Application for Insurance Agent's License Insurance Commission AFFIDAVIT OF VERIFICATION Republic of the Philippines) Province/City of Sh ‘ lone _C 0 , being duly swom, depose and say that | am the Person named in and who signed the foregoing application; that | know the contents thereof and the statements made and answers to question therein are true Tang! Cc: VINO. Affiant tin__ 425-14 pie SEC oe SSS No, 224/37>421 2 23 NOV 2023 SUBSCRIBED AND SWORN TO before me this day of ASfiant/s exhibited to me his/her TIN/SSS/Passport/PostalL TOT, NNIE B. BOLO Pobtember 31, 2024 ADMMtter No. Ree Doc.No, = _J4/_ Roll of Attorney No. 74323 PageNo. 9p PTR No, 39490871. 0: Book No, iu Series of20 1BP OR No, 263101, 0 MCLE Compliance No, Vii = ¢.) ‘es 2, "ebarag Ap, Gonzales St, San tga City APPROVED AND COUNTERSIGNED for FWD Life Insurance Corporation {or the solicitation or procurement of application for MeWvariablemon-life insurance “Authorized Representative of the Company ‘Note: This form may be revised without prior notice Made in uScan free versionApplication for Insurance Agent's License Insurance Commission AEFIDAVIT OF VERIFICATION Republic of the Philippines) ProvincelCity of D Jouet _-_Mieanoo , being duly sworn, depose and say that | am the erson rained in and who signed the foregoing application; that | know the contents thereof and the Statements made and answers to question therein are true. mae Mirando ‘Affiant Tin $889, §0 60000 ‘SSS No__ O209/¢9IN% 23 NOV 723 ‘SUBSCRIBED AND SWORN TO before me this day of 20 ‘Alfiants exhibited to me hishner TIN/SSS/Passpor’Postall. TO/ ay Notary Pubiic IE BY BOL ecember 31, 2024 aar Wo. R148 fio, 74429 3, ga City nes Sur 7 oe. No. a Page No. a9 Book No. x Series of 20, 725 APPROVED AND COUNTERSIGNED for FWD Lite insurance Corporation {or the sahetation or procurement of appicatio for WaVvariableinon-fe insurance “Rathorized Representative ofthe Company ‘note: This form may be revised without prior netics Dilan a NO COI Made in uScan free version