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. = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =

1. Name of Company ______________________________________________________

2. Business Address _______________________________________________________ 3. T I N No. _____________________________________________________________ 4. 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:

_________________________________ Address _____________________________ _________________________________ Address _____________________________

9. BANK ACCOUNTS: Where Kept 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