Republic of the PhilippinesDepartment of Finance

INSURANCE COMMISSIONl07l United Nations Avenue

I\4anila

Circular Letter (CL) No.: 2014 - 16Date: 1' May eol+Supersedes CL No. 12-89

CIRCULAR LETTER

: ALL INSURANCE/REINSURANCE COMPANIES AUTHORIZEDTO TRANSACT BUSINESS IN THE PHILIPPINES

SUBJECT : Submission of Quarterly Statement of Paid'Up Capital,Reserves and lnvestments (SPUCRI)

For purposes of determining compliance with paid-up capital, reserves andinvestments requirement pursuant to Section(s) 209, 210 & 212 of the Amendedlnsurance Code (RA 10607), a copy of SPUCRI shall be submitted quarterly withinthirty (30) days after the end of the quarter covered. The Statement should be dulysworn to by the company's Controller or any responsible officer of the insurancecompany with the rank of at least Vice-President.

For strict compliance.

TO

Head Office: P.O. Box 3589 Manila FAX No.522-14-34 Tel. Nos. 523-84-61 to 70 Website: www.insurance.gov.ph

RepublCity of

ic of the Philippines

SWORN STATEMENT

t, of legal age and residing at, after being duly

sworn in accordance with law hereby depose and state:

l. That l, , am theof

(Designation) (Name of Company)

2. That as such officer of said company, I attest under oath to the fact that thedata indicated in the attached Statements of Paid-Up Capital, Reserves andlnvestments as of are true and correctaccording to the best of my information, knowledge and belief.

3. That this sworn statement is being executed in compliance with CircularLetter No.

-

dated of the lnsurance Commission'

lN WITNESS WHEREOF, I have hereunto signed my name atthis day of

SUBSCRIBED AND SWORN to before me this day of, affiant having exhibited to me his Residence

Certificate No. issued on

NOTARY PUBLIC

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