INDIVIDUAL BOND APPLICATION

Unit 2401, 24th Flr. Antel Corporate Center, 121 Valero St. Salcedo Village, Makati City Tel. # 845-10-33 to 37/ Fax # 845-3272

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Please fill out the form truthfully. Additional information or documents may be requested any time for review as part of the application process.

BASIC INFORMATION

Complete Legal Name

Nationality

Civil Status

Name of Wife/Husband

No. Of Dependents

Home Address

Registered Company Name

Nature of Business

Office Address

Years in Business

% of Ownership

Position Held in the Company

Years Position Held

Monthly Salary

LIST OF REAL PROPERTIES OWNED

Date Acquired

Location

Area

Assessed Value (PHP)

Incumbrances

Date Acquired

Location

Area

Assessed Value (PHP)

Incumbrances

Date Acquired

Location

Area

Assessed Value (PHP)

Incumbrances

Date Acquired

Location

Area

Assessed Value (PHP)

Incumbrances

LIST OF OTHER PROPERTIES OWNED

Kind

Acquired Value

Year Acquired

Present Value

Kind

Acquired Value

Year Acquired

Present Value

Kind

Acquired Value

Year Acquired

Present Value

Kind

Acquired Value

Year Acquired

Present Value

TRADE REFERENCES

Company Name

Address

Contact Person

Position

Contact No.

Company Name

Address

Contact Person

Position

Contact No.

Company Name

Address

Contact Person

Position

Contact No.

Company Name

Address

Contact Person

Position

Contact No.

CREDITORS

Name

Year Credit Line Awarded

Loan Amount Released

Present Balance

Name

Year Credit Line Awarded

Loan Amount Released

Present Balance

Name

Year Credit Line Awarded

Loan Amount Released

Present Balance

LIFE INSURANCE

Company

Amount

Beneficiary

Company

Amount

Beneficiary

Company

Amount

Beneficiary

ADDITIONAL RELEVANT INFORMATION ABOUT THE APPLICANT CAN BE INDICATED HERE

Remarks

APPLICATION

Type Of Bond

Amount

Bond in Favor of

For the Purpose of

DATA PRIVACY CONSENT

I acknowledge that PACIFIC UNION INSURANCE COMPANY may collect, use, process, and share my/our personal information to their shareholders, duly authorized representatives, business partners, adjusters, and other third parties for purposes such as but not limited to underwriting, claims, business analysis, compliance with regulatory requirements, and any other legitimate business purpose.

I also authorize PACIFIC UNION INSURANCE COMPANY to verify and investigate the information I have given, including the documents submitted. That PACIFIC UNION INSURANCE COMPANY may retain my/our personal information as long as my/ our business transaction with PACIFIC UNION INSURANCE COMPANY is still in full force and effect and in case of termination for a period of five (5) years from the date of termination. I/we acknowledge and agree to the data of privacy provisions stated above.

I hereby provide my/our consent by affixing my signature in this form.

I HEREBY CERTIFY that the above information AND ALL OTHER SUBMITTED DOCUMENTS are TRUE, COMPLETE and CORRECT.

Upload Signature

SUBSCRIBED AND SWORN to before me in Makati City, Philippines this day of , 20 , affiant exhibiting to me his/her Community Tax Certificate No. , issued at , on , 20 , and TIN- .

NOTARY PUBLIC

Until December 31, 20

GENERAL REQUIREMENTS

Please attach copy ---

Articles of Incorporation & By Laws

Company Profile

Copy of Business Permit/Mayor's Permit/Barangay Clearance

BIR Certificate of Registration

Certificate of Business Registration (DTI)

List of Key Personnel

Latest GIS, Three Years of Audited Financial Statements, Latest Income Tax Return (ITR)

Corporate Authority to Sign Bonds (Secretary's Certificate / Bord Resolution)

Copy of thee Contract/Purchase Order/ Notice of Award or Notice to Proceed for the Bond Applied (Identify Where Undertaking of the Bond is Specifically Stipulated)

At least 2 Co-signors with Proof of Capacity Including Financial Statements

SPECIFIC REQUIREMENTS

Please attach copy ---

Certificate of Completion (For Retention or Warranty)

Invitation to Bid (For Bidder's Bond)

HEIRS BOND

Extra Judicial Settlement

Copy of Publication and Affidavit of Publisher

Death Certificate

Marriage/Birth Certificate (If the Deceased is Survived by a Spouse)

Copy of the TCT (Sec 4 Rule 74)

Loan Approval (REM)

ADDITIONAL REQUIREMENTS IF APPLICANT IS A PARTNERSHIP:

Partnership Agreement

Name of Partners and Address

IF APPLICANT IS A CONTRACTOR:

List of Completed & On-going Projects (Name of Owner, Contract Price, Type of Work, Location and Date of (Target) Completion)

List of Previous and Present Suppliers, List of Tools, Equipments and Machineries Owned

Received By (Branch/Office)

Received By (Head/Office)

Date

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