[go: up one dir, main page]
Scribd
Upload
107 views24 pages

App Form Questions

This document contains personal information for an application submitted by Arvie Macanip, a 19-year old Filipino student from Manila. It lists his contact details, family history, existing insurance policies if any, and proposed primary beneficiary as his brother Arvic Macanip. No existing health issues are reported for Arvie or his family members.

Uploaded by

Anthony Rupac Escasinas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
107 views24 pages

App Form Questions

This document contains personal information for an application submitted by Arvie Macanip, a 19-year old Filipino student from Manila. It lists his contact details, family history, existing insurance policies if any, and proposed primary beneficiary as his brother Arvic Macanip. No existing health issues are reported for Arvie or his family members.

Uploaded by

Anthony Rupac Escasinas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
You are on page 1/ 24

First Name Arvie

Middle Name Astorga


Last Name Macanip
Birthday (Month) October
Birthday (Day) 31
Birthday (Year) 2002
Age 19
Civil Status Single
Birthplace Manila
Nationality Filipino
Philippine TIN # none
SSS or GSIS # none
Permanent Address Blk 46 Lot 11 Sto. NinoII Dasmarinas, Cavite
Present Address 176 Ilaw St Balut TondoManila
Primary Occupation Student
Nature of Work NA
Total Years in Employment or Business NA
Estimated Annual Income
(range can be provided)
Employer or Name of Business
Business Address
Other occupation if applicable
Cellphone Number 9558950839
E-mail Address arvieeemac@gmail.com
Height (include measurement) 5'11''
Weight (include measurement) 60kg
Do you have any family members in
elected or appointed govt position? none
Have you ever applied for an insurance
before and declined? none

- none
How many cigarettes, cigars, e-cigarettes, - less than 5
pipes, betel nut, chewing tobacco, - 5 to 10
nicotine gum or patches or any form of - 11 to 20
tobacco have you consumed witin the last - 21 to 40
12 months? - 40+
Policy #1
company:
year issued:
total life:
total critical illness benefit:
total hospital income benefit:
total accident benefit:

List down your existing insurance Policy #2


company:
year issued:
total life:
total critical illness benefit:
total hospital income benefit:
total accident benefit:
Primary Beneficiary #1
Name (Last, First, Middle) Macanip, Arvic Astorga
Relationship to the insured brother
Citizenship Filipino
Birthdate (Day/Month/Year) 27-Nov-10
Birthplace Manila
Permanent Residence Blk 46 Lot 11Sto. Nino IIDasmarinas Cavite
Home or Mobile Number
Revocable or irrevocable? revocable
Primary Beneficiary #2 (optional)
Name (Last, First, Middle)
Relationship to the insured
Citizenship
Birthdate (Day/Month/Year)
Birthplace
Permanent Residence
Home or Mobile Number
Revocable or irrevocable?
Primary Beneficiary #3 (optional)
Name (Last, First, Middle)
Relationship to the insured
Citizenship
Birthdate (Day/Month/Year)
Birthplace
Permanent Residence
Home or Mobile Number
Revocable or irrevocable?

Contingent Beneficary #1 (optional)


Name (Last, First, Middle)
Relationship to the insured
Citizenship
Birthdate (Day/Month/Year)
Contingent Beneficary #2 (optional)
Name (Last, First, Middle)
Relationship to the insured
Citizenship
Birthdate (Day/Month/Year)
NOTES
revocable - can be changed anytime by the owner; subject to estate tax
irrevocable - can be changed anytime but with the consent of all irrevocable bene; not subject to estate tax
subject to estate tax
If Alive
Health Condition
(healthy/not healthy, If deceased, provide age and
Family Members Name Age provide sickness) cause of death
Mother Victoria Macanip 54 healthy
Father Raul Macanip 59 healthy
Brother Arvic Macanip 10 healthy
Brother
Brother
Brother
Sister Russel Macanip 31 healthy
Sister Vera Escasinas 30 healthy
Sister
Sister

For every YES, please provide the following

treatment/
item # illness/diagnosisdoctor hospital/clinic month & year detected medication/tests
100b dengue Dr. Wilfred Nueva Ecija Doctors Hospita Sep-19
Initial Payment via BPI online banking
nking Initial Payment via BDO online banking
nline banking Initial Payment via Credit Ca
1. Go to this lin https://apps.sunlife.com.ph/cdt/esales/payment
2. Choose 'New Policy Application'

3. Fill out the fields

Enter the same email you wrote in t


Application Serial Number will come
4. Proceed with the payment
Payment via Credit Card

fe.com.ph/cdt/esales/payment
lication'

ame email you wrote in the form


Serial Number will come from me

You might also like