Sun Life Application Form
These will be transferred to Sun Life Digital Application Form, then we'll send you an Email for Review and Confirmation
I am applying for __________________
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my personal plan
my relative's plan
What are you applying for
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Life Insurance with Investment (VUL)
Traditional Insurance
Name
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Mr.
Mrs.
Ms.
Prefix
First Name
Middle Name
Last Name
Sex (at Birth)
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Male
Female
Birthdate
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-
Month
-
Day
Year
Age
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Civil Status
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Single
Married
Widowed
Separated Legally
Birthplace (City/Province/State and Country)
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Citizenship/Nationality
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Philippine TIN
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SSS or GSIS No.
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Home Phone
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Area Code
Phone Number
Work Phone
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Area Code
Phone Number
Mobile Phone
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-
Country Code
Mobile Number
Email
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Permanent Residence
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Street No., Village/Subdivision, Barangay,
Street Address Line 2
City/Municipality
State / Province
Postal / Zip Code
Permanent Address same as Present Address?
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Yes
No
Present Residence
Street No., Village/Subdivision, Barangay,
Street Address Line 2
City/Municipality
State / Province
Postal / Zip Code
Primary Occupation/ Position
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Nature of Work
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Total Years in Employment or Business
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Annual Income
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Employer or Name of Business
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Nature of Business (indicate product or service)
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Business Address
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Street No., Village/Subdivision, Barangay,
Street Address Line 2
City/Municipality
State / Province
Postal / Zip Code
Mailing Address
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Permanent Address
Present Address
Business Address
Source of Funds/Property to pay premiums (select all that Apply)
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Allowance
Business
Commission/ Professional Fee
Donation
Inheritance
Regular Remittances
Rental
Retirement Fund/Pension
Salaries/ Bonus
Sale of Assets
Savings/ Placements/ Investments/Interest
Other
Have you or any of your immediate relatives and close associates (living or deceased) ever held or are currently holding an elected or appointed government position in the Philippines or another Country?
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Yes
No
Name
First Name
Middle Name
Last Name
Relationship
Government Agency(ies) and Position(s)
Primary Beneficiary 1
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First Name
Middle Name
Last Name
Sex (at Birth) 1
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Male
Female
Birthdate 1
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-
Month
-
Day
Year
Date
Birthplace (City/Province/State and Country) 1
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Citizenship 1
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Relationship to the Life to be Insured 1
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Mobile Number
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-
Country Code
Mobile Number
Address
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Street No., Village/Subdivision, Barangay,
City
State / Province
Postal / Zip Code
Primary Beneficiary 2
First Name
Middle Name
Last Name
Sex (at Birth) 2
Male
Female
Birthdate 2
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Month
-
Day
Year
Birthplace (City/Province/State and Country) 2
Citizenship 2
Relationship to the Life to be Insured 2
Mobile Number 2
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Country Code
Mobile Number
Address 2
Street No., Village/Subdivision, Barangay,
City
State / Province
Postal / Zip Code
Primary Beneficiary 3
First Name
Middle Name
Last Name
Sex (at Birth) 3
Male
Female
Birthdate 3
-
Month
-
Day
Year
Date
Birthplace (City/Province/State and Country) 3
Citizenship 3
Relationship to the Life to be Insured 3
Mobile Number 3
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Country Code
Mobile Number
Address 3
Street No., Village/Subdivision, Barangay,
City
State / Province
Postal / Zip Code
How many cigarettes, cigarillos, cigars, e-cigarettes, pipes, betel nut, chewing tobacco, nicotine gum or patches or any form of tobacco have you consumed within the last 12 months?
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Less than 5
5 to 10
11 to 20
21 to 40
40+
None
Is there anyone who will pay for this application aside from you (Third Party Individual / Entity) ?
Yes
No
Name of Payor / Third Party
First Name
Middle Name
Last Name
Relationship to the Life to be Insured
Address
Street No., Village/Subdivision, Barangay,
City
State / Province
Postal / Zip Code
Birthdate
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Month
-
Day
Year
Date
Birthplace (City/Province/State and Country)
Sex (at Birth)
Male
Female
Citizenship/Nationality
Occupation
Phone Number
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Area Code
Mobile Number
Mobile Number
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Country Code
Mobile Number
Nature of Business (indicate product or service)
Date of Incorporation
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Month
-
Day
Year
Date
Country of Incorporation
Do you have any Approved or Pending life insurance policies with Sun Life or other Insurance Companies ?
Yes
No
If yes, please provide the following
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Name of Insurance Company
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Year Issued/Indicate if still Pending
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Total Life Insurance Coverage
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Total Critical Illness Coverage
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Total Accidental Death, Dismemberment & Disablement Coverage
Is this application intended to replace any existing policies with Sun Life or other Insurance Companies ?
Yes
No
Will the payment for this application come from a policy advance or surrender of existing policy?
Yes
No
Birth Weight
Was the child born premature? or has problem gaining weight?
