COYUITO HOUSE 119 CARLOS PALANCA, JR. ST.

LEGASPI VILLAGE MAKATI CITY

P.O. BOX 3831 CPO 1099 MANILA* TEL NOS. 8104916 TO 35* FACSIMILE 8102991

CORPORATION
Name of Company : Date :
Attention :
Fax No. :

Sir /Madam:

In connection with your application for Bonds, kindly submit the following documents:

Application form duly and completely filled up

Two (2) Co-signor's Statement duly and completely filled up with assets and properties
Client Information Sheet duly and completely filled up
Company Profile (with List of on-going and completed projects)
Copy of Certificate of Registration from the SEC or Articles of Incorporation and By
Laws including amendments if applicable
Latest Audited Financial Statement and Income Tax Returns duly received and filed with
the BIR and SEC
Latest General Information Sheet
Board Resolution or Secretary's Certificate of the authorized signatory/ies binding the
Corporation
TIN number of both the Corporation and the signing officer/s
Government ID's (any two (2): SSS, LTO, PRC, Passport, Voter's ID, Postal ID) and
Income Tax Returns (ITR) of the applicant's authorized signatory/ies and co-signers
Barangay Clearance of the Corporation and Mayor's Permit

Please take note that the prompt processing of your application depends on your
immediate and full compliance with all the above requirements, while the approval of
your application depends on the evaluation of your supporting papers by our Bonds
Committee.

Thank you.

BONDS DEPARTMENT
 COYUITO HOUSE 119 CARLOS PALANCA, JR. ST. LEGASPI VILLAGE MAKATI CITY
P.O. BOX 3831 CPO 1099 MANILA* TEL NOS. 8104916 TO 35* FACSIMILE 8102991

CLIENT INFORMATION SHEET – FOR CORPORATION

Business Name :
Business Address :
Nature of Business:
Contact Numbers: TIN :
Date of Incorporation: SEC. Reg. No:
Principal Officers :

Directors/Partners:

Principal Stockholders Owning at least 2% of the capital stock :

Beneficiary Owners, if any :

Name and Position of the Authorized Representative :

Contact Numbers :

Form Accomplished by :

This portion of to be filled up by Prudential Guarantee & Assurance, Inc,

Client : Intermediary :
Policy No :

 As mandatory of Philippine Anti-Money Laundering Act and Re Implementing Rules

and Regulations.
 Please use additional sheets if necessary

Important : Please attached Articles of Incorporation / Partnership and By-Laws

 COYUITO HOUSE 119 CARLOS PALANCA, JR. ST. LEGASPI VILLAGE MAKATI CITY
P.O. BOX 3831 CPO 1099 MANILA* TEL NOS. 8104916 TO 35* FACSIMILE 8102991

BOND APPLICATION
(Corporation-Partnership)

The undersigned hereby applies for a ..........................................................Bond in the amount of

P.............................. in favor of ......................................................................................
(Indicate details of undertaking, or attach copy of contract and/or corresponding documents for which bond
is required)

For consideration. I/We am/are giving hereunder the following informations:

1. Name................................................................................................. ( ) Corporation
........................................................................................................... ( ) Partnership
2. Office Address .....................................................................................Tel.No.........................
3. Nature of Business...................................................................... Since when..........................
4. When was it organized/incorporated?...................................................................................…
5. How much is the capitalization?...............................................................................................
6. How much is subscribed & paid-up?........................................................................................
7. State the names of Officers/Directors authorized by the Board to sign and the incorporators:
(Please submit pertinent board resolution)
NAME POSITION
7.1......................................................................................................................................................
7.2......................................................................................................................................................
7.3.......................................................................................................................................................

8. If you own real estate properties, please give the following particulars(If land, state if titled or
unregistered, whether residential, commercial, or agricultural and also area thereof. If building, state
number of storeys, nature of occupancy (Residential,store,bodega, etc) and type of construction.
Description Location Area Assessed Value Market Value
a.........................................................................................................................................................
b.........................................................................................................................................................
c..........................................................................................................................................................

9 If any of the above-mentioned property/ies are presently mortgaged, please state the following:
Description Name of Amount of Present Due
of Property Mortgagee Orig.Loan Balance Date
a.........................................................................................................................................................
b.........................................................................................................................................................

10. Do you carry fire insurance on any of these properties? If so, please state the following:
Description Name of Amount of Expiry
of Property Insurance Co. Insurance Date
a…......................................................................................................................................................
b..........................................................................................................................................................

11. State the names of banks you maintain your current/savings account:
NAME BRANCH
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................

12. Have you ever been issued a bond? ( ) YES ( ) NO

Surety Company Type of Bond Amount Obligee Expiry Date
a...........................................................................................................................................................
b...........................................................................................................................................................
=====================================================================
The above foregoing statements and representation are true and correct to the best of my
knowledge and belief and are made for the purpose of inducing PRUDENTIAL GUARANTEE AND
ASSURANCE INC.

Dated at..................................this.............. day of..................................................................

Residence Cert No. ...............................................................

Authorized Signature
 COYUITO HOUSE 119 CARLOS PALANCA, JR. ST. LEGASPI VILLAGE MAKATI CITY
P.O. BOX 3831 CPO 1099 MANILA* TEL NOS. 8104916 TO 35* FACSIMILE 8102991

CO-SIGNER’S STATEMENT

Date:...........................................

