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Application for Renewal of License of Mutual Benefit Association
IC renewal application form for license of mutual benefit association
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
Department of Finance
INSURANCE COMMISSION
Manila
APPLICATION FOR RENEWAL OF LICENSE OF
MUTUAL BENEFIT ASSOCIATION
___________________________
Date
The Insurance Commissioner
Manila
Sir/Madam:
The undersigned hereby applies for the renewal of license to transact business as a mutual
benefit association for the year beginning 01 January 20 ____, under Chapter VII, Title 1, Section 403
of the Insurance Code as amended (RA 10607) and in support thereof, represents as follows:
1.
Name of applicant: ______________________________________________________________
2.
Address: ______________________________________________________________________
______________________________________________________________________
Tel. No.: ______________________________________________________________________
Attached are the following pertinent documents necessary for the renewal of said license:
1.
2.
3.
4.
Original license
Renewed Fidelity Bond
Compliance with Guaranty fund Deposit Requirement
Documentary Stamp
__________________________________
Applicant
IC-LLI-DP-OO6-F-04
Rev.0
