Requirements in case of Fire Assistance Benefit Claim
Basic Documents: Formal Claim against COCOGEN Bureau of Fire Protection Certification Barangay Certificate that insured is a fire victim Photos of the Fire Incident Valid ID’s with signature