MAAGAP-AF-UW037

BOND APPLICATION
Individual

The undersigned hereby applies for a ________________________________________________Bond in amount of

_____________________________________________________________________________________________
(P______________________) in favor of ___________________________________________________________
to fully and faithfully guarantee ___________________________________________________________________
_____________________________________________________________________________________________
(Indicate details of undertaking, or attach copy of contract or corresponding document for which bond is required).

For your consideration, I/We am/ are giving hereunder the following information:

1. Name _____________________________________Nationality ___________________Status_____________

2. Residential Address ______________________________________________________ Tel no.____________
3. Office Address __________________________________________________________ Tel no.____________
4. Occupation _____________________________________How long have you engaged as such? ____________
5. What is your Monthly salary/income? __________________________________________________________
6. If you are engaged in business, please describe its nature and state the annual income you derive from this
source. ___________________________________________________________________________________
7. Do you have any saving or checking account? If so, with what bank and what is present
balance? __________________________________________________________________________________
8. If you own real estate properties, please give the following particulars (If land, Estate if titled or unregistered,
whether residential, commercial, or agricultural and also area thereof. If store, bodega, etc.) and type of
construction (concrete, timber, light material, etc.)

Description Location Area Assessed Value Market Value

A._____________ __________________ _________ ________________ ______________

B._____________ __________________ _________ ________________ ______________
C._____________ __________________ _________ ________________ ______________

9. If any of the above-mentioned property/ics is/are presently mortgaged, please state the following:

Description of Name of Amount of Present

Property Mortgagee Original loan Balance Due Date

A.______________ _______________ _________________ ____________ ______________

B.______________ _______________ _________________ ____________ ______________

10. Do you carry fire insurance on any of these properties? If so, please state the following:

Description of Name of Amount of

Property Insurance Co. Insurance Expiry Date

11. Do you own stocks of companies listed in the Manila and Makati Stock Exchange? Yes ________ No_______

Issuing Company Kind No. of Shares Current Value

A.____________________ _________________ _____________________ ______________

B.____________________ _________________ _____________________ ______________

12. Do you carry Life Insurance? Yes_________________ No___________________

Name of Insurance Co. Face Value Beneficiary Date Issued

A.____________________ _________________ _____________________ ______________

B.____________________ _________________ _____________________ ______________
C.____________________ _________________ _____________________ ______________
 13. Are You indebted to anyone for sums of money? Yes _______________________ No___________________

Name of Creditor Amount of Loan Date Due Security

A.______________________ ________________ ______________ ______________

B.______________________ ________________ ______________ ______________
C.______________________ ________________ ______________ ______________

14. Have you ever been issued a bond? Yes _______________________ No ____________________

Surety Company Type of Bond Amount Obligee Expiry

A.___________________ _____________ ___________ ____________ ____________

B.___________________ _____________ ___________ ____________ ____________
C.___________________ _____________ ___________ ____________ ____________

15. Are you an endorser or surety for anyone? Yes____________________ No __________________

What extent? _____________________________________________________________________________

16. Have you ever had a bond cancelled or an application decline by any surety? Company? If so, when and why?
___________________________________________________________________________________________

17. Give below names, occupations and address of responsible persons for reference in no case relatives.

Name Occupation Address

A.___________________________ ______________________________ _____________________

B.___________________________ ______________________________ _____________________
C.___________________________ ______________________________ _____________________

The above and foregoing statements and representations are true and correct to the best of of my knowledge and
belief and are made for the purpose of including the MAA General Assurance Phils., Inc.

Date at_____________________________ this __________________day of ______________________

SUBMITTING AGENT :____________________________________

CODE NUMBER :____________________________________

____________________________
Signature

Residence Cert.# ______________

Issued at ____________________
On _________________________
TIN ________________________

ACTION TAKEN

Application No. _________________________Approved _____________________ Bond No. ________________

Date Received __________________________Disapproved___________________ Date ____________________
 MAAGAP-AF-UW049

CO-SIGNER’S STATEMENT

To: MAA GENERAL ASSURANCE PHILS., INC.

Date: _________

I am agreeable to sign with the applicant _____________________________________________________

covering the bond applied for by him/her from the MAA General Assurance Phils., Inc. in the amount of
P_________________________________ in favor of __________________________________________________
I am a ware of the responsibility which I will assume in signing with ______________________________________
_____________________________________________________________________________________________
I am also aware that you rely on the truth of the following statements in the consideration thereof.

I authorize you to obtain such information as you may require concerning the statements made hereunder
and I agree that this document shall remain your property whether or not the bond is granted.