Yes
No
Are there defects noted from birth, or has a doctor or health practitioner advised that child's height, weight or physical development was not meeting normal developmental milestones?
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Yes
No
For Women: Are you pregnant?
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Yes
No
If yes, Number of months
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Have you had any complications of pregnancy?
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Yes
No
If yes, provide details
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Do you have or have you ever had any gynecological problem?
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Yes
No
If yes, please specify:
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Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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Father Age (if Alive) or Age at Death
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Indicate if Alive or Death
Father Health Condition/ Medical Diagnosis
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Father's Age at the time of Health Condition Diagnosis
Mother Age (if Alive) or Age at Death
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Indicate if Alive or Death
Mother Health Condition/ Medical Diagnosis
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Mother's Age at the time of Health Condition Diagnosis
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Do you have any siblings (Kapatid)?
Yes
No
Brothers Age (if Alive) or Age at Death
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Indicate if Alive or Death
Brothers Health Condition/ Medical Diagnosis
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Brother's Age at the time of Health Condition Diagnosis
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Sisters Age (if Alive) or Age at Death
Indicate if Alive or Death
Sisters Health Condition/ Medical Diagnosis
Sister's Age at the time of Health Condition Diagnosis
Has any of your parents, brothers or sisters, whether living or dead, been diagnosed with breast, colon, ovarian, rectal, or other types of cancer, heart disease, cardiomyopathy, stroke, diabetes, muscular dystrophy, Alzheimer’s disease, Parkinson’s disease, polycystic kidney disease, or any other hereditary disorder before age 60?
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Yes
No
If yes, indicate onset of illness
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Are you currently taking any medication?
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Yes
No
If yes, Name of Medication, Doctor's Name and Clinic Address
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Date of consultation
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Diagnosis and Medications
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Present Height (indicate unit of measurement)
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Present Weight (indicate unit of measurement)
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Has there been a weight change of more than 10 pounds (4.5 kilos) within the last 12 months?
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Yes
No
If yes, provide details
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Many people during their lifetime will experience or be treated for medical conditions. Please let us know which of the following you have had, or been told you had, or sought advice or treatment for:
a. High blood pressure, chest pain/discomfort, heart murmur, rheumatic fever, stroke, aneurysm, circulatory or heart disorder?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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b. diabetes, sugar in the urine, thyroid or other glandular (endocrine) disorder?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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c. kidney, bladder, or urinary disorder/infection, sexually transmitted disease, reproductive organ or prostate disorder?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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d. disorders of the skin or pigmentation, enlarged glands or lymph nodes, nodules, polyps, cysts, lumps, tumor, mass, abnormal growth, cancer, malignancy, or any related conditions?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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e. asthma, chronic cough, pneumonia, tuberculosis, emphysema, or any other respiratory or lung disorder?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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f. fainting spells, convulsion, developmental delay, epilepsy, seizure, tremor, loss of consciousness, or paralysis, severe headache(s) or migraine(s) or any other disorder of the brain or nervous system?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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g. anxiety, depression, stress or any emotional/psychological, mental or psychiatric disorder?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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h. ulcers, ulcerative colitis, intestinal bleeding, pancreatitis, hepatitis, cirrhosis, Crohn’s disease or other disorders of the stomach, digestive organ or liver?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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i. arthritis or systemic lupus erythematosus, gout, back or spinal disorder, joint pain, multiple sclerosis, bone fracture, muscular weakness or muscle disorder?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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j. anemia, bleeding or blood disorder?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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k. AIDS or positive HIV test?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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l. any other illness or surgery?
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Yes
No
If yes, Name of Doctor and Clinic
Dates Seen
Month & Year
Reason for Visit or Diagnosis
Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
Do you have any health symptoms, recurring or persistent pains, or complaints for which physician has not been consulted or treatment has not been received?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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103. Other than previously stated, have you, within the past 5 years:
a. consulted any doctor or other health practitioner?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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b. submitted to blood tests, ecg, x-rays, treadmill, echocardiogram, scans, MRI, ultrasounds, mammography, colonoscopy, biopsies or other tests?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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c. attended or been admitted to any hospital or other medical facility?
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Yes
No
If yes, Name of Doctor and Clinic
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Dates Seen
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Month & Year
Reason for Visit or Diagnosis
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Results of Medical/Laboratory Tests, any advice/treatment received and results of treatment
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105. Are you a Filipino citizen residing in the Philippines for less than 6 months, or are you a resident alien in the Philippines without a valid immigration status and have resided in the Philippines for less than 5 years?
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Yes
No
106. In the last 12 months, have you travelled outside the Philippines for a period of more than 3 months, or do you intend to do so within the next 12 months? Specify country Duration of Travel Reason for travel
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Yes
No
Specify Country
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Duration of Travel
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Reason for travel
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107. In the last 2 years, have you flown as a pilot, student pilot, crew member or flight attendant in a non- commercial flight or airline? If “Yes,” complete and attach an Aviation Questionnaire.
