Republic of the Philippines

Department of Finance
1x1 INSURANCE COMMISSION
ID
PHOTO
APPLICATION FOR INSURANCE AGENTS
WALK-IN EXAMINATION

1. Full name:
(First Name) ( Middle Name) (Surname)
2. Address: Tel. No.:
3. Place of Birth: Date of Birth: Sex:
4. Citizenship: Civil Status: Occupation:
5. Have you ever been discharged from any position (YES/NO)?
If so, state particulars.
6. Have you ever been convicted of any crime (YES/NO)? If so, attach decision of court.
7. Have you ever been granted a license or certificate of authority to act as insurance agent/variable
life agent/general agent in this country (YES/NO)? .
If yes, state name of insurance company represented
8. Kind of examination applied for (Life/Variable/Non Life):
9. Insurance company represented: SUN LIFE OF CANADA (PHILIPPINES), INC.
10. Date of Application:

Applicant's Customary Signature

TIN Res. Cert. #

PROCESSED BY: APPROVED BY:

OR# DATE

Republic of the Philippines

Department of Finance
1x1 INSURANCE COMMISSION
ID
PHOTO
APPLICATION FOR INSURANCE AGENTS
WALK-IN EXAMINATION

1. Full name:
(First Name) ( Middle Name) (Surname)
2. Address: Tel. No.:
3. Place of Birth: Date of Birth: Sex:
4. Citizenship: Civil Status: Occupation:
5. Have you ever been discharged from any position (YES/NO)?
If so, state particulars.
6. Have you ever been convicted of any crime (YES/NO)? If so, attach decision of court.
7. Have you ever been granted a license or certificate of authority to act as insurance agent/variable
life agent/general agent in this country (YES/NO)? .
If yes, state name of insurance company represented
8. Kind of examination applied for (Life/Variable/Non Life):
9. Insurance company represented: SUN LIFE OF CANADA (PHILIPPINES), INC.
10. Date of Application:

Applicant's Customary Signature

TIN Res. Cert. #

PROCESSED BY: APPROVED BY:

OR# DATE