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    Hvcci Upi Form No. 3: Area Covered (Ha.)

    Uploaded by

    Azumi Ayuzawa
    This document is a list of growers for crop insurance. It includes fields for listing each grower's name, farm location, date of planting, number of trees, period of insurance coverage, crop variety, insured area and amount, total premium, and signature. It also includes fields to report totals for basic premium, document stamps, premium tax, and total premium due. The certifying officials confirm the data is accurate and no risks have occurred yet. [END SUMMARY]

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    © All Rights Reserved
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    Hvcci Upi Form No. 3: Area Covered (Ha.)

    Uploaded by

    Azumi Ayuzawa
    250 views2 pages
    This document is a list of growers for crop insurance. It includes fields for listing each grower's name, farm location, date of planting, number of trees, period of insurance coverage, crop variety, insured area and amount, total premium, and signature. It also includes fields to report totals for basic premium, document stamps, premium tax, and total premium due. The certifying officials confirm the data is accurate and no risks have occurred yet. [END SUMMARY]

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    Hvc Group Form Page 1

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    This document is a list of growers for crop insurance. It includes fields for listing each grower's name, farm location, date of planting, number of trees, period of insurance coverage, crop variety, insured area and amount, total premium, and signature. It also includes fields to report totals for basic premium, document stamps, premium tax, and total premium due. The certifying officials confirm the data is accurate and no risks have occurred yet. [END SUMMARY]

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    250 views2 pages

    Hvcci Upi Form No. 3: Area Covered (Ha.)

    Uploaded by

    Azumi Ayuzawa
    This document is a list of growers for crop insurance. It includes fields for listing each grower's name, farm location, date of planting, number of trees, period of insurance coverage, crop variety, insured area and amount, total premium, and signature. It also includes fields to report totals for basic premium, document stamps, premium tax, and total premium due. The certifying officials confirm the data is accurate and no risks have occurred yet. [END SUMMARY]

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    © All Rights Reserved
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    HVCCI UPI Form No.

    3
    PHILIPPINE CROP INSURANCE CORPORATION
    LIST OF GROWERS
    CROP __________________

    SUMMARY REPORT ON HVCC INSURANCE POLICY NO. H-R0 - ____________________


    LENDING INSTITUTION/ASSO/COOP/FA _______________________ 1. Accomplish in 3 copies
    ADDRESS: ________________________________________________ 2. Send original and duplicate to PCIC with premiums and
    Consolidated Farm Plan and Budget
    NUMBER PERIOD OF COVER AREA SUM
    NAME OF GROWER FARM DATE OF OF PLANTING/ HARVESTING/ VARIETY / COVERED INSURED TOTAL SIGNATURE OF
    LOCATION PLANTING TREES INCEPTION DATE EXPIRY DATE CULTIVARS (ha.) (PhP) PREMIUM CONTACT NUMBER THE GROWER

    SUMMARY: TOTAL PREMIUM We hereby certify that the data contained herein are to the best
    BASIC PREMIUM (___%) of my knowledge true and correct and that the foregoing farmers are
    Doc. Stamps ( ____%) supervised by duly accredited production technician. This further certifies
    Premium Tax ( _____%) that no risks has occurred up to the inception cover.
    Total Premium Due In the event of loss/damage to crop insured, we hereby assigned any
    Date: ______________ proceeds of indemnity to the above-named lender.

    Signature Over Printed Name Signature Over Printed Name


    Agricultural Production Technician City/Municipal Agriculturist

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