Professional Documents
Culture Documents
Application Form Corporation With DPA
Application Form Corporation With DPA
(Please provide ALL requested information to avoid delay in evaluation. On questions where “none” or “not applicable” is the
answer, please indicate accordingly. Kindly print or type your answers and use additional paper if necessary.)
1. Name of Company: TIN:
2. Business Address: Tel. No.:
3. Corporate Information
Total Paid-up
Date of Incorporation: Capital:
Designation:
Name of Authorized Signatory: TIN:
Place / Date of
Valid ID: Issue:
4. No. of years the organization has been in
business under its present business name:
5. List of other lines of business where you have a
financial interest:
6. Real Estate Owned:
Date Acquired Location Area Assessed Value Encumbrances
8. Bank Accounts
Savings: Current
9. Please indicate the banks where you have established credit facilities; amount of each facility; under what basis
each facility was granted:
10. Are there any charges, judgements, suits or claims pending against you, or against any member of your firm
If yes, please give
or any of your officers? particulars:
12. Has any Surety Company ever paid a loss for the firm or any member of the firm?
If yes, please state the name of the Surety Company and give full details:
13. Please list insurances carried by your organization, including life insurance on the persons of your officers where the
Company is named as beneficiary:
14. Have you secured bonds before? ___________ If yes, please provide the following information:
Bonding Type of Bond Amount Obligee Term
Company
I affirm that the foregoing statements and representations are true and correct to the best of my knowledge and belief
and were made to support the application for the above mentioned bond.
I warrant that I am authorized to disclose all information stated in this application. I further warrant that the Company
consents to the collection, use, processing, storage and disclosure to third parties of the information stated above, by
PLGIC, its employees, officers, directors, and other authorized personnel (1) to verify the Company’s identity; (2) to
evaluate and assess this application; (3) for the delivery of the bond forms and other materials; (4) in assessing the
Company’s interest in PLGIC’s products and services; (5) for customer research; and (6) in compliance with applicable
laws.
I likewise warrant that the Company consents to the correction, amendment or deletion by PLGIC, its employees,
officers, directors, and other authorized personnel of the Company’s information which may be inaccurate. I understand
that PLGIC will dispose, delete and/or modify the information upon the Company’s written request.
I finally warrant that the Company authorizes PLGIC, its employees, officers, directors, and other authorized personnel
to obtain such other information they may deem necessary to verify or confirm the data declared or the documents
furnished in relation to this application, and that the Company agrees that such documents may remain in the
possession of PLGIC whether or not this bond application is granted.
Name of Company