I am agreeable to sign with the applicant M........................................................................

covering the bond applied for him from the PRUDENTIAL GUARANTEE AND ASSURANCE
INC. in the amount of P............................. in favor of......................................................................
I am aware of the responsibility which I will assume in signing with M..........................................
............................................................................................................................................................
I am also aware that you rely on the truth of the following statements in the consideration thereof.

I authorized you to obtain such information as you may require concerning the statements
mede hereunder and I agree that this document shall remain your property whether or not the
bond is granted.

(All the following questions must be fully answered - If none. state “None”.”Not Applicable” is not an answer)
===============================================================================================
Name.............................................................................Res.Cert.No.............................issued at........................on.....................................
(Please print or type full name)
Business
Address..................................................................................................................................................Tel.No............................................

Residence.................................................................................................Provincial Address......................................................................

Salary, Wages per Year .........................................................................................................................(P..................................................)

Income from business, etc..............................................................................…......Amount per Year (P...................................................)

Marries/Single.............................. Living with husband or wife...................................Number of dependents............................................

===============================================================================================
If employed please state: If in business for self, please state:

Name of Employer............................................................................ Firm or trade name..........................................................................

Address................................................Tel.No.............................. Address.......................................................Tel.No..........................

Number of years with employer...................................................... Kind of Business......................................How long........................

Kind of Business of employer........................................................... Capital Invested...........................................P..................................

Position occupied by co-maker.......................................................... Sole owner or partner.......................................................................

Previous Employer............................................................................. Name..............................................Address.....................................

Address.............................................How long................................. Name..............................................Address.....................................

===============================================================================================
Bank Accounts - Where Kept -
Current........................................................ Savings......................................................
SHARE OF STOCK OWNED
NAME OF ISSUING KIND NO.OF MARKET VALUE ENCUMBRANCES
cORPORATION SHARES IF ANY

REAL PROPERTIES OWNED

DESCRIPTION LOCATION AREA OF PRESENT VALUE ENCUMBRANCES
LAND

Life Insurance (Co.)......................................................................... Amount P...............................................

Co-Signer will state whether applicant is related to him and if so in what manner..........................................
Co-signer will state how long he has known the applicant...............................................................................
Co-signer will state whether he has ever been a borrower or co-maker on a personal note at any bank or
guarantor with other companies. If so, please state particulars........................................................................
............................................................................................................................................................................
Name of references:..................................................Address............................................................................
................................................Address.............................................................................

I affirm that each of the answers given to the foregoing questions is true and correct.

.......................................................................
 (Signature of Co-Signer)

COYUITO HOUSE 119 CARLOS PALANCA, JR. ST. LEGASPI VILLAGE MAKATI CITY
P.O. BOX 3831 CPO 1099 MANILA* TEL NOS. 8104916 TO 35* FACSIMILE 8102991

CO-SIGNER’S STATEMENT

Date:...........................................

I am agreeable to sign with the applicant M........................................................................

covering the bond applied for him from the PRUDENTIAL GUARANTEE AND ASSURANCE
INC. in the amount of P............................. in favor of......................................................................
I am aware of the responsibility which I will assume in signing with M..........................................
............................................................................................................................................................
I am also aware that you rely on the truth of the following statements in the consideration thereof.

I authorized you to obtain such information as you may require concerning the statements
mede hereunder and I agree that this document shall remain your property whether or not the
bond is granted.

(All the following questions must be fully answered - If none. state “None”.”Not Applicable” is not an answer)
===============================================================================================
Name.............................................................................Res.Cert.No.............................issued at........................on.....................................
(Please print or type full name)
Business
Address..................................................................................................................................................Tel.No............................................

Residence.................................................................................................Provincial Address......................................................................

Salary, Wages per Year .........................................................................................................................(P..................................................)

Income from business, etc..............................................................................…......Amount per Year (P...................................................)

Marries/Single.............................. Living with husband or wife...................................Number of dependents............................................

===============================================================================================
If employed please state: If in business for self, please state:

Name of Employer............................................................................ Firm or trade name..........................................................................

Address................................................Tel.No.............................. Address.......................................................Tel.No..........................

Number of years with employer...................................................... Kind of Business......................................How long........................

Kind of Business of employer........................................................... Capital Invested...........................................P..................................

Position occupied by co-maker.......................................................... Sole owner or partner.......................................................................

Previous Employer............................................................................. Name..............................................Address.....................................

Address.............................................How long..................................
Name..............................................Address.....................................
===============================================================================================
Bank Accounts - Where Kept -
Current........................................................ Savings......................................................
SHARE OF STOCK OWNED
NAME OF ISSUING KIND NO.OF MARKET VALUE ENCUMBRANCES
cORPORATION SHARES IF ANY

REAL PROPERTIES OWNED

DESCRIPTION LOCATION AREA OF PRESENT VALUE ENCUMBRANCES
LAND

Life Insurance (Co.)......................................................................... Amount P...............................................

Co-Signer will state whether applicant is related to him and if so in what manner..........................................
Co-signer will state how long he has known the applicant...............................................................................
Co-signer will state whether he has ever been a borrower or co-maker on a personal note at any bank or
guarantor with other companies. If so, please state particulars........................................................................
............................................................................................................................................................................
Name of references:..................................................Address............................................................................
................................................Address.............................................................................

I affirm that each of the answers given to the foregoing questions is true and correct.

.......................................................................
(Signature of Co-Signer)