Co-Signer Statement

Date: _____________________

I am agreeable to sign with the applicant __________________________________________

covering the bond applied for by him/her from your Company in the amount of
_______________________________________________________________________________ in
favor of _______________________________________________________________.

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

NOTE: All the following question must be fully answered – if none, state “none”,
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Name: _________________________________________________________________________
Business Address: ____________________________________________ Tel. No. ______________
Residence: __________________________________________________ Tel. No. _____________
Salary/Wages per annum: P_______________________ Income from Business:
P_________________
Civil Status: ____________ living with Spouse ____________ No. of dependents ________________
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If employed, please state: If business for self, please state:

Name of employer: _________________________ Firm or trade name: _______________________

No. of years w/employer: ____________________ Address: _______________________________
Kind of business: __________________________ _______________________ Tel No. _________
Address: ________________________________ Kind of business: __________________________
Present position: __________________________ Since when: ______ Capital invested:
__________
Name of Title of superior ____________________ Sole owner or partnership? __________________
Previous employer: _________________________ Trade references: ________________________
Address: __________________ How long ______________________________________________
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BANK ACCOUNTS: WHERE KEPT:

Current: ____________________________ _________________________________

Savings: ____________________________ _________________________________

REAL ESTATE OWNED (State if the properties mentioned below are covered by torrens title
(registered) or tax declaration (unregistered).

LOCATION DESCRIPTION ASSESSED VALUE

ENCUMBRANCES

_______________________________________________________________________________
_______________________________________________________________________________

Relation to the applicant: _______________ How long have you known the applicant?
______________
References: ____________________________ Address: __________________________________

I AFFIRM THAT EACH OF THE ANSWER GIVEN TO THE FOREGOING QUESTIONS

ARE TRUE AND CORRECT.

Community Tax No. _________________ Issued at ______________________ on ______________

___________________________
Co-Signer’s Signature