Temp20151116092145 PDF

Policy Acknowledgement Receipt
OWNER
: MR. KET IAN CAJOTE COTALES
PROPOSED INSURED
: MR. KET IAN CAJOTE COTALES
POLICY NUMBER
: 50028210
PLAN NAME
: Set for Life
ADDRESS
: PUROK 2, CARANGAN OZAMIS CITY MISAMIS OCCIDENTAL PHILIPPINES 7200
This is to acknowledge the receipt of the above policy contract while the Proposed Insured and/or Owner are both alive
and in good health.
RECEIVED BY OWNER
FULL NAME and SIGNATURE
DATE RECEIVED
RECEIVED BY OWNER's AUTHORIZED REPRESENTATIVE:
RELATIONSHIP TO OWNER
FULL NAME and SIGNATURE
DATE RECEIVED
DELIVERED BY
FULL NAME and SIGNATURE of SOLICITING AGENT
DATE OF DELIVERY
THIS PORTION IS FOR COURIER SERVICES ONLY

Received at given address
Given address not found
Policy Owner moved out of given address
No person to receive at given address
Others (please specify)
FULL NAME OF MESSENGER
DATE OF DELIVERY
June 11, 2015

MR. KET IAN CAJOTE COTALES
PUROK 2, CARANGAN
OZAMIS CITY
MISAMIS OCCIDENTAL
PHILIPPINES 7200
Dear MR. COTALES,

Set for Life 50028210
On behalf of FWD, we'd like to take this opportunity to welcome you as a new customer.
You have taken an important step by looking after your financial well-being with Set for Life.
Your cover is effective as from June 09, 2015.
Attached is a copy of your Policy Contract which provides the features and benefits of Set for Life along with the terms and
conditions. You will receive the Unit Statement within thirty (30) days from the date of this letter.
Kindly email CustomerConnect.ph@fwd.com or send back the Policy Acknowledgement Form enclosed herein to acknowledge
receipt of this Policy Contract. If Set for Life does not meet your needs, you may cancel your policy in writing within fifteen (15) days
from receipt of your Policy Contract.
Your Financial Planner / Financial Solutions Consultant MS. LANIE MAY FAITH LUZON FERRER is available on 9094168350 to
assist you with your queries. You can also contact Customer Connect on (632) 888-8388 Monday to Friday between 8am to 5pm.
Again, welcome to FWD. We look forward to helping you meet your financial needs now and in the future.
Get ready to live!
Sincerely yours,
Peter Karl Grimes

President and CEO
FWD Life Insurance Corporation
This is a system-generated correspondence. If issued without alteration, this does not require a signature.
Cc:
LANIE MAY FAITH LUZON FERRER

10000069
AGENCY
Policy Data Page

Policy Information
POLICY NUMBER
50028210
EFFECTIVE DATE
09 JUNE 2015
INSURED
ISSUE DATE
11 JUNE 2015
PLAN NAME
SET FOR LIFE
NUMBER OF YEARS PAYABLE
5 YEARS
MODE OF PREMIUM PAYMENT
MONTHLY
CURRENCY
PHILIPPINE PESOS
RISK CLASS
STANDARD
POLICY DATA PAGE DATE
11 JUNE 2015
REGULAR PREMIUM
2,499.00
REGULAR TOP-UP PREMIUM
0.00
SUM ASSURED
1,000,000.00
ISSUE AGE
22
GENDER
MALE
OWNER
Schedule of Benefits
BENEFIT
BENEFIT AMOUNT
AT EFFECTIVE DATE
BENEFIT
PERIOD
EXPIRY
DATE
FORM
NUMBER
1,000,000.00 *
To Age 100
09 JUNE 2093
RPVUL.07.2014
ADBVUL.07.2014
Basic Plan
Set for Life - 5 Years
Supplementary Benefits
FWD Accidental Death Benefit Rider for UL
1,000,000.00
To Age 70
09 JUNE 2063
FWD Critical Illness Benefit Rider for UL
500,000.00
To Age 70
09 JUNE 2063
CIBVUL.07.2014
FWD Hospital Cash Benefit Rider for UL
1,500 /day
To Age 70
09 JUNE 2063
HCBVUL.07.2014
Schedule of Premiums
Annual
Regular Premiums Payable
Quarterly
Monthly
30,000.00
15,000.00
7,500.00
0.00
0.00
0.00
0.00
30,000.00
15,000.00
7,500.00
2,499.00
Regular Top-Up Premiums Payable

Total Modal Premiums Payable
Semi-Annual
2,499.00
PHP 2,499.00
Total Modal Premium Chosen
Every 9th of the month
Premium Due Dates
Investment Fund Details

Name of Funds Invested
FWD Peso Bond Fund
Fund Allocation Rate

100.00%
Charges Details
Premium Charge rate (as % Regular Premium)
First Year
70.00%
Second Year
45.00%
Third Year and Subsequent Policy Years

Premium Charge rate (as % of Regular Top-Up Premium and % of Lump Sum Top-Up Premium)
0.00%
5.00%
Fund Switching Charge rate (as % of amount switched)

First to Sixth per policy year via online facility
All others
Free
1.00%
Fund Management Charge rate (as % of Account Value per annum, VAT exclusive)
FWD Peso Balanced Fund
2.00%
FWD Peso Fixed Income Fund
1.75%
FWD Peso Equity Fund
2.00%
FWD Peso Stable Fund
2.00%
FWD Peso Bond Fund
1.75%
FWD Peso Growth Fund
2.00%
FWD Peso High Dividend Equity Fund
2.00%
Surrender Charge rate (as % of amount withdrawn)

For all Policy Years
NIL
* Subject to the provisions of Section 15 Death Benefit.
THE DOCUMENTARY STAMP TAX OF THIS POLICY HAS BEEN PAID.
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Regular Pay Variable Life Insurance Plan

Policy Contract
FWD Life Insurance Corporation shall pay the Benefits provided by this Policy to:
the Owner if the Insured is alive, or;
the surviving Beneficiaries if the Insured dies
subject to the terms and conditions set forth in this Policy.
Lucia Chona Sevilla Ventura

Chief Finance Officer
Table of Contents
PAGE
POLICY DATA PAGE
INSURANCE BENEFIT
DEFINITIONS
GENERAL PROVISIONS
1
Entire Insurance Contract
2
Effectivity of the Policy
3
Ownership
4
Non-Participating
5
Currency and Place of Payment
6
Cooling Off Period
7
Assignment
8
Misstatement of Age and/or Sex
9
Incontestability
10
Suicide
11
Beneficiary
12
Premiums
13
Reinstatement
14
Charges
15
Death Benefit
16
Claim Settlement
17
Termination of the Policy
18
Funds
19
Deferment and Limitation
20
Surrender and Withdrawals
21
Fund Switch
22
Change of Fund Allocation Rate
23
Loyalty Bonus
24
Disclosures of Conflict of Interest
25
Limitation of Action
5
5
5
5
5
5
6
6
6
6
7
7
9
9
10
11
11
11
13
13
13
14
14
14
15
IMPORTANT NOTICE
15
Form Number: RPVUL.07.2014
Page | 2
Definitions
Account Value or Account refers to Account Value per Fund as defined in Section 18 Funds.
Age refers to the age last birthday of the Insured as of the Effective Date.
Application Form refers to the form prescribed by FWD and completed and signed by the Owner and/or Insured,
which provides information about the physical and medical condition, any occupation and any avocation of the Insured.
This form is used to determine whether the Insured seeking insurance with FWD meets FWDs underwriting
requirements and to determine the Insureds appropriate risk class.
Beneficiary or Beneficiaries refers to Beneficiary as defined in Section 11 Beneficiary.
Benefit refers to the Basic Plan and Supplementary Benefit/s if any.
Contract Debt refers to the Contract Debt as defined in Section 14 Charges.
Death Benefit refers to the Benefit Amount payable upon the death of the Insured as defined in Section 1 5 Death
Benefit.
Fund or Investment Fund or Variable Unit Linked Investment Fund refers to any of the separate funds created by
FWD wherein the Owners Regular Premium, Regular Top-Up Premium/s if any and/or Lump Sum Top-Up Premium/s if
any are invested as defined in Section 18 Funds.
FWD refers to FWD Life Insurance Corporation, a corporation organized and existing under Philippine law.
Insanity refers to a psychiatric disorder or mental illness resulting in the legal incompetence or irresponsibility of the
Insured, wherein the Insured has been prescribed with long term medication by a Medical Practitioner for the
treatment of such disorder o r illness, and that he/she was on medical treatment prior to the day of his/her suicide. The
psychiatric disorder or mental illness must be of such severe nature that the Insured cannot distinguish fantasy from
reality, cannot conduct his/her affairs due to psychosis, or is subject to uncontrollable impulsive behavior. The mental
health assessment of the Insured must be done by a Medical Practitioner with a specialization in psychiatry.
Insurance Charges refer to Insurance Charges as defined in Section 14 Charges.
Insured refers to the person covered by this Policy and whose name is shown on the Policy Data Page.
Lump Sum Top-Up Premium refers to any unscheduled additional premium for this Policy which is paid by the Owner
on top of the Regular Premium and any Regular Top-Up Premium due.
Medical Practitioner refers to a doctor that is licensed or registered in the Philippines, with a medical degree and
accredited by a medical board or an equivalent organization, and who is other than the Insured or a member of the
Insureds immediate family.
Monthly Anniversary refers to the anniversary date of this Policy on succeeding calendar months determined from
the Effective Date. If there is no such date in any of the succeeding calendar months that corresponds to the same day
as the Effective Date, the Monthly Anniversary shall be on the last calendar day of such month.
Next Valuation Date refers to the Valuation Date that comes immediately after the approval date of any particular
transaction. Such transactions include, but are not limited to, creation of Units, lapsation, partial withdrawal,
cancellation, and deduction of Charges, and should occur before the cut-off schedule determined by FWD.
Page | 3
Owner refers to the Owner of this Policy who may or may not be the same person as the Insured.
Policy Data Page shows the Policy Information, the Schedule of Benefits of the Basic Plan and Supplementary
Benefit/s if any, the Schedule of Premiums, the Investment Fund Details, and the Charges Details. The Policy
Information includes the Insured, Owner, Regular Premium, Regular Top -Up Premium, Sum Assured, and Effective Date.
The Schedule of Benefits includes the Benefits, Benefit Amount, Expiry Date and Form Number of the Basic Plan and
Supplementary Benefit/s if any. The Schedule of Premiums include the Premium Due Dates. The Investment Fund
Details include s the Funds and the Fund Allocation Rate. The Charges Details includes the Premium Charge rate, the
Fund Switching Charge rate and the Fund Management Charge rate. FWD may update the contents of the Policy Data
Page from time to time.
Policy Year refers to a period of twelve (12) months from the Effective Date of this Policy and every succeeding twelve
(12) month period thereafter.
Premium Charge refers to the Premium Charge as defined in Section 14 Charges.
Regular Premium refers to the scheduled premium payable for this Policy as shown in the Policy Data Page.
Regular Top-Up Premium refers to the scheduled additional premium for this Policy which is payable by the Owner in
addition to and at the same time as the Regular Premium.
Sales Illustration refers to the form attached to the Policy which provides information to the Owner about the
product and its B enefits. The Sales Illustration illustrates how the Death Benefit and the Total Account Value vary with
assumed investment return rates over specified Policy Years.
Supplementary Benefit/s refers to additional Benefits purchased separately from the Basic Plan to enhance or modify
the terms of this Policy. Supplementary Benefit/s if any and the ir corresponding Form Number /s are shown in the
Policy Data Page.
Top-Up Premium refers to the sum of any Regular Top-Up Premium paid and any Lump Sum Top-Up Premium paid.
Total Account Value refers to the total of all Account Values per Fund applicable to this Policy. The Total Account
Value on any Valuation Date is determined and calculated as the Unit Price of each Fund for such Valuation Date
multiplied by the number of Units in the Account Value corresponding to such Fund.
Unit refers to the unit of ownership in the Investment Fund.
Unit Price refers to the value of a unit of a given Fund determined pursuant to Section 18 Funds. This is the basis for
purchasing Unit/s of the Fund/s as well as for cancelling Unit/s from such Fund/s.
Valuation Date refers to the date wherein FWD calculates the Unit Price/s of a Unit of the Fund/s applicable to this
Policy.
You, Your, I, and My refers to the Owner of this Policy.
Page | 4
General Provisions
1. ENTIRE INSURANCE CONTRACT
This Policy Contract including the Application Form, the Sales Illustration, the Policy Data Page and attached
Supplementary Benefit/s if any together with any endorsements made by FWD shall constitute this Policy. Statements
by the Insured, or on his or her behalf, shall be considered as representations and not warranties. Any form that may be
issued at any time during the life of this Policy also becomes part of this Policy.
Only the President and Chief Execu tive Officer or officers duly authorized in writing by FWD have authority to modify
this Policy. Any such modification must be in writing and duly signed by the authorized officer.
2. EFFECTIVITY OF THE POLICY

This Policy becomes effective only upon the payment of the initial Regular Premium and any Regular Top-Up Premium
and this Policys delivery to the Owner while the Insured is alive and in good health. The Effective Date of this Policy
shall be used to determine Premium Due Dates, Monthly Anniversaries, Policy Years and Policy anniversaries.
3. OWNERSHIP
While the Insured is alive, the Owner can exercise every right, title, interest and privilege given by this Policy and its
Supplementary Benefit/s if any or allowed by FWD even without the consent of any revocable Beneficiary. In case the
Owner dies before the Insured, every right, title and interest shall automatically vest to the Insured.
However, the written consent of every designated irrevocable Beneficiary while alive must be obtained by the Owner in
order to exercise any right under this Policy.
4. NON-PARTICIPATING
This Policy does not participate in any surplus distribution of FWD. This Policy participates only in the performance of
the Investment Fund/s to which the coverage of this Policy is linked.
5. CURRENCY AND PLACE OF PAYMENT

All amounts payable either to or by FWD in relation to this Policy and Supplementary Benefit/s if any will be in the
currency stated in the Policy Data Page.
Article 1250 of the Civil Code of the Philippines (Republic Act No. 386) which reads in part:
"In case an extraordinary inflation or deflation of the currency stipulated should supervene, the value of the currency at
the time of establishment of the obligation shall be the basis of payment."
is understood and agr eed not to apply to any payments made or to be made either to or by FWD. All amounts payable
by FWD will be paid only in the Philippines. This Policy will be governed by and interpreted according to Philippine law.
6. COOLING OFF PERIOD

This Policy and/or S upplementary Benefit /s if any may be cancelled by the Owner's written request to FWD within
fifteen (15) days after receipt of this Policy. This Policy is considered delivered to and deemed received by the Owner on
the date shown in the acknowledgement receipt when it is delivered via email, or at the postal address shown in the
Application Form and received by a person of suitable age and competence then present therein. This Policy shall be
considered as received within ten (10) days from the date of delivery by FWD if delivered by post.
Page | 5
On such cancellation, the amount refundable shall be the sum of:

i.
ii.
Premium Charges and Insurance Charges; plus

the Total Account Value calculated based on the Unit Price/s of the relevant Fund/s, as of the Next Valuation
Date following the receipt of written request for cancellation of this Policy.
If a claim for any Benefit has been received by FWD at any of its offices, no refunds can be made under this provision.
7. ASSIGNMENT
FWD is not bound by any assignment of this Policy unless duly endorsed on this Policy. FWD assumes no responsibility
for the effect, sufficiency or validity of any assignment. FWD has the right not to endorse any reassignment by any
assignee.
8. MISSTATEMENT OF AGE AND/OR SEX

If the age and/or se x of the Insured has been misstated, the Insurance Charges deducted from the Total Account Value
shall be adjusted using the correct age and/or sex, applicable risk class and applicable Cost of Insurance rates of this
Policy.
If at the correct age and/or sex, the Insured is not eligible for coverage, this Policy and its Supplementary Benefit/s if
any shall be terminated and the liability of FWD shall be limited to a refund of:
i.
ii.