( All the following question must be fully answered- if none, state ”None.” “Not Applicable” is not an answer)

Name _____________________________________________ Res. Cert.No.___________________Issued at________________On__________

(Please print or type full name)
Business Address _________________________________________________________________________Tel. No. ______________________
Residence__________________________________________________________ Provincial Address __________________________________
Salary, Wages per year ________________________________________________________________________( P ______________________)
Income from Business, etc. ______________________________________________________ Amount per year ( P ______________________)
Married/Single _________________________________Living with husband or wife __________________Number of dependents___________

If employed please state: _________________________________________ If in business for self, please state:___________________________

Name of employer ______________________________________________ Firm or trade name _______________________________________
Address ________________________________Tel. No. _______________ Address ____________________________Tel. No. ____________
Number of years with employer ___________________________________ Kind Business _____________________ How long ____________
Kind of business and employer ____________________________________ Capital Invested _____________________(P__________________)
Position occupied by co-maker ____________________________________ Sole owner partnership ____________________________________
Previous employer ______________________________________________Name ____________________________Address_______________
Address ______________________________ How long ________________Name ____________________________Address_______________

Bank Account – Where Kept-

Current ____________________________
Savings ____________________________

SHARES OF STOCK OWNED

NAME OF ISSUING NO.OF ENCUMBRANCES

KIND MARKET VALUE
CORPORATION SHARES IF ANY

REAL PROPERTIES OWNED

AREA OF PRESENT VALUE ENCUM- BRANCES

DESCRITPION LOCATION
LAND LAND IMPROVEMENTS AMOUNT HELD BY

Life Insurance ( Co.) ___________________________________________________ amount P ___________________________

Co-Signer will state whether applicant is related to him and if so in what manner ______________________________________
Co-Signer will state how long he has know applicant __________________________________________________________________________
Co-Signer will state whether he has even been a borrower or co-maker on a personal note at any bank or guarantor with other companies.
Companies. If so, please state particulars ___________________________________________________________________________________
_____________________________________________________________________________________________________________________
Name of references: ____________________________________________ Address ________________________________________________
____________________________________________ Address ________________________________________________

I affirm that each of the answers of the foregoing questions is true and correct.

_____________________________________________
(Signature of Co-Signer)
 MAAGAP-AF-UW049

CO-SIGNER’S STATEMENT

To: MAA GENERAL ASSURANCE PHILS., INC.

Date: _________

I am agreeable to sign with the applicant _____________________________________________________

covering the bond applied for by him/her from the MAA General Assurance Phils., Inc. in the amount of
P_________________________________ in favor of __________________________________________________
I am a ware of the responsibility which I will assume in signing with ______________________________________
_____________________________________________________________________________________________
I am also aware that you rely on the truth of the following statements in the consideration thereof.

I authorize you to obtain such information as you may require concerning the statements made hereunder
and I agree that this document shall remain your property whether or not the bond is granted.

( All the following question must be fully answered- if none, state ”None.” “Not Applicable” is not an answer)

Name _____________________________________________ Res. Cert.No.___________________Issued at________________On__________

(Please print or type full name)
Business Address _________________________________________________________________________Tel. No. ______________________
Residence__________________________________________________________ Provincial Address __________________________________
Salary, Wages per year ________________________________________________________________________( P ______________________)
Income from Business, etc. ______________________________________________________ Amount per year ( P ______________________)
Married/Single _________________________________Living with husband or wife __________________Number of dependents___________

If employed please state: _________________________________________ If in business for self, please state:___________________________

Name of employer ______________________________________________ Firm or trade name _______________________________________
Address ________________________________Tel. No. _______________ Address ____________________________Tel. No. ____________
Number of years with employer ___________________________________ Kind Business _____________________ How long ____________
Kind of business and employer ____________________________________ Capital Invested _____________________(P__________________)
Position occupied by co-maker ____________________________________ Sole owner partnership ____________________________________
Previous employer ______________________________________________Name ____________________________Address_______________
Address ______________________________ How long ________________Name ____________________________Address_______________

Bank Account – Where Kept-

Current ____________________________
Savings ____________________________

SHARES OF STOCK OWNED

NAME OF ISSUING NO.OF ENCUMBRANCES

KIND MARKET VALUE
CORPORATION SHARES IF ANY

REAL PROPERTIES OWNED

PRESENT VALUE
AREA OF ENCUMBRANCHES
DESCRITPION LOCATION
LAND AMOUNT HELD BY
LAND IMPROVEMENTS

Life Insurance ( Co.) ___________________________________________________ amount P ___________________________

Co-Signer will state whether applicant is related to him and if so in what manner ______________________________________
Co-Signer will state how long he has know applicant __________________________________________________________________________
Co-Signer will state whether he has even been a borrower or co-maker on a personal note at any bank or guarantor with other companies.
Companies. If so, please state particulars ___________________________________________________________________________________
_____________________________________________________________________________________________________________________
Name of references: ____________________________________________ Address ________________________________________________
____________________________________________ Address ________________________________________________

I affirm that each of the answers of the foregoing questions is true and correct.

_____________________________________________
(Signature of Co-Signer)
 MAAGAP-AF-UW049

For purposes of our underwriting and assessment, we would like to inform

you that we need the following documents.

- Copy of the Contract or Agreement between the principal/Contractor

and the Obligee or the project Owner
- Business Permit and/or DTI – If Individual or Single Proprietorship
- Audited Financial Statements ( Latest )
- Track Records ( List of Previous & on-going projects or contracts )
- Company Profile
- 2 Government ID’s of the Signatories
- T.I.N. No. of the Owner
- Duly accomplished bond application, together with the two co-signor’s
statement
- Copy Philippine Contractors Accreditation Board (PCAB)
- Copy Philippine Domestic Construction Board (PDCB)
- Copy Construction Industry Authority of the Philippines (CIAP)
- Xerox copy of TCT of properties owned

Should you need further clarification/s, please feel to call us at our office
telephone number (02) 867-2452 loc. 124/303 Fax-893-2230

Best regards………….

CHRISTIAN HARRIS R. HERRERA

Assistant Manager – Surety & Bonds
Bonds Department