Elaboracion De Una Poliza

United States Tourist Automobile Liability Insurance ACE Seguros S.A.

Policy Number Effective Date

Policy Term Policy term Hour 07:00 REYES LAZCANO GUSTAVO PRIVADA FRANCISCO I MADERO 2927JUAREZ CHIHUAHUA 32670 6566335777 06/05/1970 RELG700506LX6 MALE 1 days Form of Payment CASH Currency US DOLLARS Year 2011 Month 6 Day 4

880S422VC7

Insured Information

Name (Last Name(s)/FirstName) Address (Street and Number) City/State/Zip Tel Home/Office Date of Birth (dd/mm/yyyy) Federal Taxpayer ID No. Gender

Vehicle Information

Year 2008

Make
CHRYSLER

Model
CALIBER

VIN1B3JB48K88D592572

License Plate EBT3678

Engine

Use NORMAL

Coverage Details

Coverages Per Person Property Damage Bodily Injury Medical Payments N/A 50,000 USD 2,000 USD

Maximun Limitsof Liability Per Accident 50,000 USD 100,000 USD 10,000 USD Additional Drivers Names Age Net Premium 2.10 3.50 1.40

Additional Information XXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXX Premium Details

Total Net Premium Issuing Expenses V.A.T Total Premium

7.00 1.00

8.00

ACE Seguros, S.A., hereinafter "The Company" and whom herein stated as the"Insured" agree to enter into this insurance contract, subject to the general provisions recorded by the National Commission of Insurance and Surety. This policy shall not cover under any circumstancesthose vehicles not registered in the Republic of Mexico Regarding coverages for Property Damage Coverage and Bodily Injury Liability, the coverage amounts will not be lesser than the minimum Financialresponsibility limits set by each state where the insured vehicle circulates. In case the amount insured set forth in this policy is lesser than the minimum limits required by law, the limits will beautomatically increased to meet the minimum requirements.
IN CASE OF ANY EVENT, PLEASE IMMEDIATELLY CALL 1 866 ACE LOSS

This document and the technical remark on which it is based are recorded...