Bonds Application (Sole Proprietor)

Bonds Application Form (For Sole Proprietor)
Page 1 of 9
BONDS APPLICATION
(For Sole Proprietor)
Company Name: Date:

Contact Person:
Contact Number:
Email Address:
In connection with your application for Bonds, kindly submit the following documents:
LIST OF REQUIRED DOCUMENTS

1 Duly filled out Application Form
2 Two (2) Duly filled out Co-signor Statements
2.a. Copy of Government ID’s of the authorized signatory (any

two (2): Unified, SSS, TIN, Driver’s License, Senior Citizen,
Voter’s or other government identification cards with indicated
address and signature) with three (3) specimen signatures
2.b. Income Tax Return, if any
2.c. Certificate of Bank Deposit, if any
3 Duly filled out KYC or Client Information Sheet
4 Latest Audited Financial Statement and Income Tax Return (with BIR Stamp or
equivalent)
5 List of Key Officers and Personnel (certified by authorized representative)
6 Copy of Government ID’s of the authorized signatory (any two (2): Unified, SSS,
TIN, Driver’s License, Senior Citizen, Voter’s or other government identification
cards with indicated address and signature) with three (3) specimen signatures
7 Income Tax Return of the authorized signatory, if any
8 Company Profile (with list of major clients)
9 List of On-going and Completed Projects (with contact details)
10 DTI Registration
11 Business Permit
12 PCAB License, if any
13 ISO Certification, if any
Prudential Guarantee and Assurance, Inc. COYIUTO HOUSE, 119 C. Palanca St., Legaspi Village, Makati City, 1229 Philippines
Tel. Nos.: (632) 8810-4916 / 8878-3000 / 8651-9500 | Fax: (632) 8819-2991 | customercare@prudentialguarantee.com | www.prudentialguarantee.com
Page 2 of 9
14 Copy of Contract / NTP / NOA / P.O. / Invitation to Bid / Court Order / Law or
Ordinance requiring the posting of the bond / Certificate of Completion
Please note that the prompt processing of your appllication depends on your immediate and full compliance
with all the above requirements, while the approval of your application depends on the evaluation of your
supporting documents by our Bonds Committee.
In your application with us, we will be requiring the disclosure of information. We want to assure you that
PGAI and its employees will exercise the proper protocol to ensure that your information will be kept
confidentially and will be used solely for the intended purpose.
Thank you.
Best Regards,
Bonds Department
Page 3 of 9
APPLICATION FORM
(For Sole Proprietor)
Please fill in all the blanks completely and/or put a check ( √ ) mark on the applicable boxes. Kindly indicate
N/A for those not applicable. Please be reminded that the approval of your application is based on the relevant
information provided to us.
Business Name:
Business Address:
Business Contact Number/s:
Business Email Address:
Nature of Business:
Date of Registration:
No. of Years in Business:
Initial Capitalization:
Source of Funds:
Name of Beneficiaries, if any:
Name of the Sole Proprietor /

Registered Owner:
Date and Place of Birth:
TIN / SSS / GSIS ID Nos.:
Nationality:
Contact Number/s:
Email Address:
Residence Address:
Identification Cards Provided:
*As mandated by Philippine Anti-Money Laundering Act and Its Implementing Rules and Regulations
PERSONAL / BUSINESS ASSETS

(What are the properties/assets you owned?)
Titles of land and/or

improvements (if any)
If yes, please indicate:

Assessed / Market /
TCT No. Location Other Details, if any
Declared Value
Please furnish us with a copy of Please furnish us with a Please indicate the city Any material information
the title/s copy of the supporting or municipality where the regarding the aforesaid
documents of valuation property/ies is/are located. property/ies, e.g. lien or
annotation, presence of
informal settlers, third
party claimant, etc.
Page 4 of 9
1
2
3
4
5
Total: ____________
Bank Deposit/s
Bank Name Type of Account Remaining Balance Other Details, if any
Please furnish us with a copy of the certificate of deposit / passbook / screencap of online bank account reflecting the name
of the company and the amount. Please filter the information other than the company and the amount.
1
2
3
4
5
Total: ____________
Shares of Stock

Stock Certificate Assessed / Market /
Issuing Corporation Other Details, if any
No. Declared Value
Please furnish us with a copy of the stock certificates and the supporting documents for its valuation.
1
2
3
4
5
Total: ____________
Others, please specify:
Page 5 of 9
PLEASE INFORM US
How did you come to know us?
Please elaborate in brief.
Do you know any PGAI officer or
employee? If yes, please state
the complete name, position, contact
details and a brief statement on how
you are connected to him/her.
Are you PGAI’s client with the
other insurance products? Please
provide us the details, i.e. product,
assured name, property, policy
number, and amount of coverage)
For new applicant, prior to Insurance Product