the Total Account Value calculated based on the Unit Price/s of the relevant Fund/s, as of the Next Valuation
Date following FWDs termination of this Policy due to misstatement of age/sex.
9. INCONTESTABILITY
Except for non-payment of Regular Premiums, or if the Total Account Value is insufficient to cover the Insurance
Charges, or any other grounds recognized by law or jurisprudence, FWD cannot contest this Policy after it has been in
force during the lifetime of the Insured for two (2) consecutive years from the Effective Date of this Poli cy or approval
date of its last reinstatement, whichever is later. The contestability period of two (2) years shall also apply to any
increase in Death Benefit due to payment of Top-Up Premium/s if any.
Where the initial coverage and/or any increase in the Death Benefit is not payable, the liability of FWD corresponding
to the excluded coverage shall be limited to a refund of:
i.
ii.

the Total Account Value calculated based on the Unit Price /s of the relevant Fund/s as of the Next Valuation Date
following FWDs termination of such excluded coverage on this Policy.
10. SUICIDE
FWD will not be liable for the Benefit Amount/s payable under any and all Benefits if the Insured dies by suicide within
two (2) years from the:
i.
ii.
Effective Date or approval date of last reinstatement of this Policy; and

Effective Date of the increase in Death Benefit or approval date of reinstatement with respect to such increase, if
any;
Page | 6
Provided, however, that suicide committed in a state of Insanity will be compensable regardless of the date of
commission.
Where suicide is not compensable pursuant to this section, the liability of FWD shall be limited to a refund of:
i.
ii.

the Total Account Value calculated based on the Unit Price/s of the relevant Fund/s as of the Next Valuation Date
following FWDs termination of this Policy.
11. BENEFICIARY
The Beneficiaries are the surviving persons designated to receive the proceeds of this Policy upon the death of the
Insured. Unless otherwise changed, the Beneficiaries are as designated in the Application Form.
If all the Beneficiaries are designated as "revocable", the Owner may delete any Beneficiary or designate new
Beneficiaries and exercise any and all other rights, interests and privileges under this Policy while in force. If any
Beneficiary is designated as "irrevocable", the consent of all such irrevocable Beneficiaries while alive is required before
the Owner can exercise any and all rights, interests and privileges under this Policy.
Beneficiaries are classified either as a primary Beneficiary or as a contingent Beneficiary. Surviving Beneficiaries in the
same Beneficiary classification share equally in the Death Benefit proceeds for that Beneficiary classification, unless
otherwise specified.
The Death Benefit proceeds are payable to the primary Beneficiaries surviving at the death of the Insured. If no primary
Beneficiaries survive the Insured, the Death Benefit proceeds are payable to the contingent Beneficiaries surviving at
the death of the Insured.
If no contingent Beneficiaries survives the Insured, the Death Benefit proceeds are payable to the Owner, if alive,
otherwise, to any of the following surviving relations of the Insured as substitute Beneficiaries in the order named:
i.
ii.
iii.
iv.
v.
vi.
Legal spouse; then

Legitimate child / children; then
Illegitimate child / children; then
Parent/s; then
Brother/s / Sister/s of the full blood; then
Brother/s / Sister/s of the half blood.
If the primary Beneficiaries, contingent Beneficiaries, Owner, and substitute Beneficiaries do not survive the Insured,
the Death Benefits proceeds are then payable to the estate of the Insured.
The Owner can change any Beneficiary or Beneficiary designation by written notice satisfactory to FWD, together with
the written consent of all irrevocable Beneficiaries while alive, subject to any assignment of this Policy in the records of
FWD. FWD assumes no responsibility for the validity of any such written notice.
A receipt for any Death Benefit proceeds under this Policy, signed by all Beneficiaries designated either in this Policy or
in accordance with this provision or by a duly authorized representative, will be a good and valid discharge to FWD. The
receipt will be final and conclusive evidence that such Death Benefit proceeds have been duly paid to and received by
those lawfully entitled to them, and that all claims and demands against FWD with respect to them have been fully
satisfied.
12. PREMIUMS
Payment of Regular Premium
Regular Premium s shall be payable in accordance with the Schedule of Premiums. The Regular Premium, less any
applicable Premium Charges and any Contract Debt, will be used to purchase Units at Unit Price/s of relevant Fund/s at
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the Next Valuation Date following the date of receipt of such Regular Premium, in accordance with the Fund Allocation
Rate specified in the Policy Data Page or in any subsequent endorsement recorded with FWD .
Grace Period
All Regular Premium s, except for the Initial Regular Premium, must be paid not later than thirty-one (31) days after its
due date. Any outstanding Insurance Charges will be deducted from any proceeds that may become payable during the
thirty-one (31) days Grace Period.
If Regular Premium payment is not received at the end of the thirty-one (31) days Grace Period and this Policy has a
Total Account Value, this Policy will continue to be in force for the same Death Benefit for as long as the Total Account
Value is sufficient to pay for the Premium Charges and Insurance Charges. If this Policy's Total Account Value is
insufficient to pay for the Premium Charges and Insurance Charges , and Insurance Charges were not paid through
Contract Debt, this Policy and Supplementary Benefit/s if any shall immediately terminate at the end of the thirty-one
(31) days Grace Period. Any balance remaining in the Total Account Value of this Policy shall be returned to the Owner.
Payment of Regular Top-Up Premium

Regular Top -Up Premium, if elected by the Owner, will be due together with the Regular Premium. Regular T op-Up
Premium, less any applicable Premium Charges and any Contract Debt, will be used to purchase Units at Unit Price /s of
relevant Fund/s at the Next Valuation Date following the date of receipt of such Regular Top-Up Premium, in
accordance with the Fund Allocation Rate specified in the Policy Data Page or in any subsequent endorsement recorded
with FWD.
The Minimum Death Benefit will be automatically increased by 125% of each Regular Top-Up Premium paid. Regular
Top-Up Premiums do not increase the Benefit Amount of the Supplementary Benefit/s if any payable under this Policy.
Payment of Lump Sum Top-Up Premium

While this Policy is in force, the Owner may request for and upon approval by FWD pay a Lump Sum Top -Up Premium
at any time. Such Lump Sum Top-Up Premium, less any applicable Premium Charges and any Contract Debt, will be
allocated and applied in accordance with the Owner's request on FWD's appropriate form to purchase Units at Unit
Price/s of relevant Fund/s at the Next Valuation Date subject to FWD's written approval and prevailing administrative
rules and procedures at the time of application.
Lump Sum Top -Up Premium shall be subject to FWDs prevailing administrative rules on the minimum and maximum
requirements for Lump Sum Top-Up Premium. Each Lump Sum Top-Up Premium will automatically increase the
Minimum Death Benefit by 125% of such Lump Sum Top-Up Premium amount paid. Lump Sum Top -Up Premiums do
not increase the Benefit Amount of any attached Supplementary Benefit/s. FWD reserves the righ t to require evidence
of insurability or to decline such payment of Lump Sum Top -Up Premium.
Premium Holiday
Premium Holiday is allowed as long as the Total Account Value is sufficient to cover the Premium Charges and
Insurance Charges when they fall due. This Policy can go into Premium Holiday:
i.
ii.
automatically when Regular Premium/s and any Regular Top-Up Premium/s remains unpaid at the end of the
Grace Period; or
upon the Owner's request.
After the Premium Holiday period, the Owner may resume payment of t he Regular Premium/s and any Regular Top -Up
Premium/s due.
Subject to Grace Period and Contract Debt provision s, the Total Account Value may be come insufficient to cover the
Premium Charges and Insurance Charges during the Premium Holiday period and may re sult to the termination of this
Policy.
Page | 8
13. REINSTATEMENT
If this Policy terminates due to insufficient Total Account Value, this Policy may be reinstated within three (3) years
from the date of such termination provided that (i) the Insured is alive at the time of application and (ii) this Policy has
not been surrendered for its Total Account Value.
To apply for reinstatement, FWD requires the following:
i.
ii.
iii.
a written application for reinstatement using the appropriate form; and

satisfactory evidence of insurability; and
receipt of payment of all amounts necessary to put this Policy in force.
This Policy shall be reinstated on the date on which FWD determines that the requirements have been met .
Subject to Section 9 Incontestability, any reinstated Policy will only cover loss or insured events that occurred after the
date of approval of the reinstatement.
14. CHARGES
Unless otherwise stated and with at least one (1) month prior notice to the Owner , all charges and/ or payments in this
section are subject to revision. A general change to charges and/or payments requires prior approval of the Insurance
Commission.
Premium Charges
The Premium Charges consist of the following:
i.
Regular Premium Charge. This is determined by multiplying the Regular Premium by the Premium Charge rate.
The Regular Premium Charge will be deducted as follows:
a. If the Regular Premium is paid in accordance with the Schedule of Premiums, the Regular Premium Charge will
be deducted from the Regular Premium amount received by FWD before purchasing Units at Unit Price /s of
the relevant Fund/s.
b. If the Regular Premium is not paid in accordance with the Schedule of Premiums and this Policy has sufficient
Total Account Value, the Regular Premium Charge will be charged proportionately to the Account Value of
each Fund in which the Owner has invested in, subject to the Grace Period provision in Section 12 Premiums.
Any premiums received after the Regular Premium Charge has been deducted from the Total Account Value
and before purchasing Units at Unit Price/s of relevant Fund/s shall be allocated to pay for (i) any Regular
Premium/s that fell due and remains unpaid, (ii) Regular Premium for the next Premium Due Date, less any
applicable Premium Charge and less any Contract Debt, if such premiums were received before the end of
the Grace Period of such Premium Due Date, and (iii) Top-Up Premium less any applicable Premium Charge.
c. If the Regular Premium is not paid in accordance with the Schedule of Premiums and this Policy has insufficient
Total Account V alue to cover the Regular Premium Charge, th is Policy will terminate subject to the Grace
Period provision in Section 12 Premiums.
Page | 9
ii.
Regular Top-Up Premium Charge. This is determined by multiplying the Regular Top-Up Premium by the
Premium Charge rate. The Regular Top-Up Premium Charge shall be deducted from the Regular Top-Up Premium
amount received by FWD before purchasing Units at Unit Price/s of the relevant Fund/s.
iii.
Lump Sum Top -Up Premium Charge. This is determined by multiplying the Lump Sum Top-Up Premium by the
Premium Charge rate. The Lump Sum Top-Up Premium Charge shall be deducted from the Lump Sum Top -Up
Premium amount received by FWD before purchasing Units at Unit Price/s of the relevant Fund/s.
Insurance Charges
Subject to the Contract Debt provision in this section, the Insurance Charge s will be deducted each month from the
Total Account Value at the Unit Price on the Next Valuation Date after the Monthly Anniversary. Insurance Charges will
be charged to each Fund in proportion to the Account Value of each Fund in which the Owner has invested in. The
Insurance Charges consist of the following:
i.
ii.
Cost of Insurance of the Basic Plan. This is determined by multiplying the difference between the Death Benefit
and the Total Account Value by the Cost of Insurance rate of the Basic Plan as determined by FWD from time to
time. The Cost of Insurance rate of the Basic Plan is determined by the attained age and risk class.
Cost of Insurance of the Supplementary Benefit/s if any. This is determined by multiplying the Benefit Amount of
the Supplementary Benefit/s if any by the Cost of Insurance rate of the corresponding Supplementary Benefit/s if
any as determined by FWD from time to time. The Cost of Insurance rate of the Supplementary Benefit/s if any is
determined by the attained age and risk class.
Surrender Charges
No surrender charges will be applied on any partial or full withdrawals from the Total Account Value.
Other Charges
Subject to the Insurance Commission's approval, FWD reserves the right to impose additional charges by giving the
Owner at least one (1) month prior written notice.
Contract Debt
This provision on Contract Debt applies provided that during the first three (3) years of this Policy:
i.
ii.
Regular Premiums and Regular Top-Up Premiums are paid before the end of the Grace Period; and
No withdrawals are made against the Total Account Value.
If the Total Account Value is insufficient to cover the Insurance Charges, FWD will create a Contract Debt without
interest in FWDs favor equal to the cumulative Insurance Charges not paid from the Total Account Value. The Contract
Debt shall be paid by deducting its amount from any Regular Premium paid after deduction of any applicable Regular
Premium Charge and/or from any Top-Up Premium paid after deduction of any applicable Top-Up Premium Charge.
15. DEATH BENEFIT

While this Policy is in force and subject to its terms and conditions, FWD shall pay the Death Benefit less any Contract
Debt.
The Death Benefit payable is equal to the largest of:
i. The current Sum Assured; or
ii. Minimum Death Benefit; or
iii. Total Account Value.
Page | 10
The Minimum Death Benefit shall at no time be less than:

i. 500% of the Regular Premium; plus
ii. 125% of all Top-Up Premiums paid; less
iii. 125% of all partial withdrawals made.
The Total Account Value is calculated based on the Unit Price/s of each of the relevant Fund /s as of the Next Valuation
Date following FWDs receipt of written notice of the Insured's death.
16. CLAIM SETTLEMENT

For settlement of claims under this Policy, this Policy must be presented at any of FWD's duly designated offices
together with due proof for the claim and all other requirements satisfactory to FWD.
FWD must receive the requirements within ninety (90) days from the date of claim. Failure to submit the requirements
shall not invalidate or reduce the claim if it is shown not to have been reasonably possible to give such notice or proof
and that such was given as soon as was reasonably possible.
17. TERMINATION OF THE POLICY

This Policy shall terminate on the earliest of the following:
i.
at the end of the Grace Period if the Total Account Value of this Policy becomes insufficient to pay for the Premium
Charges and Insurance Charges in accordance with the Grace Period in Section 1 2 Premiums, except when Contract
Debt is in effect;
ii. the date of approval by FWD of the Policys full surrender as provided under Section 20 Surrender and Withdrawals;
iii. on the date of death of the Insured subject to Section 15 Death Benefit; or
iv. the Expiry Date of this Policy.
If this Policy terminates under (i), (ii) and (iv) above, the Total Account Value if any, less Contract Debt if any, shall be
returned to the Owner based on the Unit Price/s of the relevant Fund/s, as of the Next Valuation Date following the
termination of this Policy.
18. FUNDS
Investment Funds
FWD created and maintains Variable Unit Linked Investment Funds, where the investment portion of the premium
under this Policy shall be allocated. The investment management of each Fund will be at FWDs full discretion. The
investment policy of each Fund may be changed subject to the approval of the Insurance Commission. The Fund/s and
all its assets shall be and remain in the absolute beneficial ownership of FWD on behalf of or for the account of the
Owner.
Each Fund is denomin ated in Units of equal value, and the value of each Unit of a given Fund may change from time to
time depending on market conditions.
FWD may do the following subject to the approval of the Insurance Commission:
i.
ii.
create new Fund/s and all the provisions of this Policy shall apply to the new Fund/s;
delegate all or any of FWD's discretion and investment powers to any person and/or entity on such terms as FWD
determines;
Page | 11
iii. withdraw or change the Fund/s being offered by FWD. In such event, FWD will give the Owner a written notice at
least three (3) months in advance of FWD's intent to withdraw or change the Fund/s and request the Owner to
instruct FWD to transfer the balance of the Investment Fund/s into another Investment Fund/s of FWD. If FWD
does not receive any instruction from the Owner within the time period specified in FWD's notice, FWD will
surrender all the outstanding Units of the Fund/s being withdrawn. Proceeds from the withdrawn Fund/s will be
distributed in the following order:
a. allocate it to the remaining Fund/s in which the Owner has Account Value balances, in proportion to this
Policy's Account Values in such Fund/s; or
b. return it to the Owner if there are no remaining balances in the Fund/s in which the Owner has Account Value
balances.
Valuation of Funds and Units

