CO-SIGNER’S STATEMENT (2)
TO : STRONGHOLD INSURANCE CO., INC.
17th Floor Security Bank Centre
6776 Ayala Avenue, Makati City
PLEASE PRINT AND/OR TYPE ANSWER:
The undersigned hereby agrees to act as co-signer to SUN IMPACT ENTERPRISE in the amount of
Ps.__________________________applied by EDGAR Z. CORNELIO in favor of PNOC EXPLORATION
CORPORATION
NAME: EDGAR Z. CORNELIO AGE: 36 NATIONALITY: Filipino
ADDRESS: (Res.) 2220A Leyte Street, Brgy. 751, San Andres, Manila Tel. No. __________________
(Office) B40 L2, Deca Clark Residence, Margot, Angeles City, Pampanga
CIVIL STATUS: Single NAME OF SPOUSE: Not Applicable
OCCUPATION: Manager INCOME: __________ ANNUALLY/MONTHLY _________
IF EMPLOYED, PLEASE STATE:
NAME OF EMPLOYER: _ SUN IMPACT ENTERPRISE TRADE NAME: Not Applicable
ADDRESS: B40 L2, Deca Clark Residence, Margot, Angeles City, Pampanga
TEL. NO. 09196176242 NO. OF YEARS: 2 Years TEL. NO. ____________NO. OF YEARS 2 years
KIND OF BUSINESS: Trading KIND OF BUSINESS: _________________________
POSITION OCCUPIED: Manager CAPITAL INVESTED: _________________________
NAME & DESIGNATION OF SUPERIOR: ______________TRADE REFERENCE: _______________________
(IF THE SPACE PROVIDED IS NOT ENOUGH, USE BACK HEREOF)
BANK ACCOUNTS:
CURRENT ACCOUNT: _____________________________________________________________
TIME AND/OR SAVINGS DEPOSITS: __________________________________________________
REAL ESTATE AND/OR PERSONAL PROPERTIES OWNED:
DATE AREA ASSESSED VALUE INCUMBRANCE
ACQUIRED LOCATION OF DESCRIPTION OF LAND LAND IMPROVEMENT AMOUNT PAID
________ _____________________ ________ _________________ _____________
________ _____________________ ________ _________________ _____________
LIFE INSURANCE: _________________________________AMOUNT______________________________
RELATIONSHIP WITH APPLICANT: __________________________________________________________
HOW LONG HAVE YOU KNOWN THE APPLICANT? _____________________________________________
HAVE YOU EVER BEEN A BORROWER OR CO-MAKER ON A PROMISSORY NOTE WITH ANY LENDING
INSTITUTION? (PLEASE EXCLUDED RELATIVE) ________________________________________________
NAME OCCUPATION ADDRESS
___________________________ ____________________ __________________________
___________________________ ____________________ __________________________
___________________________ ____________________ __________________________
The foregoing statement and representation are true and correct and made for the purpose of
including the STRONGHOLD INSURANCE CO., INC., to issue the bond applied for. This will also serve as an
authority for the said company to verify from the above-mentioned persons, bank and entities the veracity of
the above information I have declared.
EDGAR ZARA CORNELIO
(Signature)
SIGNED IN THE PRESENCE OF:
___________________________________ ________________________________
REPUBLIC OF THE PHILIPPINES)
) S.S
SUBSCRIBED AND SWORN to before me this _________day of _____________________201_____ at the
__________________________________Affiant exhibiting to me his/her Community Tax Certificate No.
__________________________issued at _________________________on _______________________.
Doc. No. _______
Page No._______
Book No._______
Series of 2020.
