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Co-signer's statement

GSIS co-signer's statement for bond

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TO:

GENERAL INSURANCE GROUP
GOVERNMENT SERVICE INSURANCE

____

GIF Bond No.

_

SYSTEM

I am agreeable to sign with the applicant M ~ __ "",:""
"",:"""",:",,,,--,-,-_
covering bond applied for by him from you in the amount of P
~-----------in
favor of
I am aware of the responsibility which I will
assume in signing with
I am also aware
that you will reply on the truth of the following statement in consideration thereof.
You are hereby authorized to obtain such information wish to secure about myself pertaining to date hereunder
furnished you and I agree that this documents shall remain your property whether or not the bond shall be granted.
(Pleasejill up all bianks. Kind!)' print or !ype.your an.rwer.)
PERSONAL CIRCUMSTANCES:
Name:
Civil Status:
Living with spouse?
No. of Dependents:
Source of Income:

Residence:
If married, name of spouse:
If not, address of spouse:
TOTAL Annual Income: P

a.) Salary/ Wages, p.a.: P

_
_
_
_

~

b.) From Business, p.a. P

c.) Other Income, p.a.: P
Res. Cert. A & B

Tel. No.

_

_
issued on

at

_

IF EMPLOYED:
If employed, please state: Name of EMPLOYER
Address:
Tel. No.:
__________
Present Position:
..
No; of years in present position:
Name and TITLE of immediate SUPERIOR:
PREVIOUS EMPLOYMENT: Name of Employer:
Address:
~
Employment:
Position held:

_
Nature of Work:
Nature of Business:
No. of years in Employment:

_
_
_
_
_
No. of years in previous

Tel. No.
--'-

_

. IF IN BUSINESS:
If engaged,please state:
Nature or kind of business:
Is it registered Withthe Bureau of Domestic Trade?
Whether sale ownership / partnership / corporation:
Business Address:
Capital PersonallyInvested: P

Firm or Trade name: --'-'--With SEe?

_
_
_

Tel. No.
No. of years in Business:

--'-

_
-----

TRADE REFERENCES:
1.) ___

-----------Addre~:-------------------------

2.) ______________

Address:

_

REAL ESTATE OWNED:
Location

Area in Sq. MJ.

A.rJCJJcd

Land

P_---P
P
P

r. 'a/He

Ent"UmbrClntcU
Amount Held &

Improvement

P
P
P
P

_
_
_
_

P_----P_----P_-----

P_----

____

Co-Signor's Statement

PERSONAL PROPERTIES

GIF Bond No.

_

OWNED:
Encumbram»
Amount Held I?J

p-------

p-------

Description

Fair Maree:
Value
p------

Location

Date Acquired

p--------

BANK ACCOUNTS:
Where kept?

Savings
Current

Amount: P
Amount: P

_
_

LIFE INSURANCE:
I nsurance Company

Date POUCT issued

Casb f,'a/ue

.'lmOlfnl

P-~-----P_-----P_------- P_------

P_-------

P_------

PERSONAL REFERENCE:
Name

Firm or Cffi«

Address

Co-signor will state whether applicant is related to him and is so what manner:

_

Co-signor will state how long he has known the applicant:
_
Co-signor will state whether he has been borrower or co-maker or a personal note at any bank or guarantor with other
companies. If so, please state particulars:
_
I affirm that each of the answer given to the foregoing questions is true and correct:
Dated at

" Philippines, this day

day of

, 20,

_

Signature of Co-signer

REPUBLIC OF THE PHILIPPINES

)
S.S.

SUBSCRIBED AND SWORN to before me this
In
No. A & B
issued at

Doc. No.
Page No.
Book No.
Series of

_
_
_
_

NOTE: Plepse attach t-opyofyour latest lncome Tax Return

day of
.20
_
. affiant exhibited to me his/her Residence Certificate
on
_

NOTARY PUBLIC
 
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