The valuation of the Fund/s shall be done by FWD on a daily basis. Net asset value will be determined by using market
prices of the underlying funds or the quoted prices of direct investments, allowing for fund management fee, any fund
administration charge, purchase and sell expense, tax or other statutory levy, deposit and withdrawal made since the
last Valuation Date. The Unit Price of each Fund will be determined by dividing the Funds net asset value by the
corresponding number of outstanding Units of such Fund.
Deductions from the Funds

FWD shall deduct from each Investment Fund the following:
i.
ii.
iii.
iv.
v.
all expenses incurred by FWD directly or indirectly upon purchase and sale of investments;
all expenses incurred by FWD directly or indirectly in managing, maintaining and valuing assets in such Fund;
any tax or other statutory levy attributable to the investment income and capital gain on assets of the Fund;
Fund Management Charge, subject to FWD's sole discretion to change the Fund Management Charge rate by giving
the Owner at least three (3) months written notice; and
all other additional Charges as determined by FWD subject to approval of the Insurance Commission.
Account Value per Fund

For this Policy, the Account Value correspon ding to a Fund is the net value of that Funds Units allocated to this Policy
through such Account Value at the Unit Price on the Next Valuation Date, after adjusting for the following transactions
net of fees:
i.
ii.
iii.
iv.
v.
increased by the amount of premiums allocated and applied to such Account Value;
increased by any amount transferred from another Account Value to such Account Value;
decreased by any amount transferred to another Account Value from such Account Value;
decreased by any amounts withdrawn from such Account Value; and
decreased by the amount of any monthly deductions and any other Charges made by FWD from such Account
Value.
This Policy shall have an Account Value corresponding to each Fund the Owner has opted to invest in.
Exceptional Circumstances
Where for any reasons other than payment of the Death Benefit under this Policy, the creation and/or cancellation of
Units in any Account Value becomes necessary and FWD in its absolute discretion deems the circumstances to be
prejudicial to the interests of its policyholders, the creation and/or cancellation of Units in any Account Value shall be
deferred for a period not exceeding six (6) months from the date the creation and/or cancellation would in normal
circumstances have taken place.
Page | 12
Exceptional circumstances include, but are not be limited to:

i. the closure or suspension of dealings on recognized stock exchanges;
ii. suspension of valuation or dealings of the underlying Investment Funds ; or
iii. periods when the assets in an Investment Fund cannot be va lued or invested according to its investment objective.
19. DEFERMENT AND LIMITATION

For valid reasons solely determined by FWD, the valuation, creation or cancellation of Units of the Investment Fund/s
may be temporarily suspended or deferred.
FWD may also limit the number of Units of an Investment Fund that can be cancelled on any Valuation Date (whether
for this Policy or otherwise) as FWD may determine from time to time. In such case, Units of the Investment Fund
allocated to this Policy shall be cancelled on a pro rata basis. Units not cancelled will be carried forward for cancellation,
subject to the same limitation, on the Next Valuation Date of the Investment Fund.
20. SURRENDER AND WITHDRAWALS

The Owner may surrender this Policy for its Total Account Value while this Policy is in force. This Policy will terminate at
the effective date of such surrender.
The Owner may withdraw part of the Total Account Value of this Policy while this Policy is in force. Such transaction is
referred to as withdrawal.
The following conditions shall apply:
i.
ii.
iii.
iv.
v.
vi.
vii.
Owner must request for surrender or partial withdrawal using the appropriate form prescribed by FWD.
The Owners request shall be subject to FWDs prevailing administrative rules and procedures at the time of
application for surrender or withdrawal.
The amount of withdrawal must not be less than the minimum amount determined by FWD from time to time.
If there is more than one Investment Fund and the Owner does not specify the Investment Fund/s from which
the amount requested is to be withdrawn, then the withdrawal amount shall be taken proportionately from each
Investment Fund.
The Total Account Value immediately after the request for partial withdrawal must not be less than the minimum
amount specified by FWD from time to time; otherwise, the Owner must fully surrender this Policy. The
withdrawal amount with respect to a Fund must not exceed this Policys Account Value for such Fund.
Any amount surrendered or partially withdrawn from a Fund shall be deducted from the Account Value of such
Fund at its Unit Price determined at the Next Valuation Date following the date that FWD approves the Owner's
request.
FWD will automatically reduce the Minimum Death Benefit by 125% of the amount of the partial withdrawal,
subject to the Minimum Death Benefit requirement of the Insurance Commission.
21. FUND SWITCH

While this Policy is in force, the Owner may at any time request FWD to switch all or part of the Account Value with
respect to any of the Fund/s under this Policy, to one or more of the other Fund/s. Such transaction is referred to as
Fund Switching.
i.
Owner must request for Fund Switching using the appropriate form prescribed by FWD.
Page | 13
ii.
The Owners request for Fund Switching shall be subject to prevailing administrative rules and procedures of FWD
at the time of application for Fund Switching.
iii. The amount to be switched must not be less than the minimum amount as determined by FWD from time to time.
iv. Fund Switching may be allowed without a Fund Switching Charge for up to six (6) times per Policy Year, provided
that the Fund Switch was requested through FWDs online facility. If the Owner exceeds the maximum number of
allowed Fund Switching through FWDs online facility or requests such Fund Switching other than through FWDs
online facility, a Fund Switching Charge shall be deducted from the Total Account Value upon approval by FWD of
such Fund Switch. The Fund Switching Charge may change from time to time and shall be subject to FWDs
prevailing administrative rules and procedures at the time of the Fund Switch.
v. Immediately after the Fund Switch, the Total Account Value must not be less than the minimum amount as
specified by FWD from time to time; otherwise, the Owner must withdraw the Total Account Value. The amount
switched from a particular Fund plus any Fund Switching Charge with respect to such Fund must not exceed the
Account Value corresponding to such Fund.
vi. The amount switched from a Fund will be deducted from the Account Value of such Fund at the Funds Unit Price
on the Next Valuation Date following the date the Owner's written request for such Fund Switching is approved by
FWD. The amount switched less any Fund Switching Charge will be applied to purchase Units at Unit Price/s of the
respective Fund/s determined at the Next Valuation Date following such cancellation.
22. CHANGE OF FUND ALLOCATION RATE

While this Policy is in force, the Owner may, at any time, request FWD to change the Fund Allocation Rate under this
Policy.
i.
ii.
Owner must request for change in Fund Allocation Rate using the appropriate form prescribed by FWD.
The Owners request to change the Fund Allocation Rate shall be subject to prevailing administrative rules and
procedures at the time of application of the change in the Fund Allocation Rate.
iii. The Fund Allocation Rates to the selected Fund/s, when changed, must not be less than the minimum as
determined by FWD from time to time.
iv. The change will be effective at the Next Valuation Date following the date the Owner's request for such change in
allocation has been approved by FWD. Such change in the Fund Allocation Rate shall apply only to subsequent
allocations of the premiums to the Fund/s.
v. A fee for change in allocation may be charged, subject to FWDs prevailing administrative rules and procedures at
the time of the change in allocation.
23. LOYALTY BONUS

While this Policy is in force, FWD may award a Loyalty Bonus payable at the end of the tenth (10 th) Policy Year and on
every fifth (5th) Policy anniversary thereafter. The Loyalty Bonus shall be a percentage of the average Total Account
Value over the past sixty (60) Monthly Anniversaries of this Policy, and such percentage shall be determined by FWD
from time to time. Any Loyalty Bonus payable will be made by crediting additional Units proportionately to each
Account Value.
The Loyalty Bonus is non-guaranteed. If this Policy has been reinstated at any time during its lifetime, this Policy shall
not be eligible to receive the Loyalty Bonus after the approval date of last reinstatement.
24. DISCLOSURES OF CONFLICT OF INTEREST

The fund manager makes investment decisions for the Investment Fund/s based on the circumstances of each
Investment Fund and independently of decision made for other Investment Fund/s. The fund manager may make the
same
Page | 14
investments for an Investmen t Fund and one or more other Investment Fund/s. This may create a conflict of interest if
there is only a limited amount of the investment available, or if the investment is purchased at different times or at
different prices for different Investment Fund/s. If this happens, the fund manager will attempt to allocate the
investment fairly between the Investment Fund and other Investment Fund/s. Factors the fund manager considers in
allocations include the size and timing of previous allocations, whether the security meets the objectives of the
respective portfolios, the relative portfolio size and the rate of growth of the portfolios.
25. LIMITATION OF ACTION

No legal action on this Policy may be filed after five (5) years from the time the cause of action accrues.
IMPORTANT NOTICE
The Insurance Commission, with offices in Manila, Cebu and Davao, is the government office in charge of the
enforcement of all laws related to insurance and has supervision over insurance companies and intermediari es. It is
ready at all times to assist the general public in matters pertaining to insurance. For any inquiries or complaints, please
contact the Public Assistance and Mediation Division (PAMD) of the Insurance Commission at 1071 United Nations
Avenue, Man ila with telephone numbers +632-5238461 to 70 and email address pubassist@insurance.gov.ph. The
official website of the Insurance Commission is www.insurance.gov.ph.
THIS IS NOT A DEPOSIT PRODUCT. EARNINGS ARE NOT ASSURED AND PRINCIPAL AMOUNT
INVESTED IS EXPOSED TO ANY FINANCIAL RISK. THIS PRODUCT CANNOT BE SOLD TO YOU UNLESS
ITS BENEFITS AND RISKS HAVE BEEN THOROUGHLY EXPLAINED. IF YOU DO NOT FULLY
UNDERSTAND THIS PRODUCT, WE STRONGLY RECOMMEND THAT YOU DO NOT PURCHASE OR
INVEST IN IT.
Page | 15
This Accidental Death Supplementary Benefit is attached to Policy Number 50028210 and
with Effective Date on June 09, 2015.
Supplementary Benefit:
Accidental Death
This Supplementary Benefit applies only if the Form Number is shown on the Policy Data Page of the Policy. The Benefit
Amount of this Supplementary Benefit is also shown on the Policy Data Page.
DEFINITIONS
Accident or Accidental refers to any unforeseen and unexpected event or contiguous series of events, caused by
violent, external and visible means and which causes the death or Injury or Injuries solely and independently of any
other means.
Condition refers to any type of illness, specific Injury, disease or infirmity including all underlying or related conditions
and any manifestation thereof, whether in one (1) or more than one body system.
Injury or Injuries refers to Accidental bodily damage occurring while this Supplementary Benefit is in force caused
solely and dir ectly by external, violent and Accidental means and independent of all other causes and evidenced by a
visible contusion or wound on the exterior of the body except in the case of drowning or of internal injury revealed by
an autopsy.
Insured refers to the person covered by this Supplementary Benefit and whose name is shown on the Policy Data
Page.
Owner refers to the Owner of the Policy whose name is shown on the Policy Data Page.
Pre-Existing Condition refers to a Condition:
i. For which the Insured received medical advice, consultation or treatment, or
ii. Whose signs or symptoms are evident, or should have been evident to the Insured, even if the Insured did not seek
medical advice, consultation or treatment for it prior to the Effective Date of this Supplementary Benefit or date of
effectivity of its last reinstatement, if any.
Public Holiday refers to a day declared under Philippine law and observed within Philippine Standard Time (GMT+8)
as a R egular Holiday or as a Special Non-Working Holiday. The nineteen (19) Public Holidays in the Philippines covered
under this Supplementary Benefit are as follows:
Regular Holidays:
i. New Years Day
ii. Araw ng Kagitingan (Day of Valour)
iii. Maundy Thursday
iv. Good Friday
v. Labor Day
vi. Independence Day
vii. Eidl Fitr (End of the fasting month of Ramadan)
viii. National Heroes Day
ix. Eidl Adha (Feast of the Sacrifice)
- observed on January 1; date is fixed

- observed on April 9; date is fixed
- date declared annually by the President of the
Philippines
Philippines
- observed on May 1; date is fixed
- observed on June 12; date is fixed
Philippines
Philippines
Philippines
Form Number: ADBVUL.07.2014
Page | 2
x. Andres Bonifacio Day

xi. Christmas Day
xii. Jose Rizal Day
- observed on November 30; date is fixed

- observed on December 25; date is fixed
Special Non-Working Holidays:

i.
Chinese New Year
ii.
Black Saturday
iii.
iv.
v.
vi.
vii.
Ninoy Aquino Day

All Saints Day
All Souls Day
Christmas Eve
New Years Eve

Philippines
Philippines
- observed on August 21; date is fixed
1. EFFECTIVE DATE
Unless otherwise shown on this Supplementary Benefit, the Effective Date of this Supplementary Benefit shall be the
same as the Effective Date of the Policy.
2. BENEFIT
FWD will pay to the Beneficiary the Benefit Amount for this Supplementary Benefit if the Insured dies within one
hundred eighty (180) days from an Accident and such Accident occurs before the Expiry Date of this Supplementary
Benefit. If such Accident occurs during a Public Holiday in the Philippines, FWD will pay to the Beneficiary three (3)
times the Benefit Amount for this Supplementary Benefit.
3. MAXIMUM COVERAGE
The aggregate Benefit Amount of this Supplementary Benefit and all similar Benefits of the Insured under all FWD
Policies shall not exceed the maximum amount offered by FWD, as may be determined by FWD at the time of
application. Any excess coverage shall be void and any proportionate Cost of Insurance of this Supplementary Benefit
corresponding to such excess deducted from the Total Account Value shall be refunded without interest .
4. MISSTATEMENT OF AGE
If the age of the Insured has been misstated, the Cost of Insurance of this Supplementary Benefit deducted from the
Total Account Value shall be adjusted using the correct age and risk class. If at the correct age and risk class, the Insured
is not eligible for coverage, this Supplementary Benefit shall be terminated and the liability of FWD shall be limited to a
refund of the Cost of Insurance deducted from the Total Account Value for this Supplementary Benefit.
5. COST OF INSURANCE
The Cost of Insurance for this Supplementary Benefit shall be deducted in advance on each Monthly Anniversary from
the Total Account Value until the Expiry Date of this Supplementary Benefit.
The Cost of Insurance is determined by multiplying the Benefit Amount of this Supplementary Benefit by the Cost of
Insurance rate of this Supplementary Benefit as determined by FWD from time to time. The Cost of Insurance rate is
determined by the Insured's attained age and risk class.
The Cost of Insurance rates used to determine the Cost of Insurance for this Supplementary Benefit are guaranteed
until its Expiry Date.
Page | 3
6. RENEWAL
This Supplementary Benefit may be renewed until its Expiry Date as shown in the Policy Data Page without evidence of
insurability. The Cost of Insurance of this Supplementary Benefit shall be deducted from the Total Account Value at
FWDs Cost of Insurance rate at the time of renewal, subject to FWDs right to decline renewal on any renewal date. A
notice of any change in the basis for the Cost of Insurance of this Supplementary Benefit will be sent to the Owner at
least forty-five (45) days before the next Policy anniversary date.
7. DEDUCTION OF UNPAID INSURANCE CHARGES

Any Contract Debt shall be deducted from the proceeds of this Supplementary Benefit.
8. NON-PARTICIPATION
This Supplementary Benefit does not participate in any surplus distribution of FWD .
9. EXCLUSIONS
No benefit will be payable under this Supplementary Benefit if death of the Insured by Accident results directly or
indirectly, wholly or partly, from any of the following circumstances:
i. suicide or attempted suicide while sane or insane, or any self-inflicted injury or any sickness; or
ii. murder, provoked assault, or any attempt thereat; or
iii. war, invasion, act of foreign enemy, hostilities or warlike operations (whether war be declared or not), civil war,
mutiny, rebellion, revolution, insurrection, military or usurped power, and civil commotion assuming the
proportion of or amounting to a popular uprising. This exclusion shall not be affected by any endorsement
which does not specifically refer to it in whole or in part; or
iv. service in or being attached to the naval forces, military forces, air forces, the police forces or the opposing forces;
or
v. participation in any fight or brawl by the Insured, or assault or death with provocation from the Insured; or
vi. any violation or attempted violation of the law or resistance to arrest; or
vii. accident caused by the effect of alcohol or improper use of drugs; or
viii. any bodily or mental infirmity, disease or sickness, or infection other than infection occurring at the same
time with or because of an Accidental cut or wound; or
ix. poison, gas or fumes voluntarily taken; or
x. atomic explosion, nuclear fission or radioactive matter, chemical or biological contami nation; or
xi. entering, leaving, operating, servicing, or being in, on or about any aerial or submarine device or conveyance
except as a passenger in an aircraft provided by a commercial passenger airline; or
xii. involvement in any dangerous sports or hobbies such as racing on wheels, glider flying, sailing or other hobbies
which are comparably dangerous and risky unless sports risk p remium is paid; or
xiii. cosmetic or plastic surgery, any dental work, treatment or surgery, eye or ear examination, except to the
extent that any of them is necessary for the repair or alleviation of damage to the Insureds person caused solely by
Accident; or
xiv. any Act of Terrorism or any action taken in controlling, preventing, suppressing, or in any way relating to, any Act
of Terrorism.
10. REQUIREMENTS OF CLAIM

To make a claim, FWD must receive the following requirements:
i. Claimants Statement;
ii. Attending Physicians Statement (APS);
iii. Medical Certificate;
iv. Medical Records; and
v. Evidence of Accident.
Page | 4
FWD must receive the requirements within ninety (90) days from the date of death of the Insured due to Accident.
Failure to submit within the time required shall not invalidate or reduce any claim if it can be shown that it was not
practicable to submit the requirements and its submission was made as soon as it was reasonably possible .
FWD reserves the right to require additional documents or evidences to help assess the validity of the claim at the
Owners expense. FWD shall have the right to make an autopsy, unless forbidden by law.
11. TERMINATION
This Supplementary Benefit shall automatically terminate on the earliest of the following:
i.
The Total Account Value becomes insufficient to cover the Cost of Insurance of this Supplementary Benefit , except
when Contract Debt is in effect;
ii. On the date following FWDs approval of the Owners written request for termination of this Supplementary
Benefit;
iii. The Expiry Date of this Supplementary Benefit; or
iv. Termination of the Policy.
Termination of this Supplementary Benefit shall not prejudice any claim arising prior to such termination.

