Online Financial Planning- Aileen Lontoc

1

Name* This field is required.

First Name

Last Name

2

What’s your gender?* This field is required.

Male

Female

3

When’s your birthday?* This field is required.Month/Date/Year

4

What’s your contact #?* This field is required.

5

Email* This field is required.

example@example.com

6

What’s your occupation?* This field is required.

7

Status* This field is required.

Single

Married

Widowed

8

What are your Financial Goals?* This field is required.You can choose more than 1.

Build Wealth

Save for Retirement

Money for Health & Medical Emergencies

Save for College Tuition of my Child

Protect Family from Financial Burden

9

When are you free for an online appointment via Skype or Zoom?* This field is required.

10

Data PrivacyBy clicking the “SUBMIT” button below, I authorize Philamlife to collect, record, store for 3 years, update, transfer, use my information, to disclose my information to the company’s affiliations (including but not limited to any of its subsidiaries/affiliates in the Asia Pacific Region) , its brokers, agents and employees and staff. In this regard, the company employs security systems designed to protect information from unauthorized access. I wish to permit Philamlife to use my information/images for purposes of design, communication of other customer program, marketing campaigns, and offers in order to improve the quality of service that Philamlife provides.