ANCHOR INSURANCE BROKERAGE CORPORATION

14th Floor Taipan Place, Emerald Avenue, Ortigas Center, Pasig City
Trunklines: (632) 689-5555 * Fax Nos. (632) 637-4571

CO-SIGNER’S INFORMATION SHEET

The undersigned hereby agree to act as CO-SIGNER in a PERFORMANCE SECURITY

Bond in the amount of P ________________________applied for by FEDSTRONG SERVICES
INC. in favor of DECOARTS MARKETING INC./ CITI HARDWARE INC.

1. Co-signer’s Name: MARIETA L. SY Age: 56

2. Civil Status : MARRIED If married, name of spouse ARSENIO D. SY
3. Residential Address : 13 QUINCE ST., ROXAS DISTRICT, QUEZON CITY Tel. No. 755-3432
4. Office Address : ROOM 308 CABRERA BLDG II, #64 TIMOG AVE., BRGY. SACRED
HEART, QUEZON CITY Tel. No. 02-909-1782
5. Occupation: BUSINESS WOMAN
6. Are your engaged in other business? If so, describe its nature and state the income, monthly
or annually, that you derive from this source.
7. Do you have any savings or checking account? If so, with what bank and what is the present
balance? RCBC, 500,000
8. Personal property (Cash, Household furniture, shares of stocks, life policies, government
bonds, etc.)

LOCATION
DESCRIPTION With what Company Market / Cash Value
a)
b)
c)
d)

9. Real Estate Property (if land, state whether residential, commercial or agricultural; if
building, state the nature of occupancy - residential or commercial, and type of construction -
concrete, timber, light material, others) NONE

DESCRIPTION & TORRENTS TITLE ASSESSED MARKET

AREA (CCT/TCT) No. LOCATION VALUE VALUE
a) 210 SQM 004-2015012716 ROXAS DISTRICT 10,000,000
QUEZON CITY
b)
c)
d)

10. If any of the above-mentioned properties is/are presently mortgaged, state name of
mortgagee, amount of original loan, present balance and due date: N/A

11. State whether you have been an endorser or co-signer for anyone and for what amount:
NO

The foregoing statements and representation are true and correct to the best of my
knowledge and belief.

Signed at QUEZON CITY this __24_day of ______SEPTEMBER_________

___MARIETA L. SY____
Signature over Printed Name
TIN: 120-761-410
Residential Certificate No._________
Issued at: ______________________
On : ______________________

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