No legal action on this Supplementary Benefit may be filed after five (5) years from the time the cause of action accrues.
Page | 5
This Critical Illness Supplementary Benefit is attached to Policy Number 50028210 and
Critical Illness
DEFINITIONS
other means.
Condition refers to any type of illness, specific Injury, disease or infirmity including all underlying or related
Conditions and any manifestation thereof, whether in one (1) or more than one body system.
Critical Illness refers to a Critical Illness defined under Section 13 Definition of Covered Critical Illnesses.
solely and dir ectly by external, violent and Accidental means and independent of all other causes and evidenced by a
an autopsy.
Page.
i.
ii.
For which the Insured received medical advice, consultation or treatment, or

Whose signs or symptoms are evident, or should have been evident to the Insured, even if the Insured did not seek
medical advice, consultation or treatment for it,
prior to the Effective Date of this Supplementary Benefit.
1. EFFECTIVE DATE
2. BENEFIT
FWD will pay the Benefit Amount for this Supplementary Benefit if the Insured is diagnosed to be suffering from a
Critical Illness under Section 13 Definition of Covered Critical Illnesses, and provided that:
i. The Critical Illness occurs or manifests as a first incidence before the Expiry Date of this Supplementary Benefit, and
ii. The diagnosis is confirmed by a Medical Practitioner appointed by FWD, and
iii. The Insured survives for at least fourteen (14) days following the diagnosis of such Critical Illness.
Form Number: CIBVUL.07.2014
Page | 2
The Benefit Amount, if payable, will be paid to the Owner. However, if the Owner is incompetent as determined in good
faith by FWD, the Benefit Amount will be payable to the Beneficiary as desig nated in the Policy.
No Benefit Amount will be payable for any diagnosis of a medical Condition not covered in Section 13 Definition of
Covered Critical Illnesses.
3. MAXIMUM COVERAGE
policies shall not exceed the maximum amount offered by FWD, as may be determined by FWD at the time of
corresponding to such excess deducted from the Total Account Value shall be refunded without interest.
refund of the Cost of Insurance deducted from the Total Account Value for this Supplementary Benefit .
The Cost of Insurance rates used to determine the Cost of Insurance of this Supplementary Benefit are not guaranteed
6. RENEWAL

9. EXCLUSIONS
No bene fit will be payable under this Supplementary Benefit if the Critical Illness of the Insured results directly or
indirectly, wholly or partly, from any of the following circumstances:
i.
ii.
iii.
iv.
v.
Any Pre-Existing Condition;

Any violation or attempted violation of the law or resistance to arrest;
The Insureds refusing to consent to treatment or defying the advice of a Medical Practitioner;
Accident caused by the effect of alcohol or improper use of drug or use of narcotics;
Attempted suicide or intentionally self-inflicted Injury of the Insured while sane or insane;
Page | 3
vi. Any illness relating directly or indirectly from any congenital conditions;
vii. Any nuclear, biological, radioactive and chemical contamination;
viii. War (whether declared or not), invasion or acts of foreign enemies, civil war, revolution, rebellion, civil commotion
assuming the proportions of, or amounting to, an uprising against the government, riot or insurrection, strike, or
terrorist acts;
ix. Engaging in or taking part in air, military or naval service in peace time or in time of declared or undeclared war or
while under order for warlike operations or restoration of public order;
x. Engaging in air travel except as a fare-paying passenger in a properly licensed commercial aircraft;
xi. Involvement in any dangerous or risky sports or hobbies unless sports risk premium is paid;
xii. Human Immunodeficiency Virus(HIV) and or any HIVrelated illness including Acquired Immune Deficiency
Syndrome (AIDS) and/or any mutations, derivations or variations thereof (except HIV/AIDS due to Blood
Transfusion and Occupationally Acquired HIV/AIDS as stated in Section 13 Definition of Covered Critical
Illnesses).

iii. Medical Certificate;
iv. Medical Records;
v. Evidence of Accident, if applicable; and
vi. Any medical requirements as specified in Section 13 Definition of Covered Critical Illnesses.
FWD must receive the requirements within ninety (90) days from the date of knowledge of the occurrence of the
Critical Illness. Failure to submit within the time required shall not invalidate or reduce any claim if it can be shown that
it was not practicable to submit the requirements and its submission was made as soon as it was reasonably possible.
FWD reserves the right to require additional documents or evidences to help assess the validity of the claim at the
Owners expense. FWD shall have the right to make an autopsy, unless forbidden by law.
11. TERMINATION
i.
The Total Account Value becomes insufficient to cover the Cost of Insurance of this Supplementary Benefit , except
when Contract Debt is in effect;
ii. On the date following FWDs approval of the Owners written request for termination of this Supplementary
Benefit;
iii. The Expiry Date of this Supplementary Benefit; or
iv. Termination of the Policy.

No legal action on this Supplementary Benefit may be filed after one (1) year from the time the cause of action accrues.
Page | 4
13. DEFINITION OF COVERED CRITICAL ILLNESSES

For Benefits to be paid, all Critical Illness as further defined below, except for Myocardial Infarction, Cancer, or
Coronary Artery Bypass Grafting must not have been diagnosed within (60) sixty days from Effective Date or date of
effectivity of last reinstatement of this Supplementary Benefit whichever is later. Myocardial Infarction, Cancer, or
Coronary Artery Bypass Grafting may only be compensated if not diagnosed within ninety (90) days from Effective Date
or date of effectivity of last reinstatement of this Supplementary Benefit whichever is later.
1.
Alzheimers Disease
Deterioration or loss of intellectual capacity as confirmed by clinical evaluation and imaging tests, arising from
Alzheimer's disease or irreversible organic disorders, resulting in there being at least three (3) of the following six (6)
Activities of Daily Living which the Insured (with or without the use of mechanical equipment, special devices or other
aids and adaptations in use for disabled persons) is unable to perform without the continuous assistance of another
person:
i.
Washing : the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash
satisfactorily by other means,
ii. Dressing : the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial
limbs or other surgical appliances,
iii. Transferring : the ability to move from a bed to an upright chair or wheelchair and vice versa,
iv. Mobility : the ability to move indoors from room to room on level surf aces,
v. Continence: the ability to control bowel and bladder function so as to maintain a satisfactory level of personal
hygiene,
vi. Feeding: the ability to feed oneself once food has been prepared and made available.
The diagnosis must be clinically confirmed by an appropriate consultant appointed by FWD.
Non-organic diseases such as neurosis and psychiatric illnesses, and alcohol related brain damage are excluded.
2.
Apallic Syndrome
Universal necrosis of the brain cortex with the brainstem intact. The definite diagnosis must be confirmed by a
consultant neurologist appointed by FWD and evidenced by specific findings in neuro-radiological tests. This Condition
has to be medically documented for at least one month.
3.
Aplastic Anaemia
Chronic persistent bone marrow failure which results in anaemia, neutropenia and thrombocytopenia requiring
treatment with at least one of the following:
i.
ii.
iii.
iv.
blood product transfusion,

marrow stimulating agents,
immunosuppressive agents, or
bone marrow transplantation.
The diagnosis must be confirmed by a haematologist appointed by FWD.

4.
Bacterial Meningitis
Bacterial infection resulting in severe inflammation of the membranes of the brain or spinal cord resulting in significant,
irreversible and permanent neurological deficit confirmed by a consultant neurologist appointed by FWD. Confirmation
Page | 5
of bacterial infection in cerebrospinal fluid by lumbar puncture is required and the neurological deficit must persist
continuously for at least six (6) weeks. Bacterial Meningitis in the presence of HIV infection is excluded.
5.
Benign Brain Tumour
A benign tumour in the brain as evidenced by all of the following:

i. the tumour is life threatening,
ii. it has caused damage to the brain and
iii. it has undergone surgical removal or, if inoperable, has caused a permanent neurological deficit.
The presence of the underlying tumour must be confirmed by a neurologist or neurosurgeon appointed by FWD,
supported by findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging
techniques.
The following are excluded:
i.
ii.
iii.
iv.
v.
cysts,
granulomas,
vascular malformations,
haematomas, and
tumours of the pituitary gland or spine.
6.
Cancer
A malignant tumour characterised by the uncontrolled growth and spread of malignant cells with invasion and
destruction of normal tissue. The cancer must be confirmed by histological evidence of malignancy by an oncologist or
pathologist appointed by FWD.
i.
tumours showing the malignant changes of carcinoma-in-situ and tumours which are histologically described as
pre-malignant or non-invasive, including, but not limited to:
a. carcinoma-in-situ of the breasts and
b. cervical dysplasia CIN-1, CIN-2 and CIN-3,
ii. all of the following types of skin cancer, unless there is evidence of metastases:
a. hyperkeratosis,
b. basal cell and squamous skin cancers and
c. melanomas of less than 1.5mm Breslow thickness, or less than Clark Level 3,
iii. prostate cancers which are histologically described as TNM Classification T1a or T1b or prostate cancers of another
equivalent or lesser classification,
iv. T1N0M0 papillary micro-carcinoma of the thyroid less than 1 cm in diameter,
v. papillary micro-carcinoma of the bladder,
vi. chronic lymphocytic leukaemia less than RAI Stage 3, and
vii. all tumours in the presence of HIV infection,
viii. tumours of the ovary classified as T1aN0M0, T1bN0M0 or FIGO 1A, FIGO 1B .
7.
Cerebral Aneurism Requiring Surgery
Brain surgery to correct an abnormal dilation of cerebral arteries, involving all three layers of the walls of the cerebral
arteries. The aneurism must be at least 10 mm in size or increasing by at least 0.95 mm per year and the need for
surgery must be confirmed by a neuro-surgeon appointed by FWD, as evidenced by the results of cerebral angiography.
The following are specifically excluded:
Page | 6
i.
ii.
infection and mycotic aneurisms

limited craniotomy and burr-hole procedures.
8.
Chronic Liver Disease
End-stage liver failure as evidenced by all of the following:

i. permanent jaundice,
ii. ascites, and
iii. hepatic encephalopathy.
Liver disease secondary to alcohol or drug abuse is excluded.
9.
Chronic Lung Disease
End-stage lung disease, causing chronic respiratory failure, as evidenced by all of the following:
i.
ii.
iii.
iv.
FEV1 test results consistently less than 1 litre,

the requirement for permanent supplementary oxygen therapy for hypoxemia,
arterial blood gas analyses with partial oxygen pressures of 55mmHg or less (PaO2 < 55mmHg), and
dyspnoea at rest.
The diagnosis must be confirmed by a pulmonologist appointed by FWD.

10. Chronic recurrent pancreatitis
Continuing chronic inflammatory process of the pancreas, characterised by irreversible morphological changes and
progression of the disease and evidenced by all of the following:
i.
ii.
uniform accumulation of calcium in the pancreas as evidenced from the results of imaging tests, and
chronic failure of pancreatic function, causing continuous disruption of intestinal absorption (excess fat in the
faeces) or diabetes.
The diagnosis must be confirmed by a specialist in internal medicine appointed by FWD.

Chronic recurrent pancreatitis resulting from the use of alcohol is specifically excluded.
11. Coma
A coma that persists for a continuous period of at least 96 hours and evidenced by all of the following:
i. there is no response to external stimuli for at least 96 hours,
ii. life support measures are necessary to sustain life, and
iii. there is brain damage that results in a permanent neurological deficit.
The permanence of the neurological deficit must be assessed by a neurologist appointed by FWD at least thirty ( 30)
days after the onset of the coma.
Coma associated with alcohol or drug abuse is excluded.
Page | 7
12. Coronary Artery Bypass Grafting

The actual undergoing of open-heart surg ery to correct the narrowing or blockage of one or more of the coronary
arteries with bypass grafts.
Angiographic evidence of significant coronary artery obstruction must be provided and the procedure must be
considered medically necessary by a cardiologist appointed by FWD.
Angioplasty and all other intra-arterial, catheter-based techniques, keyhole or laser procedures are excluded.
13. Fulminant Viral Hepatitis
A submassive to massive necrosis of the liver by the hepatitis virus, leading precipitously to liver failure. The diagnosis
in respect of this illness must be evidenced by all of the following:
i.
ii.
iii.
iv.
v.
a rapidly decreasing liver size,

necrosis involving entire lobules, leaving only a collapsed reticular framework,
rapid deterioration of liver function tests,
deepening jaundice, and
hepatic encephalopathy.
14. Heart Valve Surgery

The actual undergoing of open-heart surgery to replace or repair heart valve abnormalities. The diagnosis of heart
valve abnormality must be supported by cardiac catheterization or echocardiogram and the procedure must be
considered medically necessary by a consultant cardiologist appointed by FWD.
15. HIV/AIDS due to Blood Transfusion
Infection with the Human Immunodeficiency Virus (HIV) through a blood transfusion, as evidenced by all of the
following:
i.
ii.
the infection was due to a blood transfusion that was medically necessary or given as part of a medical treatment,
the blood transfusion was received in Philippines after the Effective Date, date of endorsement or date of
reinstatement of this Supplementary Benefit (whichever is the latest),
iii. the source of the infection is established to be from the institution that provided the transfusion and the institution
is able to trace the origin of the HIV tainted blood; and
iv. the insured does not suffer from thalassaemia major or haemophilia.
No payment will be made under this condition where a cure has become available prior to the infection. Cure means
any treatment that renders the HIV inactive or non-infectious.
16. Loss of Hearing (Deafness)
Total and irreversible loss of hearing in both ears as a result of illness or accident. The inability to hear must be
established for a continuous period of six (6) months and must (at the end of that period) be deemed permane nt on the
basis of audiometric and sound-threshold test results furnished by an Ear, Nose and Throat (ENT) specialist appointed
by FWD.
Total means the loss of at least 80 decibels in all frequencies of hearing.
Page | 8
17. Loss of Sight (Blindness)

Total and irreversible loss of sight in both eyes as a result of illness or accident. The blindness must be confirmed by an
ophthalmologist appointed by FWD.
18. Loss of Speech
Total and irrecoverable loss of the ability to speak as a result of Injury or disea se to the vocal cords. The inability to
speak must be established for a continuous period of twelve ( 12) months and must (at the end of that period) be
deemed permanent on the basis of medical evidence furnished by an Ear, Nose and Throat (ENT) specialist appointed
by FWD.
All psychiatric related causes are excluded.
19. Major Burns
Third degree (full thickness of the skin) burns covering at least 20% of the surface of the Insureds body.
Diagnosis must be confirmed by a specialist appointed by FWD and must be evidenced by specific results using the Lund
Browder Chart or equivalent burn area calculators.
20. Major Head Trauma
Accidental head Injury resulting in there being at least three (3) of the following six (6) Activities of Daily Living which
the Insured (with or without the use of mechanical equipment, special devices or other aids and adaptations in use for
disabled persons) is unable to perform without the continuous assistance of another person:
i.
iv. Mobility : the ability to move indoors from room to room on level surfaces,
v. Continence: the ability to control bowel and bladder function so as to maintain a satisfactory level of personal
hygiene,
vi. Feeding: the ability to feed oneself once food has been prepared and made available.
The neurological deficit must have persisted continuously for at least six (6) weeks and must (at the end of that period)
be deemed permanent by a consultant neurologist appointed by FWD, supported by unequivocal findings on Magnetic
Resonance Imaging, Computerised Tomography, or other reliable imaging techniques.
The Accident must be caused solely and directly by Accidental, violent, external and visible means and independently of
all other causes.
i. head injury due to any other cause, and
ii. spinal cord injury.
Page | 9
21. Major Organ Transplant

The actual undergoing (as a recipient) of a transplant of:
i.
ii.
one of the following human organs:

a. heart,
b. lung,
c. liver,
d. kidney,
e. pancreas, or
human bone marrow using haematopoietic stem cells preceded by total bone marrow ablation,
as a result of irreversible end-stage failure of the relevant organ.

