ref #:

Supplier Accreditation

(Name of Company)

Corporate Papers
SEC Registration
Company Profile
Financial Statements
BIR Certifcatte
Price List

Corporate Information
Date of Incorporation
Total Assets
Address: Contact Person/s:

Stockholders/Incorporators:: Contact Number:

List of Clients (top 5 clients) Clients Addresses/Contact Number:

Remarks
Do you have any relative (up to the third degree of consaquinity) who is working or connected with Allianz PNB Life
as an employee, agent, sales manager or managing partner? _________ If yes, please indicate the name of your
relative.__________

Terms of Payment :

TO BE FILLED OUT BY PNB LIFE

Prepared by: Recommended for approval: Approved by:

Signature over Printed Name Signature over Printed Name Signature over Printed Name
Procurement Manager Finance Director Chief Finance Officer
Date Date Date
Note:
1. After approval, the supplier will be required to sign the accountability sheet.
2. The supplier will be required to sign the P.O. to conform to the requirements of the company.
3. Renewal/review of the accreditation shall be made on a quarterly basis or as the need arises.
4. Approval of the accreditation shall be made by the CFO.