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  • Application Form Corporation With DPA

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    This 3 sentence summary provides the key details from the bond application document: The document is a bond application form for Paramount Life & General Insurance Corporation where the applicant provides information about the type of bond being applied for, details about the applicant company such as name, address, years in business, bank and trade references, and authorizes Paramount to verify the application information. The applicant also warrants that they are authorized to disclose the application information and consents to Paramount collecting, using and storing the data.

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    Application form corporation with DPA

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    This 3 sentence summary provides the key details from the bond application document: The document is a bond application form for Paramount Life & General Insurance Corporation where the applicant provides information about the type of bond being applied for, details about the applicant company such as name, address, years in business, bank and trade references, and authorizes Paramount to verify the application information. The applicant also warrants that they are authorized to disclose the application information and consents to Paramount collecting, using and storing the data.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    26 views2 pages

    Application Form Corporation With DPA

    Uploaded by

    joy
    This 3 sentence summary provides the key details from the bond application document: The document is a bond application form for Paramount Life & General Insurance Corporation where the applicant provides information about the type of bond being applied for, details about the applicant company such as name, address, years in business, bank and trade references, and authorizes Paramount to verify the application information. The applicant also warrants that they are authorized to disclose the application information and consents to Paramount collecting, using and storing the data.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 2

    BOND APPLICATION (For Corporations)

    TO : PARAMOUNT LIFE & GENERAL INSURANCE CORPORATION


    th
    15 Floor, SAGE House, 110 V.A. Rufino Street, Legaspi Village, Makati City

    The undersigned hereby applies for a bond described as follows:

    Kind of Bond: Amount:


    Obligee:
    Conditions of the Bond:

    (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

    7. Trade References (Name and Address):

    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:

    Are you acting as Surety Bondsmen for others, or as endorser on


    11.
    their notes or accounts?
    If yes, kindly indicate particulars:
    BOND APPLICATION page 2

    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

    Date Name of Signatory and Designation

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