Other stem cell transplants are excluded.
22. Major Stroke
A cerebro-vascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, cerebral
embolism and cerebral thrombosis, as evidenced by all of the following:
i.
ii.
there is evidence of permanent neurological damage confirmed by a neurologist appointed by FWD at least 6
weeks after the event,
there are findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging
techniques consistent with the diagnosis of a new stroke.

i.
ii.
iii.
iv.
transient ischaemic attacks,

brain damage due to an accident or Injury, infection, vasculitis, and inflammatory disease,
vascular disease affecting the eye or optic nerve, and
ischaemic disorders of the vestibular system.
23. Medullary Cystic Disease

A progressive hereditary disease of the kidneys characterised by the presence of cysts in the medulla in both kidneys,
tubular atrophy and intestitial fibrosis with the clinical manifestations of anaemia, polyuria and renal loss of sodium.
The condition must present as the chronic irreversible failure of both kidneys to function, requiring regular renal
dialysis.
Diagnosis must be supported by renal biopsy.
24. Motor Neurone Disease
Motor neurone disease of unknown aetiology, as characterised by progressive degeneration of corticospinal tracts and
anterior horn cells or bulbar efferent neurones. These include spinal muscular atrophy, progressive bulbar palsy,
amyotrophic lateral sclerosis and primary lateral sclerosis.
The condition must result in there being at least three ( 3) of the following six ( 6) Activities of Daily Living which the
Insured (with or without the use of mechanical equipment, special devices or other aids and adaptations in use for
i.
Page | 10
v.
Continence : the ability to control bowel and bladder function so as to maintain a satisfactory level of personal
hygiene,
vi. Feeding : the ability to feed oneself once food has been prepared and made available.
For a benefit to be payable, such disability must have persisted for a continuous period of at least three (3) months and
must (at the end of that period) be confirmed by a neurologist appointed by FWD as progressive and resulting in
permanent disability and neurological deficit.
25. Multiple Sclerosis
The definite occurrence of multiple sclerosis, as diagnosed by a neurologist appointed by FWD, and as evidenced by all
of the following:
i. investigations unequivocally confirm the diagnosis to be multiple sclerosis,
ii. multiple neurological deficits have occurred over a continuous period of at least six (6) months, and
iii. there is a well documented history of exacerbations and remissions of said symptoms or neurological defic its.
Other causes of neurological damage such as SLE and HIV are excluded.
26. Muscular Dystrophy
A group of hereditary degenerative diseases of muscle, characterised by weakness and atrophy of muscle. The
diagnosis of muscular dystrophy must be unequivocal and made by a consultant neurologist appointed by FWD. The
condition must result in the re being at least three (3) of the following six (6) Activities of Daily Living which the Insured
(with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled
persons) is unable to perform without the continuous assistance of another person:
i.
v. Continence : the ability to control bowel and bladder function so as to maintain a satisfactory level of personal
hygiene,
For a b enefit to be payable, such disability must have persisted for a continuous period of at least six (6) months and
must (at the end of that period) be deemed permanent by a consultant phy sician appointed by FWD.
27. Myocardial Infarction (Heart Attack)
Death of a portion of the heart muscle arising from inadequate blood supply to the relevant area. The diagnosis must
be met by three or more of the following five criterias, which are consistent with a new heart attack:
i. a history of typical chest pain,
ii. new electrocardiogram (ECG) changes proving infarction,
iii. diagnostic elevation of cardiac enzyme CK-MB,
iv. cardiac troponin T or I at 0.5ng/ml and above, or
v. left ventricular ejection fraction less than 50%, measured three (3) months or more after the event.
Page | 11
28. Occupationally Acquired HIV/AIDS

Infection with the Human Immunodeficiency Virus (HIV) which resulted from an Accident occurring after the Effective
Date, date of endorsement or date of reinstatement of this Supplementary Benefit (whichever is the latest) and whilst
the Insured was carrying out the normal professional duties of his or her occupation in Philippines. No payment will be
made unless all of the following are proved to our satisfaction:
i.
proof of th e Accident giving rise to the infection must be reported to FWD within thirty ( 30) day of the accident
taking place,
ii. proof that the Accident involved a definite source of the HIV infected fluids and
iii. proof of sero-conversion from HIV negative to HIV positive occurring during the one hundred eighty (180) days
following the documented accident. This proof must include a negative HIV antibody test conducted within five (5)
days of the accident.
HIV infection resulting from any other means, including sexual activity and the use of intravenous drugs, is excluded.
This benefit is only payable when the occupation of the Insured is a medical practitioner, medical student, state
registered nurse, medical laboratory technician, dentist (surgeon or nurse) or paramedical worker, registered with the
appropriate body and working in a medical center or clinic (in Philippines).
No payment will be made under this condition where a cure has become available prior to the infection. Cure means
any treatment that renders the HIV inactive or non-infectious.
29. Paralysis
Total and irreversible loss of use of at least two entire limbs due to Injury or disease. This condition must have
persisted for a continuous period of at least 6 months and must (at the end of that period) be deemed permanent by a
consultant neurologist appointed by FWD.
Injuries that are self-inflicted are excluded.
30. Parkinsons Disease
The unequivocal diagnosis of Parkinsons Disease by a consultant neurologist appointed by FWD, as evidenced by all of
the following:
i. it cannot be controlled with medication,
ii. it show signs of progressive impairment and
iii. it results in there being at least three (3) of the following six (6) Activities of Daily Living which the Insured (with or
without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons)
is unable to perform without the continuous assistance of another person:
a. Washing : the ability to wash in the bath or shower (including getting into and out of the bath or shower)
or wash satisfactorily by other means,
b. Dressing : the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces,
artificial limbs or other surgical appliances,
c. Transferring : the ability to move from a bed to an upright chair or wheelchair and vice versa,
d. Mobility : the ability to move indoors from room to room on level surfaces,
e. Continence : the ability to control bowel and bladder function so as to maintain a satisfactory level of
personal hygiene,
f. Feeding : the ability to feed oneself once food has been prepared and made available.
For a benefit to be payable, such disability must have persisted for a continuous period of at least six (6) months and
must (at the end of that period) be deemed permanent by a consultant neurologist appointed by FWD.
Page | 12
Only idiopathic Parkinsons Disease is covered. Drug-induced or toxic causes of Parkinsonism are excluded.
31. Poliomyelitis
The occurrence of poliomyelitis as evidenced by all of the following:
i.
ii.
the polio virus is identified as the cause, and

paralysis of the limb muscles or respiratory muscles must be present and must have persisted continuously for at
least 3 months.
Other causes of paralysis are specifically excluded.

32. Primary Pulmonary Arterial Hypertension
Primary pulmonary hypertension with substantial right ventricular enlargement, established by investigations including
cardiac catheterisation and resulting in permanent physical impairment to the degree of at least Class 4 of the New
York Heart Association classification of cardiac impairment.
Class 4 is defined as the inability to carry out any activity without discomfort. Symptoms of Congestive Cardiac Failure
are present even at rest. With any increase in physical activity, discomfort will be experienced.
33. Progressive Scleroderma
A systemic collagen -vascular disease causing progressive diffuse fibrosis in the skin, blood vessels and visceral organs.
An unequivocal diagnosis of this disease must be supported by biopsy and serological evidence and the disorder must
have reached systemic proportions to involve the heart, lungs or kidneys such that two (2) of the following criteria are
met:
i.
pulmonary involvement showing carbon monoxide diffusing capacity (DLCO) < 70% of the predicted value, or
forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC) or total lung capacity (TLC) < 75% of the
predicted value;
ii. renal involvement showing glomerular filtration rate (GFR) < 60 m l/min;
iii. cardiac involvement showing evidence of either congestive heart failure, cardiac arrhythmia requiring medication,
or pericarditis with moderate to large pericardial effusion.
Localised scleroderma (linear scleroderma or morphea), eosinophilic fasciitis and CREST syndrome are specifically
excluded.
34. Renal Failure
Chronic irreversible failure of both kidneys, requiring either permanent renal dialysis or kidney transplantation.
35. Severe Rheumatoid Arthritis
Severe rheumatoid arthritis, with the diagnosis confirmed by a consultant rheumatologist appointed by FWD and as
evidenced by all of the following:
i. x-ray reveals typical rheumatoid change,
ii. the joint deformity change persists continuously for at least six (6) months, and
iii. at least three of the following groups of joints are involved and deformed:
finger joints,
wrist joints,
elbow joints,
knee joints,
Page | 13
hip joints,
ankle joints,
spine.
The condition must result in there being at least three ( 3) of the following six ( 6) Activities of Daily Living which the
Insured (with or without the use of mechanical equipment, special devices or other aids and adaptations in use for
i.
v. Continence : the ability to control bowel and bladder function so as to maintain a satisfactory level of personal
hygiene,
For a benefit to be payable, such disability must have persisted for a continuous period of at least six (6) months and
must (at the end of that period) be deemed permanent by a consultant physician appointed by FWD.
36. Surgery to Aorta
The actual undergoing of major surgery to repair or correct an aneurysm, narrowing, obstruction or dissection of the
aorta through surgical opening of the chest or abdomen.
For the purpose of this definition aorta shall mean the thoracic and abdominal aorta but not its branches.
Surgery performed using only minimally invasive or intra-arterial techniques are excluded.
37. Systemic Lupus Erythematosus
A multi -system, multi -factorial, autoimmune disorder characterized by the development of auto-antibodies directed
against various self-antigens. In respect of this Supplementary Benefit, systemic lupus erythem atosus will be restricted
to those forms of systemic lupus erythematosus which involve the kidneys (Grade 3 to Grade 6 lupus nephritis,
established by renal biopsy, and in accordance with the WHO classification as defined below). The diagnosis must be
evidenced by a histological report and confirmed by a specialist in rheumatology and immunology appointed by FWD.
Other forms of lupus, such as discoid lupus erythematosus or those that affect only the blood and joints are specifically
excluded.
The WHO classifications of lupus nephritis are:
i.
ii.
iii.
iv.
v.
vi.
Grade 1:
Grade 2:
Grade 3:
Grade 4:
Grade 5:
Grade 6:
minimal change glomerulonephritis

Pure messangial alterations
focal segmental or focal proliferative glomerulonephritis
diffuse proliferative glomerulonephritis
diffuse membranous glomerulonephritis
advanced sclerosing glomerulonephritis
38. Terminal Illness

Means the conclusive diagnosis by a specialist of an illness that is expected to result in death of the Insured within 12
months.
Page | 14
The insured must no longer be receiving active treatment other than that for pain relief and the diagnosis must be
confirmed by a specialist appointed by FWD.
Terminal illness in the presence of HIV infection is specifically excluded.
Page | 15
This Hospital Cash Supplementary Benefit is attached to Policy Number 50028210 and
Hospital Cash
DEFINITIONS
other means.
Condition refers to any type of illness, specific Injury, disease or infirmity including all underlying or related conditions
and any manifestation thereof, whether in one (1) or more than one body system.
Hospital means a facility which meets all of the following re quirements:
i. is duly licensed as a hospital under existing laws;
ii. is open twenty-four (24) hours a day;
iii. is operated mainly to diagnose and treat illnesses on an in-patient basis;
iv. has a staff of one or more physicians on call at all times;
v. has twenty-four (24) hour nursing services by registered nurses;
vi. is not primarily a nursing facility, clinic, nursing home, r est home and convalescence home, home for the aged, or a
place for alcoholics or drug addicts; and
vii. has organized facilities for X-ray and major surgery.
Hospital Confinement refers to a medically necessary admission in a Hospital as an in-patient for more than twelve
(12) continuous hours upon the recommendation and care of a Medical Practitioner.
solely and directly by external, violent and Accidental means and independent of all other causes and evidenced by a
an autopsy.
Page.
Intensive Care Unit refers to a class of rooms within a Hospital designated for the treatment of in-patients who are
acutely ill or in critical conditions which:
i.
have additional services and equipment provided on a twenty-four (24) hour operating basis, including full
facilities for the resuscitation of critically ill in-patients;
ii. equipped for constant, continuous monitoring of the vital body functions of critically ill in-patients; and
iii. have specific charges over and above the room and board charge billed by the Hospital.
i. For which the Insured received medical advice, consultation or treatment, or
Form Number: HCBVUL.07.2014
Page | 2
ii.
Whose signs or symptoms are evident, or should have been evident to the Insured, even if the Insured did not seek
medical advice, consultation or treatment for it,
prior to the Effective Date of this Supplementary Benefit.
1. EFFECTIVE DATE
2. BENEFIT
FWD will pay t he Benefit Amount for this Supplementary Benefit for each day of the Insureds Hospital Confinement as
a result of a Condition, and provided that:
i.
Hospital Confinement must be at least three (3) days before the Benefit Amount is payable, after which the
payment of the Benefit Amount is retroactive on the first (1st) day of Hospital Confinement. Two (2) or more
separate Hospital Confinements due to the same cause shall be considered as one continuous Hospital
Confinement period for the purpose of determining the minimum three (3) days Hospital Confinement
requirement, provided that they occur within thirty (30) days from each other; and
ii. the Benefit Amount is payable only for Hospital Confinement in the Philippines; and
iii. the aggregate number of days of Hospital Confinement shall not exceed one thousand (1,000) days for the period
until Expiry Date of this Supplementary Benefit, inclusive of confinement in the Intensive Care Unit ; and
iv. the Hospital Confinement occurs prior to the Expiry Date of this Supplementary Benefit.
Furthermore, FWD shall double the Benefit Amount of this Supplementary Benefit
Hospital Confinement in the Intensive Care Unit, and provided that:
i.
ii.
for each day of the Insureds
the aggregate number of days of Hospital Confinement in the Intensive Care Unit shall not exceed three hundred
sixty-five (365) days during the period until Expiry Date of this Supplementary Benefit; and
the Hospital Confinement in the Intensive Care Unit occurs prior to the Expiry Date of this Supplementary Benefit.
3. MAXIMUM COVERAGE
policies shall not exceed the maximum amount offered by FWD, as may be determined by FWD at the time of
corresponding to such excess deducted from the Total Account Value shall be refunded without interest.
refund of the Cost of Insurance deducted from the Total Account Value for this Supplementary Benefit .
Page | 3
The Cost of Insurance rates used to determine the Cost of Insurance of this Supplementary Benefit are not guaranteed
6. RENEWAL
During each subsequent renewal period, the number of days that may be compensated shall be limited to the unused
portion of the aggregate number of days defined in Se ction 2 Benefit , counting all paid days of Hospital Confinement
from Effective Date of this Supplementary Benefit.

