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Application for Registration as Accredited Actuary

IC registration application form for accredited actuary

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Department of Finance
INSURANCE COMMISSION
Manila
APPLICATION FOR REGISTRATION AS ACCREDITED ACTUARY
Type of Application
a) New

b) Renewal

Application for Accreditation
a)

Life Actuary

b) Non-Life Actuary

c) Pre-Need Actuary

To the Insurance Commissioner:
The undersigned hereby applies for registration as Accredited Actuary and states the
following information.
1. Name:

____________________________________________________________

2. a) Business Address: _________________________________________________
Tel. No.: _________________________________________________________
b) Residence Address: ________________________________________________
Tel. No.: _________________________________________________________
3. Sex: __________________________ Civil Status: __________________________
Date of Birth: _______________________ Place of Birth: ____________________
4. Citizenship: _____________ (If a naturalized citizen of the Philippines, give date and
place of naturalization and attach photostatic copy of certificate of naturalization. If
an alien, submit Alien Certificate of Registration.) ___________________________.
5. Are you an Associate1 or Fellow of good standing of the Actuarial Society of the
Philippines (ASP)? ________ If yes, state date accepted as an Associate or Fellow.
________.
6. Are you a member of good standing of other actuarial societies? __________ If yes,
state name of society and classification of membership. _______________________
7. Companies presently connected.
Company

1 Associate

Position/Designation

Date of Appointment

is applicable only to Non-Life Actuary until December 31, 2017

8. Entities under the supervision of this Commission for which applicant proposes to
provide actuarial services/certifications:
Name

Address

9. Previous employment: (For the last 3 years up to the date of this application)
Inclusive
Dates

Name of Employer

Address

In What Capacity

10. Previous IC Registration No. ______________ (if any)
Date of Registration _____________________ period covered ______________.
11. References:
Name

Occupation

Address/Contact Number

1.
2.
3.
12. Have you filed your ITR for the preceding year? ___________. If, yes, attach proof of
such filing, otherwise, give reason for not filing. _____________________________.
13. The following requirements are attached to support this application.
a. Certificate of Good Standing from ASP and other equivalent actuarial society;
b. Copy of Professional Tax Receipt;
c. Copy of Income Tax Receipt, if any;
d. Copy of previous Accreditation, if any;
e. Written acquiescence from present employer; (Section 347 of the Amended
Insurance Code)
f. Documentary Stamp (Php15.00);
g. Licensing Fee:
i. For Life: Php 45,000 plus LRF of 1% valid for 3 years;
ii. For Non-Life: Php 45,000 plus LRF of 1% valid for 3 years;
iii. For Pre-Need: Php 15,000.00 plus LRF of 1% yearly; and
For Accreditation as Non-Life Actuary
h. Certificate of Completion of Basic Non-life Insurance Course and other proofs
(CL Nos. 15-33 & 2015-33-A).

_____________________________
Applicant
TIN _________________________
PTR No. _____________________

SUBSCRIBED AND SWORN TO before me this ____ day of _______________,
20______, applicant-affiant exhibiting to me his/her Community Tax Certificate No.
______________________ issued on _______, 20_____ at ___________________.

Notary Public

Doc. No.
Page No.
Book No.
Series of 20

______
______
______
______

IC-LLI-DP-005-F-02
Rev.0
 
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