Professional Documents
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Forms - Waiver
Forms - Waiver
Forms - Waiver
We, EDGARDO P. DAVID, President, and MAYBELLE L. LIM, Vice-Chairman & CEO, duly
authorized signatories of TRAVELLERS INSURANCE AND SURETY CORP., all of legal age,
Filipinos, and with postal address at 10 th Floor G.E. Antonino Building, TM Kalaw St., corner J.
Bocobo St., Ermita, Manila, after having been duly sworn in accordance with law, hereby depose
and say:
1. That we hereby waive our rights under Republic Act 1405 (Bank Secrecy Law) to
confidentiality of TRAVELLERS INSURANCE AND SURETY CORPORATION with bank
account with EASTWEST BANK under Account No. 20002763671, in favor of the
INSURANCE COMMISSION in reference to the infusion made by our stockholders.
2. That we hereby give consent to the INSURANCE COMMISSION or its duly authorized
agents to look into and examine our aforementioned bank account in connection with the
above-mentioned capital infusion.
Subscribed and sworn to before me this ____ day of June, 2021 at Manila, Philippines.
EDGARDO P. DAVID and MAYBELLE L. LIM, exhibited to me his/her Community Tax
Identification No. 130-191-205 and 106-248-377, respectively.
1. That we hereby waive our rights under Republic Act 1405 (Bank Secrecy Law) to
confidentiality of TRAVELLERS INSURANCE AND SURETY CORPORATION with bank
account with CITYSTATE BANK under Account No. 008-20-001441-9, in favor of the
INSURANCE COMMISSION in reference to the infusion made by our stockholders.
2. That we hereby give consent to the INSURANCE COMMISSION or its duly authorized
agents to look into and examine our aforementioned bank account in connection with the
above-mentioned capital infusion.
Subscribed and sworn to before me this ____ day of June, 2021 at Manila, Philippines.
MARIANITO G. FARAL and SANDRA L. ANG, exhibited to me his/her Community Tax
Identification No. 100-175-234 and 106-248-328, respectively.
AFFIDAVIT
I, SAMUEL U. LEE, of legal age, married with office address at 10th Floor G.E. Antonino
Building, TM Kalaw St., corner J. Bocobo, Ermita Manila. After having been duly sworn in
accordance with the law. Do hereby depose and say;
3. That I hereby execute this affidavit for the purpose of attesting to the truth of
the foregoing and other legal intents and purposes.
IN WITNESS WHEREOF, I have hereto set my hands this 30th day of June, 2021.
___Samuel U. Lee____
Authorized Signatory
Subscribed and sworn to before me this 30th day of June, 2021 at Manila, Philippines,
Affiant exhibited his Tax Identification No. 106-248-302.
AFFIDAVIT
I, DOLORES G. FERNANDEZ, of legal age, married with office address at 10th Floor G.E.
Antonino Building, TM Kalaw St., corner J. Bocobo, Ermita Manila after having been duly sworn
in accordance with the law do hereby depose and say;
4. That I hereby execute this affidavit for the purpose of attesting to the truth of
the foregoing and other legal intents and purposes.
IN WITNESS WHEREOF, I have hereto set my hands this 30th day of June, 2021.
Subscribed and sworn to before me this 30th day of June, 2021 at Manila, Philippines,
Affiant exhibited his Tax Identification No. _____________
I hereby give consent to the INSURANCE COMMISSION or its duly authorized agents to
look into and examine my aforementioned bank account/s in connection with the capital
infusion to Travellers Insurance and Surety Corporation. I further authorize (Name of
Bank) to give, provide or disclose whatever document or information to the INSURANCE
COMMISSION or its duly authorized representative relating to our aforementioned account/s,
which said Office may request in connection with the purpose as stated herein.
____DOLORES G. FERNANDEZ__
Account Holder
President
Subscribed and sworn to before me this 30th day of June, 2021 at Manila, Philippines. Ms.
Dolores G. Fernandez exhibited to me her Tax Identification No. _____________.
I, Samuel U. Lee, of legal age, single/married, with postal address at 10th Floor G.E.
Antonino Building, TM Kalaw St., corner J. Bocobo St., Ermita, Manila, hereby waive my right
under Republic Act No. 1405 (Bank Secrecy Law) to confidentiality of my bank account no.
200015461186 with Eastwest Bank – United Nations Avenue Branch in favor of the Insurance
Commission.
I hereby give consent to the INSURANCE COMMISSION or its duly authorized agents to
look into and examine my aforementioned bank account/s in connection with the Networth
Deficiency. I further authorize Eastwest Bank to give, provide or disclose whatever document or
information to the INSURANCE COMMISSION or its duly authorized representative relating to
my aforementioned account/s, which said Office may request in connection with the purpose as
stated herein.
SAMUEL U. LEE
Account Holder
Subscribed and sworn to before me this 30th day of June, 2021 at Manila, Philippines. Mr.
Samuel U. Lee exhibited to me his Tax Identification No. 106-248-302.
AFFIDAVIT
I, Samuel U. Lee , of legal age, married with office address at 10th Floor G.E. Antonino
Building, TM Kalaw St., corner J. Bocobo, Ermita Manila. After having been duly sworn in
accordance with the law. Do hereby depose and say;
3. That I hereby execute this affidavit for the purpose of attesting to the truth of
the foregoing and other legal intents and purposes.
IN WITNESS WHEREOF, I have hereto set my hands this ______ day of ______________
___Samuel U. Lee____
Authorized Signatory
1. That we hereby waive our right under Republic Act 1405 (Bank Secrecy Law) to
confidentiality of Travellers Insurance and Surety Corporation with bank account with
EastWest Bank under Account No. 200002763671, in favor of the INSURANCE
COMMISSION in reference to the infusion made by our stockholders.
2. That we hereby give consent to the INSURANCE COMMISSION or its duly authorized
agents to look into and examine our aforementioned bank account in connection with the
above-mentioned capital infusion.
3. That we further authorize EastWest Bank- United Nations Branch, UN Avenue, Ermita,
Manila to give, provide or disclose whatever document or information relating to our
aforementioned account which said Office may request in connection with the purpose as
stated herein.