9. EXCLUSIONS
No benefit will be payable under this Supplementary Benefit for any Hospital Confinement due to a Condition resulting
from or caused by any of the following circumstances:
i.
ii.
Any Pre-Existing Condition;

The Condition occurred within thirty (30) days from the Effective Date or date of effectivity of last reinstatement,
whichever is later, except when the Condition was caused by Accident;
iii.
Drug addiction or alcoholism;
iv.
Attempted suicide or intentionally self-inflicted Injury of the Insured while sane or insane;
v.
Poison, gas or fumes voluntarily taken;
vi.
Accident caused by the effect of alcohol or improper use of drug or use of narcotics;
vii. Any violation or attempted violation of the law or resistance to arrest;
viii. Any attempt or commission of assault or unlawful act by the Insured;
ix.
Any nuclear, biological, radioactive and chemical contamination;
x.
War (whether declared or not), invasion or acts of foreign enemies, civil war, revolution, rebellion, civil
commotion assuming the proportions of, or amounting to, an uprising against the government, riot or
insurrection, strike, or terrorist acts;
xi.
Engaging in or taking part in air, military or naval service in peace time or in time of declared or undeclared war
or while under order for warlike operations or restoration of public order;
xii. Engaging in air travel except as a fare-paying passenger in a properly licensed commercial aircraft;
xiii. Involvement in any dangerous or risky sports or hobbies unless sports risk premium is paid;
xiv. Pregnancy, childbirth, miscarriage, abortion or any complications thereof;
xv. Mental, nervous or manifested sleep disorders or any other complications arising therefrom;
xvi. Routine physical check-up and rest cures, rehabilitation and hospice care;
xvii. Diagnosis, X-ray examination, treatment of infertility, or physical therapy;
xviii. Sterilization of either sex, circumcision and sex transformation ;
xix. Congenital anomalies and conditions arising therefrom;
xx. Cosmetic or plastic surgery, any dental work, eye or ear examination, except to the extent that any of them
is necessary for the repair or alleviation of damage to the Insureds person caused solely by an Accident;
xxi. Work related Accidents which are otherwise indemnified by employee compensation programs or insurances;
xxii. Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC), or infection by Human
Immunodeficiency Virus (HIV).
Page | 4

iii. Evidence of Accident, if applicable;
iv. Admitting Medical History Record and Discharge Summary (Certified True Copy) ;
v. Duly Certified Statement of Account of Hospitalization; and
vi. Complete Medical Records of Confinement (Certified True Copy) .
In the event of continuous Hospital Confinement of over thirty (30) days , the Insured may file a claim on the thirty-first
(31st) day of Hospital Confinement or every thirty (30) days thereafter or upon discharge from confinement, whichever
is earlier.
FWD must receive the requirements of claim within ninety (90) days from the date of discharge from the Hospital.
Failure to submit within the time required shall not invalidate or reduce any claim if it can be shown that it was not
practicable to submit the requirements and its submission was made as soon as it was reasonably possible.
FWD reserves the right to require additional documents or evidences .
11. TERMINATION
i.
ii.
Upon exceeding the maximum number of one thousand (1,000) days of Hospital Confinement;
The Total Account Value of the Policy becomes insufficient to cover the Cost of Insurance of this Supplementary
Benefit, except when Contract Debt is in effect;
iii. On the date following FWDs approval of the Owners written request for termination of this Supplementary
Benefit;
iv. The Expiry Date of this Supplementary Benefit; or
v. Termination of the Policy.

Unless the claim has been rejected, no legal action under this Supplementary Benefit may be brought before the end of
sixty (60) days after proof of Hospital Confinement has been filed nor after one (1) year from the date the Insured
leaves the Hospital.
Page | 5
SET FOR LIFE 5PAY SALES ILLUSTRATION
Quotation Reference No : 9900249000023
FOR THE PROPOSED OWNER :

NAME :
MR KET IAN COTALES
DATE OF BIRTH:
January 13, 1993
GENDER:
Male
AGE:
22
PROPOSED INSURED :
NAME :
MR KET IAN COTALES
DATE OF BIRTH:
January 13, 1993
GENDER:
Male
AGE:
22
RISK CLASS :
Standard Class 1
OCCUPATION :
School Instructor
Thank You for considering Set for Life 5PAY - the perfect way to protect You and Your family' future. By investing regularly in FWD's professionally managed Investment Funds,
You benefit from the long term growth potential of carefully selected equities and bonds. You also have the flexibility to invest additional amounts at any time (subject to our
approval) or, if money is tight, suspend regular investments and/or withdraw some or all of Your investment without penalties. You can give Your family even more peace of mind
by attaching Supplementary Benefits which provide financial support if the Insured is hospitalized, suffer a critical illness, is disabled or worse. With Your family's financial future
secure, You can get ready to live!
To reward our long term Customers, FWD Life Insurance Corporation ("FWD") aims to pay Loyalty Bonuses on the 10th policy year and every five years thereafter. The Loyalty
Bonus is now at 2% of the average Total Account Value of the preceding sixty months. The Loyalty Bonus is not guaranteed and may be adjusted by FWD.
An illustration of Your potential benefits is shown below, amounts are in Philippine Pesos. Total Living Benefits shown below shall be subject to applicable Surrender Charges, if
any, for full or partial withdrawals.
TOTAL
POLICY
YEAR
AGE
REGULAR
PREMIUMS
PAID
TOP-UP
AMOUNT
PREMIUMS
ALLOCATED
PAID*
TO FUND
TOTAL LIVING BENEFITS
PROJECTED DEATH BENEFIT
(AT THE END OF YEAR)

4%
8%
10%
4%
8%
10%
22
29,988
8,996
4,250
4,338
4,382
1,000,000
1,000,000
1,000,000
23
29,988
16,493
16,362
16,877
17,136
1,000,000
1,000,000
1,000,000
24
29,988
29,988
42,806
44,555
45,445
1,000,000
1,000,000
1,000,000
25
29,988
29,988
70,437
74,582
76,721
1,000,000
1,000,000
1,000,000
26
29,988
29,988
99,231
107,075
111,192
1,000,000
1,000,000
1,000,000
27
98,298
110,649
117,276
1,000,000
1,000,000
1,000,000
28
97,302
114,493
123,954
1,000,000
1,000,000
1,000,000
29
96,233
118,616
131,278
1,000,000
1,000,000
1,000,000
30
95,068
123,025
139,293
1,000,000
1,000,000
1,000,000
10
31
95,730
130,065
150,623
1,000,000
1,000,000
1,000,000
11
32
93,813
134,664
159,854
1,000,000
1,000,000
1,000,000
12
33
91,716
139,536
169,924
1,000,000
1,000,000
1,000,000
13
34
89,411
144,689
180,903
1,000,000
1,000,000
1,000,000
14
35
86,879
150,136
192,875
1,000,000
1,000,000
1,000,000
15
36
85,893
158,719
209,434
1,000,000
1,000,000
1,000,000
16
37
82,000
164,096
223,096
1,000,000
1,000,000
1,000,000
17
38
77,714
169,694
237,943
1,000,000
1,000,000
1,000,000
18
39
72,991
175,509
254,077
1,000,000
1,000,000
1,000,000
19
40
67,790
181,543
271,620
1,000,000
1,000,000
1,000,000
20
41
63,562
191,244
295,633
1,000,000
1,000,000
1,000,000
39
60
35,457
1,038,375
1,000,000
1,038,375
44
65
1,437,576
1,437,576
49
70
2,060,028
2,060,028
59
80
5,516,254
5,516,254
69
90
14,764,779
14,764,779
78
99
35,926,672
35,926,672
Version 2.5
This Sales Illustration is prepared on June 04, 2015 and valid until July 04, 2015
FWD LIFE INSURANCE CORPORATION

19/F, W Fifth Avenue Bldg., 5th Avenue cor. 32nd Street,
Bonifacio Global City, Taguig City 1634, Philippines
T: (632) 888 8393 | F: (632) 558 7393
FWD.COM.PH
Page 1 of 5
IMPORTANT INFORMATION TO NOTE ABOUT SET FOR LIFE 5PAY

(i)
ALL INVESTMENT RISKS ASSOCIATED WITH SET FOR LIFE 5PAY ARE BORNE SOLELY BY THE OWNER.
(ii)
The Total Living Benefits illustrated assume investment earnings of 4%, 8%, 10%. Fund Management Charge, tax and other investment expenses are also assumed to
have been deducted from the Investment Funds. These earnings rates are not based on past fund performance and actual Investment Fund earnings will differ from these
rates.
(iii)
The value of Your Policy is NOT GUARANTEED and depends on the actual investment performance of the Funds. It is possible that the value of Your policy will become
less than the amount that You invest.
(iv)
The amounts above assume that the illustrated Premiums are paid in full when due, are net of Policy Charges and assume Policy Charges are not reviewed. Fund
Switching Charges may apply.
(v)
If the Insured dies while the Policy is in force, FWD will pay whichever is higher of (i) 1,000,000, (ii) the Total Account Value or (iii) the Minimum Death Benefit. The
Minimum Death Benefit is the sum of 125% of any Premiums paid less 125% of any Partial Withdrawals.
(vi)
If You decide this Policy is not suitable for Your needs, You can return the Policy to FWD for cancellation within 15 days from the date You receive it and
receive a refund equal to the sum of the Total Account Value, Premium Charges and the Insurance Charges that have been deducted from Your Fund Account
Value.
(vii)
This Sales Illustration becomes part of Your Policy after the Policy is issued. The terms and conditions applicable to Your Policy are presented in more detail in the Set for
Life 5PAY Policy Contract. The Policy Contract will be followed if there are inconsistencies between this Sales Illustration and the Policy Contract.
(viii)
FWD may change the Regular Premiums, Regular Top-Up Premiums and Policy Charges but only after seeking approval from the Insurance Commission and informing
You one (1) month prior to the change. The exception being the Accident Death Insurance Charges which are guaranteed not to change.
SUMMARY OF BENEFITS, PREMIUMS AND INSURANCE CHARGES

BENEFIT
BENEFIT DESCRIPTION
Set for Life 5PAY Death Benefit
BENEFIT
INITIAL INSURANCE
PAYMENT
TOTAL ANNUAL
AMOUNT
PERIOD
CHARGES*
PERIOD
PREMIUM
1,000,000.00
78 Years
1,575.09
5 Years
30,000.00
Supplementary Benefits:
FWD Accidental Death Benefit Rider for UL
1,000,000.00
48 Years
1,209.48
FWD Critical Illness Benefit Rider for UL
500,000.00
48 Years
634.80
FWD Hospital Cash Benefit Rider for UL
1,500.00 per day
48 Years
1,416.96
Regular Premium
30,000.00
Regular Top Up Premium
0.00
* Initial Insurance Charges will be deducted from your Total Account Value in the first year as payment for the
Benefits you have selected. The Insurance Charges are deducted in subsequent years until the end of the
Benefit Period and will increase based on the Insured's age at that time.
Total Annual Premium
30,000.00
Total Semi-Annual Premium
15,000.00
Total Quarterly Premium
7,500.00
Total Monthly Premium
2,499.00
SUPPLEMENTARY BENEFITS ATTACHED TO THIS PLAN

ACCIDENTAL DEATH BENEFIT pays PHP 1,000,000 in the event of the Insured's death due to an Accident prior to attaining age 70. If death is due to an Accident and occurs
during an official Philippine Public Holiday, the amount payable triples to PHP 3,000,000
CRITICAL ILLNESS BENEFIT This benefit pays PHP 500,000 if the Insured is diagnosed with one of the below Critical Illness before age 70:
1. Alzheimer's Disease
2. Apallic Syndrome
3. Aplastic Anaemia
4. Bacterial Meningitis
5. Benign Brain Tumour
6. Blindness
7. Cancer
8. Cerebral Aneurism Requiring Surgery
9. Chronic Liver Disease
10. Chronic Lung Disease
11. Chronic Recurrent Pancreatitis
12. Coma
13. Coronary Artery Bypass Grafting
14. Deafness
15. Fulminant Viral Hepatitis
16. Heart Valve Surgery
17. HIV due to Blood Transfusion
18. Loss of Speech
19. Major Burns
20. Major Head Trauma
21. Major Organ Transplant
22. Major Stroke
23. Medullary Cystic Disease
24. Motor Neurone Disease
25. Multiple Sclerosis
26. Muscular Dystrophy
27. Myocardial Infarction (Heart Attack)

28. Occupationally Acquired HIV
29. Paralysis
30. Parkinson's Disease
31. Poliomyelitis
32. Primary Pulmonary Arterial Hypertension
33. Progressive Scleroderma
34. Renal Failure
35. Severe Rheumatoid Arthritis
36. Surgery to Aorta
37. Systemic Lupus Erythematosus
38. Terminal Illness
HOSPITAL CASH BENEFIT : This benefit pays PHP 1,500 for each day that the Insured is confined in a Hospital due to sickness or injuries. The benefit is limited to a total of
1,000 days before age 70. The Benefit Amount doubles to PHP 3,000 for each day that the Insured is confined in an Intensive Care Unit, up to a limit of 365 days.
Please ask Your Financial Consultant for more details about these benefits including which circumstances benefits will not be paid.
Version 2.5
FWD.COM.PH
Page 2 of 5
ACKNOWLEDGEMENTS BY THE OWNER

POLICY CHARGES
I acknowledge that I understand that the following Policy Charges will be charged to my Set for Life 5PAY Policy:
(i)
Premium Charges are deducted according to the following table:

Premium Charge as a Percentage of Premium Payable in :
1st Policy Year
2nd Policy Year
3rd Policy Year
4th Policy Year Onwards
Regular Premium Charge
70%
45%
0%
0%
Regular Top-Up Premium Charge
5%
5%
5%
5%
Lump Sum Top-Up Premium Charge
5%
5%
5%
5%
You can suspend payment of Regular Premiums and Regular Top-Up Premiums at any time. However any Regular Premium Charges that would have been received by
FWD had You continued to pay Regular Premiums will be deducted from Your Total Account Value. If Total Account Value becomes insufficient to cover these Charges,
Your Policy will terminate.
(ii)
Insurance Charges are deducted every month from Your Total Account Value as payment for the Death Benefit and Benefit Amount of Supplementary Benefit/s that You
have selected. If the Total Account Value becomes insufficient to cover the Insurance Charges during the first three (3) Policy Years, Your Basic Plan Death Benefit and
any Supplementary Benefit/s will continue for as long as Regular Premiums and Regular Top-Up Premiums are paid when due and no withdrawals. A Contract Debt is
created equal to any undeducted Insurance Charges and accumulated without interest. Any Premiums paid net of Premium Charges will reduce the Contract Debt with
any remaining amounts being invested in the Total Account Value. The Policy will terminate at the end of the third (3rd) year if the Total Account Value is zero (0) or
below. The Contract Debt balance will be deducted from any Death Benefit that may become payable.
(iii)
Fund Management Charges are deducted from the Investment Funds to cover the cost of administering the Investment Funds and determine the net asset values of
each of the Investment Funds.
(iv)
Fund switching is free up to six (6) times per Policy Year, provided that it is requested through FWD's online facility. In other situations, a Fund Switching Charge of 1%
of the amount switched will be deducted from the Total Account Value.
I acknowledge that:
(i)
I have applied to FWD for a Set for Life 5PAY Insurance Policy and have reviewed the illustrations showing how variable life insurance policies perform using FWD's
assumptions and the Insurance Commission's guidelines on interest rates.
(ii)
I understand that since the fund performance may vary, the values of my units are not guaranteed and will depend on the actual performance and that the value of my
Policy could be less than the total of the Regular Premiums and Regular Top-Up Premiums and any Lump Sum Top-Up Premiums paid. The actual unit values of the
Investment Funds are published regularly.
(iii)
I fully understand that the investment risks under my Policy are to be borne solely by me, as the Owner.
June 04, 2015
MR KET IAN COTALES
DATE SIGNED
June 04, 2015

