Republic of thePhilippines

GOVERNMENT SERVICE INSURANCE SYSTEM

GENERAL INSURANCE FUND
f--.

Bond Number

Applicant

BOND APPLICATION

FORM

Bill Number

Tel. No.

Obligee

Tvpe of Application

Wi

Kind of Bond

New
Endorsement
I
jBond No.:
Renewal
[Bond No.:

':=1

fB;dT;me

C;dD.re

,=:]
a
Q

Bond Amount

o Surety Bond

Bidder's Bond

Standing Bid Bond

General Bid-Performance

Performance Bond
Bond
Cl Judicial Bond
QOther

Q Customs

Bond

VaUditv Period

L__

a Callable

Clauses

011 Demand
Penal in Nature

Cl

Actions Sheet

r:e

Principal Signatory

Financial Statement
Year

1--.

, Designation

Total Assets

----

gfNo.
Issued at

hssued on

Total Liabilities

Net Worth

19nors
Co~81
"

Property .

Name

Mirket Value

Location

,.

--

"

"

Undertaking
,

I
W arrantles/Clauses

tl

~Clausc
I

MWSS Clause

Q B &CClause

GSIS Clause

Premium Comnutatlon
Bond Amount
I

. Rate
Premium

E-YAT
Notarial Fee
Total

U.Standing Bid Bond Clause .

CJ Gen. Bid-Performance Clause

...
Q Others:
Remarks