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Application for Renewal of Company CA
IC application for renewal of company
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
Department of Finance
INSURANCE COMMISSION
Manila
APPLICATION FOR RENEWAL OF COMPANY C/A
For the Year Beginning 01 January _______
___________________________
Date
1.
Name of applicant: ______________________________________________________________
2.
Address: ______________________________________________________________________
______________________________________________________________________
Tel. No.: ______________________________________________________________________
3.
(A) State whether applicant is a domestic or foreign corporation __________________________
(B) If foreign, state the country under those laws applicant was organized. __________________
______________________________________________________________________________
4.
Indicate the line/s of business where authority is sought by placing a “x” mark on the space
indicated, as follows:
Life Insurance
Fire Insurance
Marine Insurance
Casualty Insurance
Suretyship
5.
State if the applicant is authorized under the provisions of Act No. 536, as amended by Act No.
2206 to become a surety upon official recognizances, stipulations, bonds and undertakings.
______________ If yes, state number and date of Administrative Order._____________________
6.
(A)
If a domestic corporation, state the amount of paid-up capital as of the date of this
application. _______________________________________________________________
(B)
If a foreign corporation, state the actual market value of the securities deposited with the
Insurance Commission under the provisions of Section 191 of the Insurance Code as of the
date of this application. ________________________________
7.
Attached hereto are documents forming part of their application
a. Copy of license;
b. Updated General Information Sheet showing Capital Structure and Latest Incorporators,
their citizenship and percentage of shares owned and paid;
c. Updated List of Officers/Board of Directors; and
d. Documentary Stamp worth P 15.00
_______________________________________
(Insurance Company)
TIN ____________________________________
By:
IC-LLI-DP-OO6-F-01
Rev.0
2
____________________________________
____________________________________
(Designation)