DATE SIGNED
Version 2.5
FWD.COM.PH
OWNER'S SIGNATURE OVER FULL NAME
10000069
CODE
Ms. Lanie May Faith Luzon Ferrer

FINANCIAL WEALTH PLANNER SIGNATURE OVER FULL NAME
Page 3 of 5
INVESTMENT FUND OPTIONS

FWD PESO BOND FUND
Your nominated allocation to this fund : 100.0 %
The fund targets long term growth by investing in a diversity of high quality, medium-to-long term fixed securities such as government securities and corporate bonds and
notes. It is designed for people with lower than average investment risk tolerance. The fund invests in assets managed by Security Bank. The Fund Management Charge is
1.75% of the fund per year.
FWD PESO FIXED INCOME FUND
Your nominated allocation to this fund : 0 %
The fund targets long term growth by investing in a diversity of high quality, medium-to-long term fixed securities such as government securities and corporate bonds and
notes. It is designed for people with lower than average investment risk tolerance. The fund invests in assets managed by Bank of the Philippine Islands. The Fund
Management Charge is 1.75% of the fund per year.
FWD PESO STABLE FUND
The fund targets long term growth by investing in a balanced diversity of high quality equities listed in the Philippine Stock Exchange and fixed income securities such as
government securities and corporate bonds and notes. The fund invests in assets managed by Security Bank. The Fund Management Charge is 2.00% of the fund per year.
FWD PESO BALANCED FUND
The fund targets stable long term growth by predominantly investing in high quality government securities and corporate bonds whilst investing a smaller proportion in
carefully selected equities listed in the Philippine Stock Exchange. The fund invests in assets managed by Bank of the Philippine Islands. The Fund Management Charge is
2.00% of the fund per year.
FWD PESO HIGH DIVIDEND EQUITY FUND
The fund targets total returns through income growth and long term capital appreciation by investing in carefully selected equities listed in the Philippine Stock Exchange that
offer high dividend payments. While You are still exposed to the possibility of capital losses given the volatile nature of equities, consistent and high dividend payments help
cushion declines in actual stock prices. The fund invests in assets managed by Security Bank. The Fund Management Charge is 2.00% of the fund per year.
FWD PESO GROWTH FUND
The fund is designed to optimize growth over the long term from a diversified portfolio of equities listed in the Philippine Stock Exchange and money market securities. This
fund is suitable for investors with an aggressive risk profile and long investment horizon. You should only invest in this fund if You are willing to accept negative investment
returns. The fund invests in assets managed by Security Bank. The Fund Management Charge is 2.00% of the fund per year.
FWD PESO EQUITY FUND
The fund is designed to optimize growth over the long term from a diversified portfolio of equities listed in the Philippine Stock Exchange and money market securities. This
fund is suitable for investors with an aggressive risk profile and long investment horizon. You should only invest in this fund if You are willing to accept negative investment
returns. The fund invests in assets managed by Bank of the Philippine Islands. The Fund Management Charge is 2.00% of the fund per year.
The assets in our Investment Funds are valued using the marked-to-market valuation method on a daily basis. The Unit Prices of the Investment Funds are published weekly
in major newspapers and daily in our website (www.fwd.com.ph)
DISCLOSURES OF CONFLICT OF INTEREST
The fund manager makes investment decisions for the Investment Fund/s based on the circumstances of each Investment Fund and independently of decision made for
other Investment Fund/s. The fund manager may make the same investments for an Investment Fund and one or more other Investment Fund/s. This may create a conflict of
interest if there is only a limited amount of the investment available, or if the investment is purchased at different times or at different prices for different Investment Fund/s. If
this happens, the fund manager will attempt to allocate the investment fairly between the Investment Fund and other Investment Fund/s. Factors the fund manager considers
in allocations include the size and timing of previous allocations, whether the security meets the objectives of the respective portfolios, the relative portfolio size and the rate
of growth of the portfolios.
This is not a deposit product. Earnings are not assured and principal amount invested is exposed to risk of loss. This product cannot
be sold to you unless its benefits and risks have been thoroughly explained. If you do not fully understand this product, we strongly
recommend that you do not purchase or invest in it.
Version 2.5
FWD.COM.PH
Page 4 of 5
OTHER IMPORTANT INFORMATION

What are the key risks of my product?
Purchasing a Variable Life insurance product has its advantages and trade-offs. You should understand that Variable Life products are subject to investment risks which
include, but are not limited to credit risk, mark-to-market risk, taxation risk, regulatory risk, liquidity risk and default risk which could affect the value of your Variable Life
Policy. FWD is guided by its Investment Policies and Guidelines in managing these risks however, this does not guarantee investment returns nor protect against capital loss.
To further understand the nature of these risks, please talk to your FWD Financial Wealth Planner.
Is it possible to terminate my investment and will this incur Charges?

Set for Life 5PAY allows you to withdraw some or all of your Total Account Value however Surrender Charges may apply. If you withdraw all of your Total Account Value,
your Policy will immediately terminate. Doing this may be more disadvantageous than beneficial as you lose potential investment earnings plus the benefits of having life
insurance protection. We recommend that you talk to your Financial Consultant first to explore other options.
Your policy will also terminate if the Total Account Value is no longer sufficient to cover Premium Charges and Insurance Charges. In this case, you may reinstate your Policy
and any Supplementary Benefits within three (3) years if you satisfy our Reinstatement requirements.
Other important information I need to know.

Should you need further information, you may contact FWD Life Insurance Corporation at the address shown on Page 1.
DEFINITION OF INVESTMENT RISKS

Credit Risk
This risk refers to the probability that a counterparty to an investment may not be able to fulfill its obligations accordingly, resulting to an adverse effect on the value of a
money market or debt security such as a bond.
Interest Rate Risk

This risk refers to the possibility that the value of an investment with holdings in fixed-income securities such as bonds may rise and fall as interest rates change. When
interest rates fall, the value of an existing bond rises. On the contrary, when interest rates rise, the value of an existing bond generally falls.
Liquidity Risk
This risk refers to the possibility that assets or securities cannot be bought or sold within a desired time and/or at fair value, which in turn may affect the value of an
Investment Fund or affect FWD's ability to satisfy the investment purchase and redemption requests of its Owners.
Mark-to-Market Risk
This risk refers to the probability that the market value of an investment will rise or fall based on overall market conditions. The value of the market can vary with changes in
the general economic and financial conditions as well as political, social and environmental factors.
Regulatory Risk
This risk refers to the probability that certain laws and regulations applicable to investments, including income tax and securities laws, and the administrative policies and
practices of regulatory authorities may change in a manner that adversely affects the value of an investment.
Taxation Risk
This risk refers to the probability that the application of tax on investment may differ from jurisdiction to jurisdiction and tax treatment may change before the maturity or
redemption date of an investment. For more information on the effects of tax on the acquisition, ownership or liquidation of Investment Funds, you should consult a personal,
independent tax adviser.
Version 2.5
FWD.COM.PH
Page 5 of 5
Regular Application for Life Insurance

Policy No.
50028210
Please fill-out in block letters and mark the appropriate circles. Fields with asterisk are mandatory fields. An incomplete form may not proceed for evaluation.
PROPOSED INSURED DETAILS
OWNER DETAILS
(Please fill in if other than the Owner)
A. PERSONAL INFORMATION *
1.
Name*
Mr.
Title/Honorific
Title/Honorific
COTALES
Last Name
Last Name
KET IAN
First Name
First Name
Extension Name
Extension Name
CAJOTE
Middle Name
2.
Mothers Maiden Name*
Middle Name
CAJOTE
Last Name
Last Name
DELIA
First Name
3.
Other Legal Name
First Name
COTALES
Last Name
Last Name
KET IAN
First Name
First Name
Extension Name
Extension Name
CAJOTE
4.
Relationship of Proposed
Insured to the Owner*
5.
Date of Birth*
Middle Name
Middle Name
Self
Employee
Father
Mother
Spouse
Others: _____________________
Child
Sister
Brother
* If Employee, please fill in Item 28. Corporate Account.
Month (MM)
6.
Age Last Birthday
7.
8.
Country of Birth*
Birth Place*
Philippines
9.
Civil Status*
10.
11.
Gender*
Religion
Single
Separated
Male
12.
Nationality*
13.
TIN/SSS/GSIS No.*
14.
ID Details*
Day (DD)
Year (YYYY)
Philippines
U.S.
Divorced Widower
Widow
Single
Separated
Male
Married
Annulled
Female
Roman Catholic
SDA
Others:_____________________
Roman Catholic
Others:___________________________
Filipino
U.S.
Others:_____________________
Filipino
U.S.
Others:___________________________
TIN
None
SSS
420-714-544-000
GSIS ________________________
TIN
None
SSS
GSIS _____________________________
ID Type
Married
Annulled
Female
PRC ID
: ____________________________________
ID Type
1 3
Day (DD)
: ____________________________________
Month (MM)
Day (DD)
Year (YYYY)
Note: ID should be valid and expiry should not be within 6 months from the date of signing of
this application
PUROK 2, CARANGAN, OZAMIZ CITY
Barangay/Subdivision/District
Ozamis City
Municipality/Town/City
Philippines
Country
(Fill in Permanent address if not
the same as the current address)
Divorced Widower
Widow
Year (YYYY)
House/Bldg No. Street
Permanent Address*
Others:_____________________
ID Number :_____________________________________
Expiry Date:
Note: ID should be valid and expiry should not be within 6 months from the date of signing of
this application
16.
Year (YYYY)
Others:__________________
U.S.
Month (MM)
Current Address*
Day (DD)
OZAMIZ
1284821
ID Number :_____________________________________
Expiry Date:
15.
Month (MM)
Misamis
Occidental
Province
Province
Country
Zip code
7200
Zip code

Ozamis City
Philippines
Country
Misamis
Occidental
Province
Province
Country
Zip code
7200
Zip code
17.
Contact Information*
Mobile No.*
( 63
(
) (
) (
Business/Office Tel. No. (
) (
) (
Country code
Area code
Country code Area code
18.
19.
20.
Policy Correspondence*
21.
Business or Employers
Name* (not applicable for
DEPARTMENT OF EDUCATION
Business or Employers
Address*
Bldg No.
E-mail is the default and

recommended option.
juvenile)
22.
) (
) (
) (
) (
Business/Office Tel. No. (
) (
) (
Country code
Area code
Telephone number
Street
Mobile number
Telephone number
)
)
)
Telephone number
Email address*: ____________________________________

Mobile No. Business/Office Tel. No. Residential Tel. No.
Bldg No.
Pick-up from FWD Connect Center
Street
Misamis
Occidental
Province
Philippines
Province
Country
Zip code
7200
Country
Zip code
23.
Industry*
E.g. Banking and Finance,

Construction, etc.
Teacher
24.
Occupation *
School Instructor
25.
Annual Income*
26.
Purpose of Insurance*
27.
Source of Fund*
28.
Corporate Account
222588
Investment
Protection
Savings
Retirement
Education
Others: ________________________________________
Salary
Business
Inheritance
Savings
Income from other investments
Accumulated savings and investments
Others: __________________________________
Estate Planning
Proceeds from Insurance
Donations, grants
__________________________________________________
Position / Designation of Proposed Insured
__________________________________________________
Contact Person/Authorized Representative
__________________________________________________
Business TIN
__________________________________________________
Email of Contact Person/Authorized Representative
BASIC POLICY INFORMATION *
29. Plan Details

Sum Assured
Base Plan:
Unit-Linked Insurance
Traditional Life Insurance

Others
Payment Period:
Single Pay
Others
30.
Telephone number
Ozamis City
B.
Residential Tel. No.
E-mail (if opted, the date of the email to you is the date of policy receipt)
Financial Wealth Planner/Financial Solutions Consultant
Postal
E-mail
Postal (Please select one below)
Current Address
Permanent Address
Business Address
This item must be filled in if

answer to Item 4. is Employee.
Mobile No.*
Mobile number
ketianc@yahoo.com
Email address*: ___________________________________
Mobile
No. Business/Office Tel. No. Residential Tel. No.
Preferred mode of
contact*
Policy Delivery Method*
Policy delivery shall be to
Philippine address only
) ( 918 ) ( 9930227
Residential Tel. No.
1000000
: ____________________________________________
Set for Life
: ____________________________________________
: ____________________________________________
: ____________________________________________
________________________________________________
________________________________________________
________________________________________________
5
: _____________________________________________
Premium Amount:
Single Premium
Regular Basic Premium
Regular Top Up
Lump Sum Top Up
:_________________________
:_________________________
30000
:_________________________
:_________________________
Fund Allocation ( For Unit Linked Insurance Products Only)

Fund Name
Percentage (%)
FWD PESO Bond Fund

_________________________________________________________________________
100
________________
_________________________________________________________________________
________________
_________________________________________________________________________
________________
_________________________________________________________________________
________________
_________________________________________________________________________
________________
_________________________________________________________________________
________________
_________________________________________________________________________
________________
_________________________________________________________________________
________________
_________________________________________________________________________
________________
_________________________________________________________________________
________________
Each fund should have minimum of 10%

and multiple of 5%. Total Fund Allocation
should equal to 100%
C.
RIDERS (The attachment of rider(s) may vary per product design)

1000000
___________________________
ACCIDENTAL DEATH BENEFIT
WAIVER OF PREMIUM ON THE LIFE OF THE PROPOSED INSURED
CRITICAL ILLNESS BENEFIT
500000
___________________________
WAIVER OF PREMIUM ON OWNER
DAILY HOSPITAL CASH BENEFIT
1500
___________________________
Others:_______________________________
D.
BENEFIT OPTION (For Traditional Life Insurance Only)
Dividend Option (If policy is participating)
If premium is not paid by the end of the grace period, cash value will be applied to effect:
Leave to Earn Interest

Pay in Cash
Extended Term Insurance (ETI)

Reduced Paid-Up Insurance (RPU)
Use to Reduce Premium

Use to Purchase Additional Insurance
By default, if no option is selected, ETI will apply for Standard Cases and RPU for Rated Cases .
By default, if no Dividend Option is selected, Leave to Earn Interest will apply.
BENEFIT/SETTLEMENT BANK ACCOUNT

Bank name
: __________________________________________________
Account number : __________________________________________________
Account Type:
1.
2.
E.
Savings
Branch
: ____________________________________________
Account owner : ____________________________________________
Current
Please attach copy of ATM card or Proof of bank account number and name of depositor to ensure correctness of data.
Bank account currency should be the same as the policy currency.
PAYMENT DETAILS
MODE OF PREMIUM PAYMENT

Annual
Semi-annual
Quarterly
INITIAL PREMIUM
Payment Gateway
Direct to bank - ATM, Over-The-Counter (OTC)
F.
Premium Loan with Interest (PL)

