Forms - Waiver

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Republic of the Philippines)

City of Manila ) S.S.

WAIVER AND CONSENT

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.

3. That we further authorize EASTWEST BANK – UNITED NATIONS AVENUE, MANILA


BRANCH 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.

Signed this 30th day of June, 2021 at Manila, Philippines.

TRAVELLERS INSURANCE AND SURETY CORP.


(Name of Company)

EDGARDO P. DAVID - President

MAYBELLE L. LIM - Vice-Chairman & CEO

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.

Doc. No. ______________ ________________________


Page No. _____________ (Notary Public)
Book No. _____________
Series of 20___

(For company authorized bank signatories)


Republic of the Philippines)
City of Manila ) S.S.

WAIVER AND CONSENT

We, MARIANITO G. FARAL, SVP-Comptroller, and SANDRA L. ANG, SVP-Treasurer, 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 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.

3. That we further authorize CITYSTATE BANK – BACLARAN BRANCH 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.

Signed this 30th day of June, 2021 at Manila, Philippines.

TRAVELLERS INSURANCE AND SURETY CORP.


(Name of Company)

MARIANITO G. FARAL - SVP-Comptroller

SANDRA L. ANG - SVP-Treasurer

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.

Doc. No. ______________ ________________________


Page No. _____________ (Notary Public)
Book No. _____________
Series of 20___

(For company authorized bank signatories)


Republic of the Philippines)
City of ________________) S.S.

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;

1. That I am a stockholder of Travellers Insurance and Surety Corporation

2. That by virtue of the directive of the Insurance Commission, I am hereby


disclosing the source of funds of my infusions to the Travellers Insurance and
Surety Corporation as compliance to the Networth Deficiency as per
examination made by the Insurance Commission as of 31 st December 2016.
To wit;

Date Infused Source of Funds Amount

January 13, 2021 LOAN P 1,400,000.00


January 13, 2021 LOAN 750,000.00
January 14, 2021 LOAN 3,920,000.00
January 15, 2021 LOAN 7,000,000.00
January 18, 2021 LOAN 3,500,000.00
January 19, 2021 LOAN 9,000,000.00
January 25, 2021 LOAN 4,000,000.00
----------------------
P29,570,000.00

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.

Doc. No. ______________ ________________________


Page No. _____________ (Notary Public)
Book No. _____________
Series of _______
Republic of the Philippines)
City of Manila ) S.S.

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;

1. That I am the PRESIDENT of Toptraders Import Export Corporation

2. That Toptraders Import Export Corporation is a stockholder of Travellers


Insurance and Surety Corporation

3. That by virtue of the directive of the Insurance Commission, I am hereby


disclosing the source of funds of our infusions to the Travellers Insurance and
Surety Corporation as compliance to the Networth Deficiency as per
examination made by the Insurance Commission as of 31 st December 2016.
To wit;

Date Infused Source of Funds Amount

January 12, 2021 P 25,000,000.00


January 12, 2021 20,000,000.00
January 20, 2021 3,100,000.00
January 20, 2021 2,000,000.00
January 20, 2021 800,000.00
January 20, 2021 2,400,000.00
January 21, 2021 6,100,000.00
January 22, 2021 6,000,000.00
January 22, 2021 4,000.000.00
January 26, 2021 4,000,000.00
January 26, 2021 6,000,000.00
January 26, 2021 4,500,000.00
January 26, 2021 2,000,000.00
January 27, 2021 2,000,000.00
January 29, 2021 1,300,000.00
March 11, 2021 5,000,000.00
March 12, 2021 10,800,000.00
------------------------------
P 105,000,000.00

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.

Toptraders Import Export Corporation

By: DOLORES G. FERNANDEZ


President

Subscribed and sworn to before me this 30th day of June, 2021 at Manila, Philippines,
Affiant exhibited his Tax Identification No. _____________

Doc. No. ______________ ________________________


Page No. _____________ (Notary Public)
Book No. _____________
Series of _______
Republic of the Philippines)
City of ________________) S.S.

WAIVER AND CONSENT

I, Dolores G. Fernandez , President of Toptraders Import Export Corporation,


hereby waive our right under Republic Act No. 1405 (Bank Secrecy Law) to confidentiality of
our bank account no/s. ___________________ with (Name of Bank) 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 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.

Signed this 30th day of June, 2021 at Manila, Philippines.

Toptraders Import Export Corporation


by:

____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. _____________.

Doc. No. ______________ ________________________


Page No. _____________ (Notary Public)
Book No. _____________
Series of 20___

(For individual stockholders)


Republic of the Philippines)
City of ________________) S.S.

WAIVER AND CONSENT

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.

Signed this 30th day of June, 2021 at Manila, Philippines.

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.

Doc. No. ______________ ________________________


Page No. _____________ (Notary Public)
Book No. _____________
Series of 20___

(For individual stockholders)


Republic of the Philippines)
City of ________________) S.S.

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;

1. That I am a stockholder of Travellers Insurance and Surety Corporation

2. That by virtue of the directive of the Insurance Commission, I am hereby


disclosing the source of funds of my infusions to the Travellers Insurance and
Surety Corporation as compliance to the capital impairment as per
examination made by the Insurance Commission as of 31 st December 2016.
To wit;

Date Infused Source of Funds Amount

July 15, 2016 Personal Money 800,000.00

July 27, 2016 Personal Money 350,000.00

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

Subscribed and sworn to before me this ______ day of ______________ at


____________________________, Affiant exhibited his Tax Identification No. _____________

Doc. No. ______________ ________________________


Page No. _____________ (Notary Public)
Book No. _____________
Series of _______
Republic of the Philippines)
City of ________________) S.S.

WAIVER AND CONSENT

I/We Edgardo P. David , President , and Florinda R. Callo__, AVP-Finance , duly


authorized signatories of Travellers Insurance and Surety Corporation , all of legal age, Filipinos,
and with postal address at 10th Floor G.E. Antonino Building, TM Kalaw St., corner J. Bocobo,
Ermita Manila , after having been duly sworn in accordance with law, hereby depose and say:

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.

Signed this 3rd day of _October_, 20 17_ at Manila City, Philippines.

Travellers Insurance and Surety Corporation


(Name of Company)

Edgardo P. David, President ______________

Florinda R. Callo, AVP-Finance ______________


(Authorized Signatories)

Subscribed and sworn to before me this ______ day of ______________, 20_____ at


____________________________. Mr./Ms. _Edgardo P. David_ and _Florinda R. Callo_
exhibited to me his/her Community Tax Certificate No. 01239487 and 10424707 issued on
January 2017 and January 2016 , at _Manila_.

Doc. No. ______________ ________________________


Page No. _____________ (Notary Public)
Book No. _____________
Series of 20___

(For company authorized bank signatories)

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