Sample Co-Indemnitor’s Statement


I, Rowena L. dela Rosa,  of legal age, Filipino citizen and with address at Toyo, Balanga, Bataan  hereby agree to be the co-indemnitor of Melinda Bright of Charter Insurance Corporation “PCIC” in the amount of Php 300,000 in favor of Nissan Car model 2012.  As such, I agree to sign and be bound by the terms and conditions of the Indemnity Agreement which is one of the documents I am required to sign.  I understand and agree that I will be the co-indemnitor of the above-stated bond principal for any and all other bonds that it may subsequently secure for PCIC.

In relation, I hereby authorize PCIC to obtain such informationto verify any statement made hereunder and agree that this document shall remain its property whether or not the bond is granted.  Any and all information provided hereunder is given freely and voluntarily.

I hereby confirm that the above information is true and correct.

Rowena L. dela Rosa
Printed Name and Signature