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    1x1 ID Photo: Insurance Commission

    Uploaded by

    Bryan Magnaye
    The document is an application for an insurance agent's walk-in examination from the Insurance Commission of the Philippines. It requests information such as the applicant's name, address, citizenship, employment history, criminal history, and insurance licensing history. The applicant must sign and date the application, which will then be processed and approved or denied by Insurance Commission officials.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    1x1 ID Photo: Insurance Commission

    Uploaded by

    Bryan Magnaye
    45 views1 page
    The document is an application for an insurance agent's walk-in examination from the Insurance Commission of the Philippines. It requests information such as the applicant's name, address, citizenship, employment history, criminal history, and insurance licensing history. The applicant must sign and date the application, which will then be processed and approved or denied by Insurance Commission officials.

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    references

    Original Title

    LIC_WE

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    The document is an application for an insurance agent's walk-in examination from the Insurance Commission of the Philippines. It requests information such as the applicant's name, address, citizenship, employment history, criminal history, and insurance licensing history. The applicant must sign and date the application, which will then be processed and approved or denied by Insurance Commission officials.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    45 views1 page

    1x1 ID Photo: Insurance Commission

    Uploaded by

    Bryan Magnaye
    The document is an application for an insurance agent's walk-in examination from the Insurance Commission of the Philippines. It requests information such as the applicant's name, address, citizenship, employment history, criminal history, and insurance licensing history. The applicant must sign and date the application, which will then be processed and approved or denied by Insurance Commission officials.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Republic of the Philippines

    1x1 Department of Finance


    ID INSURANCE COMMISSION
    PHOTO
    APPLICATION OF 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 discharge 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: _______________________________________________________
    10. Date of Application: ___________________________________________________________________

    ________________________________________________
    Applicant’s Customary Signature
    TIN ________________ Res. Cert. # _________________

    PROCESSED BY: ____________________________ APPROVED BY: _____________________________


    OR # _____________________ DATE ________________________

    IC-LLI-DP-001-F-01
    Rev.0

    Republic of the Philippines


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

    6. Full Name: __________________________________________________________________________


    (First Name) (Middle Name) (Surname)
    7. Address: _________________________________________________ Tel. No.: ___________________
    8. Place of Birth: __________________________ Date of Birth: ________________ Sex: __________
    9. Citizenship: _______________ Civil Status: _____________ Occupation: ______________________
    10. Have you ever been discharge from any position (YES/NO)? ________________________________
    If so, state particulars _________________________________________________________________
    11. Have you ever been convicted of any crime (YES/NO)? ___________ If so, attach decision of court.
    12. 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 ______________________________________
    13. Kind of examination applied for (Life/Variable/Non Life): ____________________________________
    14. Insurance company represented: _______________________________________________________
    15. Date of Application: ___________________________________________________________________

    ________________________________________________
    Applicant’s Customary Signature
    TIN ________________ Res. Cert. # _________________

    PROCESSED BY: ____________________________ APPROVED BY: _____________________________


    OR # _____________________ DATE ________________________

    IC-LLI-DP-001-F-01
    Rev.0

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