BOND APPLICATION FORM

(For Corporation / Partnership)

TO: ALPHA INSURANCE AND SURETY COMPANY, INC.

1025 San Marcelino St., Ermita, Manila

The undersigned hereby applies for a ___________________________________ Bond

In the amount of _______________________________________________________ ONLY
(P______________ ), Philippine Currency, in favor of _________________________
Conditions of the Bond _______________________________________________________
___________________________________________________________________________
___________________________________________________________________________
We are submitting to you the following information about ourselves which you may
consider in the processing of this application.
We are hereby authorized to obtain such other information you may wish to secure
about ourselves pertaining to the data hereunder furnished you. We hereby affirm that the
following answers are the truth without reservation and agree that the documents shall
remain your property whether or ritthe bond shall be granted or not.
==============================================
PLEASE FILL UP ALL THE BLANKS. ALL THE ANSWERS MUST BE MADE IN FULL TO
RECEIVE PROMPT ACTION AND IF THE ANSWER BE NONE WRITE SO. KINDLY PRINT
OR TYPE YOUR ANSWERS.
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1.
2.
3.
4.

Name of Company ______________________________________________________

Business Address _______________________________________________________
T I N No. _____________________________________________________________
If a CORPORATION:
4.1 When Incorporated ___________________________________________________
4.2 Total Paid-Up Capital ________________________________________________
4.3 Name of Authorized Signatory for Bond _________________________________
_____ Articles of Incorporated and By-Laws
_____ SEC Certification of Registration _____________________________________
_____ List of Key Personnel _______________________________________________
(Designation)
_____ Latest Financial Statement (Audited)
(For the Signatory Please attach Corporate Authority to sign bond)

5.

If a PARTNERSHIP:
5.1 When Organized ____________________________________________________
5.2 Total Paid-Up Capital _______________________________________________
5.3 Is a partnership general or limited ______________________________________
If limited, kindly explain fully ________________________________________
5.4 Name of Partners and Address _________________________________________
__________________________________________________________________
__________________________________________________________________
5.5 Please attach copy of the following:
a) Partnership Agreement
b) SEC Certification of Registration
c) Latest Financial Statement (Audited)
5.6 Name of Authorized Bond Signatory ____________________________________
Designation _________________________ TIN No. _______________________
(Please attach Partnership Authority to sign bond)

6. How many years has your organization been in business under its present
business name? ___________________________________________________________
7. PERSONAL PROPERTY OWNER:
Date Acquired
Location Description MKT Value Encumb Amt
Held By
______________ _________ __________ ___________ ____________ _________
______________ _________ __________ ___________ ____________ _________
8. Trade References:
_________________________________
_________________________________
9. BANK ACCOUNTS: Where Kept

Address _____________________________
Address _____________________________

Savings ___________________ P ____________

Current ___________________ P ____________

10.Please indicate at what banks you have established lines of credit; What is the extent and
on what basic have been granted? _______________________________________________
___________________________________________________________________________
11. Are there any judgement, suite or claims pending against you or against any member or
your firm, or any of your officers? ______________ If so, give particulars ______________
___________________________________________________________________________
12. In what other lines of business do you have as financial interest? ___________________
__________________________________________________________________________
13.Are you acting as Surety or Bondsman for others,or as endorser on their note or accounts?
___________________________________________________________________________
14. Are you having any controversy with any other or any one over any contact? __________
___________________________________________________________________________
15. Are you or any members of your firm, or any of your officers ever failed in business or
compromised with creditors? __________________________________________________

16. Are you or any members of your firm, or any of your officers granted in any other lines
of business? ________________________________________________________________
17. Has any Surety Company ever paid loss on you, or any members of your firm,
or any members of your officers? ___________________________________________
If so, state name Surety company and give full particulars _________________________
___________________________________________________________________________
18. Please list Insurance carried by your organization, including life insurance on the lives
officers and payable to Company Partnership of Business:
________________________________________________________________________
19. Have you secured a Bond before? __________ If yes, please fill up the following details:
Bond Company
Amount
Obligee
Period of Bond Terminated
_________________ ______________ ____________ _______________________
_________________ ______________ ____________ _______________________
The above and foregoing statement and representation are true and correct to the best of my
knowledge and belief and made for the purpose of inducing your goodselves to approve and
execute the bond I am applying for.
______________________________
NAME OF COMPANY
BY:
______________________________
AUTHORIZED SIGNATURE