é Insurance Institute for Asia and the Pacific, Inc. PHOTO ht: iap.com ph rer APPLICATION FOR ADMISSION FORM 0930 “This section shoul be filec-out by Applicant SEMINAR TITLE LIFE INSURANCE AGENTS COURSE sponte ona int Nae ‘Famiy Ramey FrsiNamey Tindale Namey Caer _,_ [Tie arFresent Postion Froveason Ema ATES 8 eens espera] —— ER FE OPT — | ORS TOG & [Rome nares RESGRCEINBTE No Fee] Sex] Bate crn (MBI) | Pace oT AR Crise | ‘Single _Maried _Wowed Separated Tye of Senet ‘Name and Lozaton of Scho! nese |e Dear High Schoo! Gallege or | University 3 | Sena 5 See ] Essen & Other Courses and Seminars Attended (During the last 9 years) Cau Year Where Taken Company Tocaion a § Position From To 58 ‘This section is reserved for Life Insurance Co. Personnel Only Date of Seminar. Certification ‘This sto contty that ‘Sumame First Name Middle Name Has undergone the necessary predicensing theoretical and actual training with ‘to stor the Life Insurance Agents Course validating final exam. ‘Company ‘This isto certify further thatthe applicant is morally fit and technically able to represent our company and market our life insurance products. Printed Name and Signature TAP Accredited Trainer