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Application for Renewal of Certificate of Registration as Non-Life Company Underwriter
IC renewal application form for certificate of registration as non-life company underwriter
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 CERTIFICATE OF REGISTRATION
AS NON-LIFE COMPANY UNDERWRITER
___________________________
Date
The Insurance Commissioner
Manila
Sir/Madam:
The undersigned hereby applies for the renewal of Certificate of Registration as Non-Life
Company Underwriter of ______________________________________________________________
for the year beginning 01 January 20 ____, under Chapter IV, Title 4, Section 327 of the Insurance
Code as amended (RA 10607). In support of this application are the following information:
1.
Name of applicant: ______________________________________________________________
2.
Lines of insurance: ______________________________________________________________
3.
Company represented:____________________________________________________________
Attached are the following requirements in support of this application:
1.
2.
3.
Original Certificate of Registration No. ___________
Verified photocopy of Income Tax Return
Documentary Stamp
__________________________________
Applicant
IC-LLI-DP-OO8-F-01
Rev.0