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Yes
No
108. In the last 2 years, have you engaged in scuba diving, automobile or motorcycle racing, sky diving or other aerial activities, rock mountain climbing or other hazardous sports, or do you intend to do so in the next 12 months? If “Yes,” submit appropriate questionnaire.
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Yes
No
109. Do you drink more than 4 drinks* in a single day, or drink before or during work, or drink to cope with difficulties or depression, or combine alcohol with other drugs or with certain prescription medications? If “Yes,” complete and attach an Alcohol Questionnaire. *1 drink = 330ml/bottle of beer or 148 ml/glass of wine or 43 ml/shot of liquor
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Yes
No
110. In the last 5 years, have you used marijuana, shabu, ecstacy, cocaine, LSD or other psychoactive drugs, heroin or other narcotics? If “Yes,” complete and attach a Drug Usage Questionnaire.
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Yes
No
111. Have you ever applied for or received a pension, payment, or benefit due to injury, sickness or disability?
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Yes
No
If “Yes,” provide details
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112. Do you have any physical or mental condition which prevents or has prevented continuous full-time employment in your usual occupation?
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Yes
No
If “Yes,” provide details
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113. In the last 10 years, have you declared or been petitioned for insolvency, or have been charged with or convicted with any criminal offense? If “Yes,” provide details
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Yes
No
If “Yes,” provide details
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Have you ever applied for life or health insurance and been refused coverage? If “Yes,” provide details,
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Yes
No
If “Yes,” provide details
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Within the last 2 years, have you consulted a doctor for chest pain, stroke, heart attack, any other disease of the heart or cancer? If “Yes,” provide details
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Yes
No
If “Yes,” provide details
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Within the last 60 days, have you been admitted or advised to be admitted as an in-patient in a hospital or clinic (except for pregnancy, child birth or routine health check-up), or have you been advised to have any test or to undergo surgery? If “Yes,” provide details
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Yes
No
If “Yes,” provide details
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I.D. Presented (Government-Issued and Photo-Bearing I.D.)
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Passport
SSS
GSIS
Voter's ID
NBI Clearance
Postal ID
PRC
Driver's License/ Student Permit
Firearms License Card
UMID
Barangay ID
Police Clearance
Other
ID No.
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Expiry Date
Client Suitability Assessment Form
What is your present life stage?(Choose one)
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Getting Started (Building Independence&Confidence)
Moving Up (Prioritizing Family above all)
Preparing Ahead (Nurturing my health&wealth)
Leaving a Legacy(Ensuring lasting golden years)
What is/are your objective(s) for purchasing our product?(Choose all that apply)
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Income Protection
Health Protection
Education
Retirement
Life Milestones
Estate Transfer
What type(s) of products are you looking for to meet your objective(s) above? Choose all that apply
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Insurance
Insurance with Savings
Insurance with Investment
Investment
For how long are you able and willing to contribute and keep this application (Choose one)
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1 year
5 years
10 years
over 20 years
Whole Life
What percent of your investible/financial assets will be set aside for this application?
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Less than 5%
5% to 15%
16% to 25%
26% to 35%
over 35%
Approximate Net Worth
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Under 1 Million
1 Million to 15 Million
over 15 Million
Risk Profiling (Answer only if applying for plan with Mutual Fund Investment)
How much is your knowledge of Investment?
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No Knowledge
Limited( I have limited knowledge of investments outside of bank deposits)
Moderate( (I have some knowledge of investments like bonds, stocks and pooled funds)
Good( I have general knowledge of investments like bonds, stocks, mutual funds and derivatives)
Extensive( I have extensive knowledge of investments like bonds, stocks, mutual funds, derivatives, and structured products)
How many years have you been investing in stocks, bonds and mutual fund/UTIFs (Choose one)
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No Experience
Less than 1 year
1 to 5 years
6 to 10 years
over 10 years
How would you best describe your investment objective and the level of risk you can take? (Choose One)
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Capital Preservation( I want my capital secured even if the investments provide low returns.)
Regular Income( I prefer investments that provide a predictable flow of income, as opposed to funds that widely fluctuate.)
Income Growth( I seek a regular flow of income but will accept some volatility for capital growth. I prefer investments that provide both opportunities toincome and to grow over time.)
Capital Growth( I seek long term growth with some income. I am comfortable with volatility in order to achieve capital growth.)
Capital Appreciation( I seek capital appreciation and fully accept volatility. I prefer high-risk investments with high potential returns.)
How much are you willing to invest in higher risk investment?(choose one)
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less than 20%
21% to 40%
41% to 60%
61% to 80%
over 80%
How long can you keep your money invested to achieve your financial goals? Choose one
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less than 1 year
1 year to 2 years
3 years to 5 years
6 to 10 years
over 10 years
Which statement best describes your current financial situation?
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I need this investment to supplement my current income.
I do not need this investment to supplement my current income; however, this could change in the next months.
I do not expect to use this investment to meet current requirements, but I would need to access these funds in an emergency.
My financial situation is stable and I have sufficient cash flow to meet most of my requirements.
My financial situation is completely secure and I can meet emergency requirements.
Submit
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