Total
applying with us, who is Company (Bonds, Motor Car, Property Total Sum
Premium
your previous insurance Name Fire, CARI, Personal Insured Insured
Due
provider? Please state the Accident, etc.)
Company Name, Insurance
Product, Property Insured,
Total Sum Insured and Total
Premium Due.
DECLARATIONS
I agree and conform that:
PGAI will use the information I voluntarily disclosed to process my application for the issuance of bond
policy/ies.
PGAI may seek for updated underwriting documents annually, including, but not limited to, audited
financial statement, certified list of officers and personnel, and list of on-going and completed projects.
I am under the obligation to provide update should there be changes on the information I herein or
hereafter provided.
PGAI may seek for updated contact details annually.
The application, including all the submitted documents and information, will undergo evaluation.
The result of the application may be as follows: approval, denial, or requirement for additional
documents and/or securities / collateral.
This application and all the information provided herein or in any other documents submitted shall
remain effective unless and until the I provide a written notice indicating otherwise. Such written
notice, to be effective, must be duly received by the authorized representative of PGAI.
Page 6 of 9
CONSENT AND PRIVACY NOTICE
By transacting with Prudential Guarantee and Assurance, Inc. (PGAI), I hereby allow and authorize PGAI
to collect, use and process my personal data provided in this form and its attachments in accordance with
this Privacy Notice and all applicable laws. I agree to be bound by the Data Privacy Act of 2012 and related
laws, rules and regulations. I understand that my personal data may be made available to PGAI’s agents,
affiliates, brokers, service providers, third-party companies and government bodies whenever necessary.
By freely and voluntarily providing personal data to PGAI, I am confirming that they are true and correct. I
understand that PGAI reserves the right to revise any decision made on the basis of the data provided should
the same be found untrue or incorrect. I hold PGAI, its agents and affiliates, brokers, service providers and,
where applicable, third-party companies free and harmless from any liability which may arise as a result of
the authorization herein given.
PGAI shall collect, process, use, store, record and update my personal data necessary for securing an
insurance contract and other related purposes. The same may be shared, disclosed, or transferred to agents,
affiliates, brokers, service providers of PGAI and government bodies authorized by law to receive such
information. PGAI shall retain all information provided for a period necessary to fulfull the aforesaid
purposes, unless a longer retention period is required or permitted by law. Such personal data shall be
treated with utmost confidentiality and shall be accessed by authorized personnel only. In accordance with
the Data Privacy Act of 2012, data subjects shall have the right to access their personal data to correct,
update or supplement any false, inaccurate or incomplete information. Should there by any question, please
contact the Data Protection Officer of PGAI through 8878-3000 loc. 7284.
ATTESTATION
I hereby attest to the truthfulness and accuracy of the information provided herein. As proof thereof, I hereto
affix my signature.
Applicant
(Please indicate signature above printed name)
Page 7 of 9
CO-SIGNOR STATEMENT
I of legal age, Filipino, and with residence address at

do hereby depose and state that:
I personally and professionally know the applicant and can

guaranty its/his/her character and capability.
I hereby agree to act as its/his/her guarantor. As such, I undertake to indemnify PGAI for all the obligations and
liabilities that it may incur by virtue of its issuance of the bond/s applied for by the applicant. I am aware of
the responsibility which I will assume in signing with the applicant.
I am also aware that PGAI relies on the truth of the following statements in the consideration thereof.
(Please fill in all the blanks completely and/or put a check ( √ ) mark on the applicable boxes. Kindly indicate N/A for those
not applicable.)
Complete Name:
Contact Number/s:
Email Address:
Permenant Residence:
Current Residence:
Provincial Address (if any):
Civil Status:
If married, name of Spouse:
No. of dependents (if any):
Source of Funds:
If employed, Salary (Per Year):

Employer’s Name:
Business Address:
Contact Number:
Email Address:
Position:
No. of years with Employer:
If self-employed, Net Income (Per Year):

Business Name:
Page 8 of 9
Business Address:
Contact Number:
Email Address:
Date of Registration / Operation:
Capital Invested:
COSIGNOR’S ASSETS
(What are the properties/assets)


Assessed / Market /
Declared Value
1
2
3
4
5
Total: ____________
Bank Deposit/s
1
2
3
4
5
Total: ____________
Shares of Stock
Page 9 of 9

