\UcP@ Gana insurance Co oe, > UCPB GEN oe ‘tr ra epgen com mat pope om APPLICATION FOR BOND (For Single Proprietor / Individual Account) ‘The undersigned hereby applies fora PERFORMANCE BOND in the amount of B 1,952,417.45 _Infavor of PHIL NIPPON KYOEI CORPORATION to fully and faithfully guarantee “Indicate details of undertaking or allach copy ofthe contract and Jor corresponding documents for which bond is required) 10. 1" For your consideration. | am giving hereunder the following information: Name ELOISAF. CORNEL Age 29 Nationality FILIPINO Givi Status SINGLE 21 CORALVILLE TOWNHOMES, PASACOLA ST, QUEZON Residence CITY Tel No, 0917-696-3047 ‘Uamosa Compound, Sitio Uno, Bahay Pare Road, Offico Address Meycavayan City Tel No. (02)7211-4633, Business or Occupation E. F. CORNEL ELECTRICAL SERVICES eS ee How long have you been engaged as such? 3 YEARS. What is your monthly salary or income? N/A. Ht you are engaged in business or ha income derived: other source of income, ploase describe its nature and state annual a. Business E.F. CORNEL ELECTRICAL SERVICES: 2,500,000 NET b. OtherSource = NIA 1 you own any legal estate property, please give the particulars: (I land, state whether residential, ‘commercial or agricultural and the are thereof. If building, state number of story's, nature of occupancy whether residential, store, bodega, etc. and type of construction whether concrete, timber, light material, etc.) DESCRIPTION LOCATION ASSESSED VALUE | MARKET VALUE ‘@) NONE ‘Do you have any savings or checking account? If so, with what bank and what is the present balance? {BPI FAMILY SAVINGS BANK: PHP1,277,790.89 if any of the above mentioned properties is / are presently mortgaged, please state name of mortgagee, amount of original loan, prosont balance and due date: NIA BNDo0S. 10073, Page 102APPLICATION FOR BOND (For Single Propretor/Inavidual Account) 12, Do you cary fee insurance on any ofthese properties? Iso, with what company and for what amount? NONE 48, Do you own stocks of companies listed in the Manila Makati Stock Exchange? | so, state name of issuing company, kind and number of shares owned and current market value thereot NONE 44. Do you carry fe insurance? Ifo, how much and in what company, to whom fst payable, how long has the policy been in force and approximate cash value thereof: NONE oo 45. Are you indebied, besides mortgaged, o anyone for sums of money? Is, state name of creditors, how much, on what account and when due? NONE 46. State whether you are an endorser or surety for anyone and to what extent: NONE 417, Have you ever had a bond cancelled or an application decined by any Surety Company? fo, when and why? NO 48, Have you secured a bond before? State particulars as follows: NAME OF SURETY | TYPE OF BOND |_ AMOUNT. OBLIGEE [STILL INFORCE, ‘a) COCOGEN SURETY BOND | 640,176.68 | Sanmaon YES, 49. References (excluding relatives). NAME OCCUPATION ‘ADDRESS JONATHAN CERVO ‘SALES MANAGER, WALATE, MANILA WILLIAM MERIDA ‘VIBRATION ANALYST UGONG, VALENZUELA CITY GILBERT PINEDA PROJECT MANAGER DALANDANAN, VALENZUELA | cry, ‘The forgoing statements and representation are true and correct to the best of my knowledge and boliof ‘and are made for the purpose of inducing UCPB GENERAL INSURANCE COMPANY ING. to execute said bond. ‘Signed at _MEYCAUAYAN CITY this 28° day of _JUNE BND. 10073 Page 20t24 UCPB GEN CO-SIGNER’S INFORMATION SHEET “Tho undersigned hereby agree to act as CO-SIGNER in a PERFORMANCE Bond in the ‘amount of P1.982.417 45 applied for by ELOISA F, CORNEL in favor of PHIL NIPPON KY OE! ‘CORPORATION Cosigner’s Name: LUCENAMERIDA Age: 52 Chil Status: MARRIED if married, name of spouse WILLIAM MERIDA Residential Addrose: «01 que BALAGST,UCONGVALENZuELAciTY Tel No. 09215984841 Office Address: LsmoesCompouns,Ratay Par Rose, Meaunyan Cry, Bascan Tel No, (02)72174633 ‘Occapation: ADMIN Income: P 400,000/ANNUM (per annumimonth) Rie you engaged in other business? If so, describe its nature and state the income, ‘monthly oF annually, that you derive from this source. NVA Oe 7. De you have any savings or checking account? 