F-BND-03

Revision : 00
01 October 2008
Page 1 of 2

APPLICATION FOR A SURETY BOND

The undersigned hereby applies for a ___________________________________________ Bond in the

amounting of P______________________, in favor of ____________________________________________ for the
purpose of _________________________________________________________________________________________
_______________________________________________________________________________ .
(Indicate details of the undertaking or attach copy of contract and/or relevant documents for which bond is
required).

INDIVIDUAL INFORMATION

1. Applicant's Name: _________________________________________ Trade Name:_______________________

2. Nationality: ______________________ Civil Status ___________________ Date of Birth _____________________
3. Complete Residential Address: ______________________________________________________________________
Home Landline : _____________ email address : _________________Cell Phone No. _______________
4. Complete Office Address: ____________________________________________________________________________
Telephone Nos.: ________________ Fax Nos.:___________________ Office eMail: _____________________
5. Name of Spouse: ____________________________________________________________________________________
6. Occupation:__________________________________ Occupation of Spouse: ________________________________
7. How long engaged as such: __________________________________________________________________________
8. Income: P _____________________ /month Spouse Income P __________________ / month
9. Are you engaged in other business? If so, describe its nature and state the income (monthly or
annually) derived from this source or these sources

10. Real Properties owned. (If land, state whether residential, commercial, industrial, or agricultural as
well as area thereof in square meters or hectares. If building, state number of storeys, nature of
occupancy (residential, store, bodega, etc.) and type of construction (concrete, timber, light materials,
mixed materials, etc.)
Description Location Assesed Value Market Value
a. P P
b.
c.
d.
(Pls. use separate sheet for other real estate properties)

11. If any of the above-mentioned properties is/are presently mortgage, please state name of mortgage,
amount of original loan, present balances and when due:

12. Do you have/carry fire insurance on any of these properties? If so, with what company and for what
amount? State corresponding expiry date.

13. Do you have any savings or checking account? With what bank and present balance:

14. Do you own stocks of companies listed in the Manila/Makati Stock Exchange? State name of issuing
company, king and number of shares owned and current value thereof ?

15. If you carry life insurance, state how long policy has been in force, with what company, and
approximate case value thereof?

16. Are you indebted, besides mortgages, to anyone for sums of money? If so, state name of creditor, how
much, for what account and when due:

15. Page 1 of 2 (Please see 2nd Page at the back)

 F-BND-03
Revisiob : 00
01 October 2008
Page 2 of 2

17. State whether you are an endorser or surety for anyone and to what extent:
__________________________

18. Have you ever have a bond cancelled; or an application declined by any surety company? If so,
when and why ?

19. If you have ever before given a bond, state particulars in the following: (Please state only those
bonds with substantial amount).

Name of Surety Type of Bond Amount Obligee Expiry Date

20. Refences: Give only construction firms, individuals, material suppliers, banks, and project owner

with whom you have previous/current transactions. (References should be non-relatives)

NAME OCCUPATIONS ADDRESS

We/I warrant the foregoing statements and information are true and correct to the best of
knowledge and belief and are made for the purpose of inducing BPI/MS Insurance Corporation to
execute said bond. We also authorize BPI/MS Insurance Corporation to otain such other
information it may require from herein and any sources.

Dated at _________________________ this ________ day of _______________________, 20_____

Signature

Tax Account No.

Residence Cert. for 20
AB-_________________________________
issued at ___________________________
issued on ___________________________
____________________________________
Tel. No. (Office) ______________________
Tel. No. (Res.) _______________________

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