No. Declared Value
1
2
3
4
5
Total: ____________
PLEASE INFORM US
How are you related to the Applicant?
employee?
If yes, please state the complete name,
position, contact details and a brief
statement on how you are connected
to him/her.
Are you PGAI’s client with the other
insurance products? Please provide
us the details, i.e. product, assured
name, property, policy number, and
amount of coverage)
DECLARATIONS
PGAI will use the information I voluntarily disclosed to process the application of the applicant for the
issuance of bond policy/ies.
hereafter provided.
This Co-signor’s Statement and all the information provided herein or in any other documents
submitted shall remain effective unless and until I provide a written notice indicating otherwise. Such
written notice, to be effective, must be duly received by the authorized representative of PGAI.
Page 10 of 9
ATTESTATION
affix my signature.
CO-SIGNOR
Page 11 of 9
CO-SIGNOR STATEMENT
I of legal age, Filipino, and with residence address at

do hereby depose and state that:
I personally and professionally know the applicant and can

guaranty its/his/her character and capability.
I hereby agree to act as its/his/her guarantor. As such, I undertake to indemnify PGAI for all the obligations and
liabilities that it may incur by virtue of its issuance of the bond/s applied for by the applicant. I am aware of
the responsibility which I will assume in signing with the applicant.
I am also aware that PGAI relies on the truth of the following statements in the consideration thereof.
(Please fill in all the blanks completely and/or put a check ( √ ) mark on the applicable boxes. Kindly indicate N/A for those
not applicable.)
Complete Name:
Contact Number/s:
Email Address:
Permenant Residence:
Current Residence:
Provincial Address (if any):
Civil Status:
If married, name of Spouse:
No. of dependents (if any):
Source of Funds:
If employed, Salary (Per Year):

Employer’s Name:
Business Address:
Contact Number:
Email Address:
Position:
No. of years with Employer:
If self-employed, Net Income (Per Year):

Business Name:
Page 12 of 9
Business Address:
Contact Number:
Email Address:
Date of Registration / Operation:
Capital Invested:
COSIGNOR’S ASSETS
(What are the properties/assets)


Assessed / Market /
Declared Value
1
2
3
4
5
Total: ____________
Bank Deposit/s
1
2
3
4
5
Total: ____________
Shares of Stock
Page 13 of 9

No. Declared Value
1
2
3
4
5
Total: ____________
PLEASE INFORM US
How are you related to the Applicant?
employee?
If yes, please state the complete name,
position, contact details and a brief
statement on how you are connected
to him/her.
Are you PGAI’s client with the other
insurance products? Please provide
us the details, i.e. product, assured
name, property, policy number, and
amount of coverage)
DECLARATIONS
PGAI will use the information I voluntarily disclosed to process the application of the applicant for the
issuance of bond policy/ies.
hereafter provided.
This Co-signor’s Statement and all the information provided herein or in any other documents
submitted shall remain effective unless and until I provide a written notice indicating otherwise. Such
written notice, to be effective, must be duly received by the authorized representative of PGAI.
Page 14 of 9
ATTESTATION
affix my signature.
CO-SIGNOR

Bonds Application (Sole Proprietor)

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Bonds Application Form (For Sole Proprietor)

Company Name: Date:

LIST OF REQUIRED DOCUMENTS

2 Two (2) Duly filled out Co-signor Statements

2.a. Copy of Government ID’s of the authorized signatory (any

2.b. Income Tax Return, if any

2.c. Certificate of Bank Deposit, if any

3 Duly filled out KYC or Client Information Sheet

5 List of Key Officers and Personnel (certified by authorized representative)

7 Income Tax Return of the authorized signatory, if any

8 Company Profile (with list of major clients)

9 List of On-going and Completed Projects (with contact details)

12 PCAB License, if any

13 ISO Certification, if any

Name of the Sole Proprietor /

PERSONAL / BUSINESS ASSETS

Titles of land and/or

If yes, please indicate:

If yes, please indicate:

Bank Name Type of Account Remaining Balance Other Details, if any

If yes, please indicate:

Others, please specify:

For new applicant, prior to Insurance Product

I agree and conform that:

PGAI may seek for updated contact details annually.

CONSENT AND PRIVACY NOTICE

I of legal age, Filipino, and with residence address at

I personally and professionally know the applicant and can

If employed, Salary (Per Year):

If self-employed, Net Income (Per Year):

Titles of land and/or

If yes, please indicate:

If yes, please indicate:

Bank Name Type of Account Remaining Balance Other Details, if any

If yes, please indicate:

Others, please specify:

I agree and conform that:

PGAI may seek for updated contact details annually.

CONSENT AND PRIVACY NOTICE

I of legal age, Filipino, and with residence address at

I personally and professionally know the applicant and can

If employed, Salary (Per Year):

If self-employed, Net Income (Per Year):

Titles of land and/or

If yes, please indicate:

If yes, please indicate:

Bank Name Type of Account Remaining Balance Other Details, if any

If yes, please indicate:

Others, please specify:

I agree and conform that:

PGAI may seek for updated contact details annually.

CONSENT AND PRIVACY NOTICE

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