180, with what bank and what isthe present balance? _ BANCO DE ORO. 8. Personal property (Cash, Household fumiture, shares of stocks, fe policies, government bonds, et.) DESCRIPTION Loca Market / Cash Value NONE with what Company | é 8. Real Estate Property (land, state whether residential, commercial or agricultural if ullding, state the nature of occupancy — residential or commercial, and type of Construction — concrete, timber, light materials etc.) B R ASSESSED | MARKET AREA, fect/rcTyNo,| LOCATION | \vatue | VALUE 200 SQM ‘V-t04i77 | VALENZUELA [7,200,000 | 7,500,000 2) ») ¢ 10. If any of the above-mentioned properties is/are presently mortgaged, state name of morigagee, amount of original loan, present balance and due date: NIA a +1. Slate whether you have bean an endorser oF co-signer for anyone and for what amount: “The foregoing statements and representation are true and correct to the best of my knowledge ‘and boliet and are made for the purpose of inducing UCP GENERAL INSURANCE CO., INC. to execute the said bond, ‘Signed at MEYCAUAYAN CITY this 2° day of JUNE 2021. ' ‘Signature ) Tax Account No. 2 i Residential Certificate for 20, RG No. issued at4 UCPB GEN CO-SIGNER’S INFORMATION SHEET “The undersigned hereby agree to act as CO-SIGNER in a PERFORMANCE Bond in the amount of P1,952.417.45 applied for by ELOISA F. GORNEL in favor of PHIL NIPPON KYOEL CORPORATION, Cosigner’s Name: DARLENE PURA Age: 36 Gl Status: MARRIED if married, name of spouse JAYSON C. PURA Residential Address: 090127 vita isa Norm Sut, Caloran Cy “Tel No. 09489952177 Office Address: ours Hany, Caron Cy Tel No, (02)72114633, Gccupation: TEACHER Income: P 400,000/ANNUM (per annumn/month) ‘ire you engaged in other business? If so, describe its nature and state the income, ‘monthly or annually, that you derive from this source. N/A I 7. Do'you have any savings oF checking account? If so, wih what bank and what is the present balance? _ BANCO DE ORO. '& Personal property (Cash, Household furiture, shares of stocks, life policies, government bonds, ete.) TOCATION with what Company DESCRIPTION NONE Market / Cash Value 9. Real Estate Property (land, state whether residential, commercial or agricultural; buiding, state the nature of occupancy — residential or commercial, and type of construction - concrete, timber, light materials et) D ASSESSED | MARKET AREA (covrrer)No, LOCATION | vaLuE | VALUE a5SOM ‘o1-2014004203 | CALOOGAN | 1,200,000 | 7500,000, ») ) 40. Wf any of the above-mentioned properties isfare presently mortgaged, state namo of mortgagee, amount of original loan, present balance and due date NAR a 11. Slate whether you have been an endorser or Co-signer Tor anyone and for what amount: a7 in ERE “The foregoing statements and representation are true and correct to the best of my knowledge and bolle! and are made for the purpose of inducing UCPB GENERAL INSURANCE CO. INC. to-execute the said bond, ‘Signed at MEYCAUAYAN CITY this 2%° day of JUNE 2024 Stanpehre ‘Tax Account No. Residential Cortiicate for 20, RCNo. issued at on