CO-SIGNER’S STATEMENT

Makati City, Philippines Date _____________________

I am agreeable to sign with the applicant _______________________________________________ covering P/N

bond/Bond applied for by him from your company in the amount of P ______________________ in favor of
______________________________________________________. I am aware of the responsibility which I will assume
in signing with ____________________________________________________________. I am aware that you will rely
on the truth of the following statement in consideration thereof.

I authorized you obtain such information as you may require concerning the statements made hereunder and agree
that this document shall remain your property whether or not the bond is granted.

______________________________________________________________________________________________

*ALL THE FOLLOWING QUESTIONS MUST BE ANSWERED – IF NONE, NOTE “NONE”*

Name _________________________________ Community Tax Cert. __________________ issued at ______________

On _________________ ACR __________________ _________________ ______________

Business Address ________________________________________________________ Tel No. __________________

Residence Address _________________________________________________________________________________

Salaries, Wages per year P _________________________________ Income from business P ______________________

Amount per year P _______________________________________ Married/Single _____________________________

Living with husband or wife ________________________________ Number of dependents ______________________

If employed please rate: If in business for self, please rate:

Name of Employer _______________________________________ Firm or Trade Name ________________________

Address ________________________________________________ Address __________________________________

Tel Nos. ________________________________________________ Tel Nos. __________________________________

No. of years with employer _________________________________ Kind of business ___________________________

Kind of business of employer _______________________________ How long __________ Capital Invested _________

Position occupied by co-maker ______________________________ _____________Sole Owner or partner _________

Name & Title of superior ___________________________________ Trade references ___________________________

________________________________________________________ Address _________________________________

________________________________________________________ How long ________________________________

Bank Account – Where Kept:

Current _________________________________________________ Savings __________________________________

Real Estate Owned – PLEASE SUBMIT XEROX COPY OF TCTS (FRONT & BACK PAGE)

Title Date Location Area of Assessed Value Encumbrance

No. Acquired Land Land Improvements Amount/Held By

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
____________________________________________________________________________________________

Life Insurance Co. __________________________________________ Amount P _____________________________

Co-signer will state whether applicant is related to him and if so in what manner ________________________________

How long he has known _______________________________ Co-signer will state whether he has ever been a borrower
or co-maker on a personal note at any bank ______________________________________________________________

Name of references __________________________________________ Address _______________________________

_________________________________________ Address _______________________________

I affirm and certify that the foregoing representations are true, correct and accurate.

NOTE: PLEASE SUBMIT THIS WITH YOUR

LATEST INCOME TAX RETURN _______________________________

Signature of Co-signer

SUBSCRIBED AND SWORN TO BEFORE ME this ______day of _______, affiant exhibiting to me his/her Community
Tax Cert No. ________________________ issued at ___________________ on ________________________.

Doc. No. __________ Page No. ________

Book No. _________ Series of 20 ______ NOTARY PUBLIC