SECURITIES AND EXCHANGE COMMISSION

SEC FORM SCA R-002

APPLICATION FOR RENEWAL OF SURETY COMPANY ACCREDITATION
For the Year
(To be accomplished in four (4) copies with cover sheet; 3 copies for SEC & 1 receiving copy for the applicant)

Corporate Name of Applicant: Certificate of Accreditation No.

TIN #:

Complete
Address: Tel #
Fax #

Name of President: TIN #

List of Broker/Dealer Client/s . (use another sheet if necessary) Types of business engaged in:

(1)

(2)

(3)

(4)

(5)

Contact Position in
Person: Contact #
the firm

The above-named Surety Company hereby makes the application for the renewal of its registration located
at the address shown above and hereby certifies that the information contained in its most recent filing of
SEC Form SCA R-002 is true, correct, accurate and complete.

Printed Name and Signature of Authorized Signatory

Designation in the Company

……………………………………………………………………………………………………………………………….

Renewal Requirements:

1. Notarized certification that the firm is in compliance with the general qualification requirements
under Section 2 of the Guidelines on Accreditation of Surety Companies.
2. Board Resolution authorizing the signatory in SEC Form SCA R-002.
3. Current Certificate of Accreditation issued by the Commission.
4. Payment of Php5050.00 renewal fee.
5. Payment of additional fee based on broker/dealer client in excess of 5.

Signature of Processor Date

SEC Form SCA R-002
October 2009