Surrendered for Cash Value (SCV)
RENEWAL PREMIUM
Auto Debit Arrangement. Please submit accomplished Authorization Form to Debit or Charge.
Auto Credit Arrangement. Please submit accomplished Credit Card Enrollment Form.
Direct to bank - ATM, Over-The-Counter (OTC), Internet Banking
APP No.: 0100249000023

BENEFICIARY DETAILS*
Name
(first name, extension name,
middle name, last name)
ELMER RABINA COTALES

DELIA MENDEZ CAJOTE
If Beneficiary designated is not a

minor ELMER RABINA COTALES
Monthly (Monthly mode of payment is for auto debit/credit card only.)
Relationship
to the Proposed
Insured
Gender
Date of Birth
(MM-DD-YYYY)
Benefit
(Must total
100%)
03-04-1962
Father
50.0
10-26-1963
Mother
50.0
Contact Details:
09198930281
Type of
Beneficiary
Designation
Trustee for Minor

Beneficiary
Revocable
Primary
Secondary
Irrevocable
Revocable
Primary
Secondary
Irrevocable
Primary
Revocable
Secondary
Irrevocable
Primary
Revocable
Secondary
Irrevocable
Primary
Revocable
Secondary
Irrevocable
Address: PUROK 2, CARANGAN, OZAMIZ CITY,
Ozamis City, Misamis

Occidental, 7200, Philippines
If designation is left blank, all beneficiary(ies) will be designated as PRIMARY REVOCABLE. If the beneficiary is not changed during the lifetime of the insured, the
designation shall be deemed IRREVOCABLE.
If more than one beneficiary(ies) is named, equal share shall be assumed unless stated otherwise.
The consent of a designated irrevocable beneficiary(ies) is required for all policy transactions. If you designate irrevocable beneficiary(ies), you must submit a copy of
his/their valid IDs bearing his/their photo and signature.
G.
MEDICAL INFORMATION*
BUILD*
Owner
Proposed Insured
(to be filled in only if Waiver of Premium on Owner is applied for and Owner
and Proposed Insured are not the same person)
Height
5
_________
ft. ________inch
6
_________ ft. ________inch
Weight
187
_________
lbs
_________ lbs
Weight Change of more than 5

pounds in the last 12 months:
YES
If yes:
Weight Loss
Weight Gain
Weight Loss
Weight change in pounds:
6 to 10 pounds
11 to 20 pounds
more than 20 pounds
6 to 10 pounds
11 to 20 pounds
more than 20 pounds
Diet/Exercise
As advised by medical doctor
Due to medical condition
Other:___________________________________
Diet/Exercise
As advised by medical doctor
Due to medical condition
Other:___________________________________
Reason for weight change:
NO
YES
NO
Weight Gain
Owner
MEDICAL DECLARATION*
- A YES answer on any of the medical questions must provide details such as Diagnosis, Date of diagnosis, Name and address o f Attending
Physician/s, and Drug and Result of Treatment.
1.
(to be filled in only if

Waiver of Premium on
Owner is applied for and
Owner and Proposed
Insured are not the same
person)
Proposed
Insured
Have you ever known, had been told, sought consult, been treated or had surgery for:
a.
Rashes, pigment discoloration, infections, misalignment of the eye, cataract, glaucoma, loss of vision/blindness, hearing loss/deafness,
chronic hoarseness or disorder or disease of the skin, eye, ear, nose and/or throat?
NO
YES
b.
Dizziness, severe headache, vertigo, fainting spells, seizure/epilepsy, sleep apnea, stroke, tremor, movement disorder, nervous
breakdown, meningitis, neuropathy or any disease or disorder of the brain, spinal cord and/or nervous system? If yes to seizure or
epilepsy, please accomplish appropriate questionnaire.
NO
YES
YES NO
YES NO
c.
High blood pressure, chest pain, shortness of breath, palpitations, rheumatic fever, heart murmur, structural heart abnormalities and/ or
any disease or disorder of the heart or blood vessels? If yes to high blood pressure, please accomplish appropriate questionnaire.
d.
Prolonged or chronic cough, difficulty of breathing, coughing up of blood, bronchial asthma, tuberculosis, chronic obstructive pulmonary
disease, and/or any disorder or disease of the respiratory system? If yes to bronchial asthma or tuberculosis, please accomplish
appropriate questionnaire.
e.
Difficulty in swallowing, gastroesophageal reflux, severe constipation, gallbladder stones, stomach or abdominal pain and enlargement,
ulcer, gastritis, colitis, hepatitis, cirrhosis, blood in the stools and/or abdominal and or anal abscess or any disorder or disease of the
digestive system? If yes to hepatitis, please accomplish appropriate questionnaire.
f.
Joint or muscular pains, arthritis, severe swelling and inflammation of joints or extremities, range of motion limitations, stiffness,
fractures, paralysis, or any disorder or disease of the bone, and/or joint and muscle?
g.
Back or flank pain, difficulty in urination, pain or passing out of stones during urination, changes in urine output, tea-colored/bloody
urine, frequency of urination, skin itchiness,and/or frequent urinary infection or any disorder or disease of the kidney and urinary tract? If
yes to kidney disease, please accomplish appropriate questionnaire.
For Female:
NO
YES
YES
NO
NO
YES
i.
Anemia, easy bruising, bleeding, and/or enlarged or swollen lymph nodes or any disorder or disease of the blood and lymphatic system or
declined as a blood donor?
NO
YES
j.
Positive test for Human immune-Deficiency Virus (HIV), Acquired Immunodeficiency Syndrome (AIDS), or AIDS related complex?
k.
Lump, cyst, new or abnormal growth and/or cancer?
l.
Any birth or congenital defect or abnormality, chromosomal or genetic abnormalities, and/or behavioral or developmental problems?
m.
Goiter, excessive sweating, elevated blood sugar, (+) sugar in the urine, hypo or hyperthyroidism, obesity or weight problem, and/or any
disorder or disease of the endocrine system? If yes to goiter, please accomplish appropriate questionnaire.
Any other condition, disorder and/or disease not mentioned above?
YES
NO
NO
YES
YES
NO
NO
YES
NO
YES
i. Hernia, hydrocele, varicocoele, prostate swelling or enlargement, enlargement of breast, sexual dysfunction, sexually-transmitted disease or
any disorder or disease of the reproductive system?
NO
YES
i. Irregularities in menstruation, abnormal vaginal discharge or bleeding, sexual dysfunctions, breast cyst or lumps, discharges from the breast,
infections or inflammation, menopause or any disorder or disease of the breast and reproductive system within 10 years?
YES NO
YES NO
YES NO
2.
Except as prescribed by a physician, have you ever used marijuana, shabu, cocaine, amphetamines, heroin or other habit-forming or narcotic drugs?
3.
Are you currently on a restricted diet or using any medical instrument/aid, or taking medications, drugs or pills, or alternative or herbal medicine or
receiving medical or alternative treatment or under medical care of any kind and have been advised /scheduled to have operation (including aesthetic
and sex reversal procedures), diagnostic test or treatment by a physician in near future?
Do you drink alcohol?
a.
b.
c.
5.
NO
YES
Anxiety, depression, eating disorder, personality disorder, panic attacks, post-traumatic stress disorder and/or nervous breakdown or
mental disorder?
ii. Are you pregnant?

If yes, what is the age of gestation?
3 months and below
between 3 months and 8 months
more than 8 months
iii. Do you have a history of pregnancy related diseases or post-delivery complications?
4.
NO
YES
h.
n.
For Male :
NO
YES
If yes, how long have you been drinking alcohol?

less than 2 years
2 years to 5 years
more than 5 years
How do you describe your drinking habit?
Occasional less than 1 bottle of wine/week or less than 6 bottles of beer/week
Moderate 1 to 2 bottles of wine/week or 6 to 7 bottles of beer/week
Heavy more than 2 bottles of wine/week or more than 7 bottles of beer/week
Have you ever been advised to limit your alcohol intake or to stop drinking alcohol?
Do you smoke?
If yes, what is your consumption and how long have you been smoking? months: __________ years:__________?
1 to 30 sticks per day
31 to 50 sticks per day
51 sticks per day and up
NO
YES
NO
YES
NO
YES
YES NO
YES
NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
Please provide full details on Yes answers, attach a separate sheet if the space below is not enough.
Item No.
Diagnosis
Date of Diagnosis
Name and Address of Attending Physician
Drug and Result of Treatment
Owner
H.
NON-MEDICAL DECLARATION*
1.
2.
3.
I.
Do you intend to, or have you or are you currently engaged in scuba/sky diving, mountaineering, mountain/rock climbing,
parasailing, paragliding, bungee/base jumping, car/motor racing, street luging, water rafting or airplane piloting or any other
extreme or hazardous sports or activities? If yes, please accomplish appropriate questionnaire.
Have you ever been active or intend to be active in politics as a candidate or in any other capacity?
If yes, please give details. ____________________________________________________
Have you ever been declined, postponed, or accepted at special terms under a life, accident, medical, critical illness, disability or
other health related insurance? If yes, name the company: _________________________
(to be filled in only if

Waiver of Premium on
Owner is applied for and
Owner and Proposed
Insured are not the same
person)
YES
NO
YES NO
YES
NO
YES NO
YES
NO
YES NO
OTHER DECLARATION*
a. Are you any of the following: born in the U.S., a U.S. citizen, a U.S. passport holder, green card holder or U.S. person?
If yes, please provide details below:
U.S. Permanent residence address
:________________________________________________________________
Proposed
Insured
Owner
Proposed
Insured
YES
NO
YES NO
YES
YES
NO
NO
YES NO
YES NO
U.S I.D. / passport no. / Green Card no. :_________________________________________________________________

U.S. Tax Identification Number
: ________________________________________________________________
If yes, are you willing to provide W8 or W9 form?
b. If you are a Corporate Client, do you have a beneficial Ownership holding a 10% or more direct or indirect interest as a U.S. entity?
J.
FAMILY HISTORY*
Do your parents or 2 or more of your siblings suffer from or have died due to bronchial asthma, tuberculosis, hypertension,
tumor/cancer, diabetes mellitus, mental/psychiatric disorder or any other hereditary disease?
Medical Condition
Family Member
Age of Onset
K.
1.
NO
YES
YES NO
Status
EXISTING POLICY(IES)*
Does the Proposed Insured and/or Owner have any existing and inforce insurance policy for life, dread or critical illness, or hospital benefit, or accident (If yes, provide details below.)
Owner
NO
YES
Proposed Insured
YES
NO
Company
Year of issue
Basic plus term benefit (sum assured amount)
Dread or critical illness plan/rider (sum assured amount)
Hospital benefit plan/rider (sum assured amount)
Accident plan/rider (sum assured amount)
2. Does the Proposed Insured and/or Owner have any pending life, dread or critical illness, or hospital benefit, or accident insurance application or reinstatement with any insurance
company?(if yes, provide details below.)
Owner
Proposed Insured
NO
YES
YES
NO
Company
Year of issue
Basic plus term benefit (sum assured amount)
Dread or critical illness plan/rider (sum assured amount)
Hospital benefit plan/rider (sum assured amount)
Accident plan/rider (sum assured amount)
L.
DECLARATION ON PROPOSED REPLACEMENT OF EXISTING POLICY/IES*
a.
Is the Policy applied for intended to change or replace any existing insurance inforce on the Proposed Insured or Owner?
YES
b.
Will premiums for the insurance applied for be paid by a policy loan or surrender value from any existing policy(ies)?
NO
YES
Company
Policy Number
Date
NO
Amount of Coverage
REMINDERS: It is usually disadvantageous to REPLACE existing life insurance policy/ies with a new one. By doing so:
You may not be insurable on standard terms;
KET IAN COTALES
You may have to pay a higher premium in view of higher age; or
__________________________________________________
You may lose financial benefits accumulated over the years.
Signature of Owner over printed name
Please note that in your own interest, we would advise that you consult your present insurer before making a final decision. Hear from both sides and make a careful comparison. You can then
be sure that you are making a decision that is your best interest.
DECLARATION
I/WE UNDERSTAND, DECLARE AND AGREE THAT:
1.
Before signing this Application, I/We confirm that I/We have fully understood the questions and have carefully read it. Any question(s) I/We had were fully explained to me/us in a
language/dialect which I/We understand.
2.
The answers or statements made in this Application and any attached document/s are complete, true and correctly recorded and shall form part of and be the basis of the insurance
contract applied for. Failure to make a full disclosure renders the contract voidable.
3.
I/We have not made any statement to the Financial Wealth Planner/Financial Solutions Consultant which in any way modifies the answers and statements made on this application.
4.
5.
The Proposed Insured shall automatically become the new Owner of the Policy in the event that the Owner predeceases the Proposed Insured while the Policy is inforce.
I/We am/are aware of the consequences of a minor beneficiary designation as follows: (a) that a minor, if designated irrevocable, is still unable to give a valid consent to any transaction
on the policy; where such consent is required, the minor would need representation by a guardian appointed by the court when transactions like policy loan, surrender, changes in
benefit, etc. are applied for under the policy: (b) subject to Article 225 of the Family Code and Section 182 of the Insurance Code, when a death claim is filed under the policy, whether
the minor is a revocable or irrevocable beneficiary, a court appointed trustee and judicial bond will be required, unless a trustee has been previously elected.
6.
FWD may collect, hold, store, and/or use my/our personal information to evaluate and assess my/our application and need for life insurance and investments, as well as to service any
of my/our policy (ies) including the evaluation of any future claims as well as my/our need for other or additional life insurance and/or investments. I/We also authorize FWD to disclose
and/or transfer to affiliated entity(ies) or to persons or entities providing services on FWDs behalf (whether within or outside the Philippines) consistent with the purpose for which the
information was obtained.
7.
I/We have the right to access my/our personal information held by FWD and to correct and/or update such personal information from time to time.
8.
I/We may receive notices from FWD and/or its affiliated entity(ies) in relation to my/our policy, products, service or offers through mail/email/fax/SMS/telephone provided above.
9.
FWD may request and obtain from third parties, any information relevant to this application, including my/our medical and financial information. Any person, physician, clinic, hospital,
insurance company, or other organization, insurance association, institution, that has any record or knowledge of my/our health and/or financial information, may disclose or release to
FWD or its authorized representatives and their affiliates or to any medical information sharing facility of the insurance industry, or any governmental agency requiring such, for any
legitimate purpose, including underwriting and administration of insurance coverage and claims.
I/We have fully disclosed my/our citizenship(s) and tax residency(ies), provided FWD with my/our relevant taxpayer identification number(s), and agree to promptly notify and update
FWD of any changes to said information. I/We authorize FWD to disclose my/our personal and financial information to any government or tax authority (within or outside the Philippines)
for the purposes of ensuring FWDs compliance and adherence with applicable laws, regulations, orders, guidelines, codes, market standard or good practices as promulgated and
amended from time to time. Further, I/We agree that FWD shall have the right to require the beneficiary(ies), claimant(s), and/or payee(s) of the Policy to: (a) provide FWD with their
respective personal and financial information; (b) sign and submit such documents as FWD may reasonably require; and (c) authorize FWD to disclose such personal and financial
information to any relevant government or tax authority (whether within or out of the Philippines).
The amounts invested in my/our policy(ies) have been declared to relevant government or tax authorities (within or outside the Philippines) and none of it was derived, directly or
indirectly, from illegal activities or sources and/or tax evasion. If required by the proper tax and/or other governmental authorities (within or outside the Philippines), FWD may, in its
discretion, disclose my/our personal and/or financial information or such information about my/our policy.
10.
11.
12.
There shall be no contract of insurance unless and until a policy is issued on this Application and the full first premium of the basic life insurance and any rider applied for is actually paid
and received during the lifetime and good health of the Proposed Insured.
13.
An electronic copy of this application (i.e. scanned or faxed) shall be binding to me/us and shall be considered as good as the original manually signed document. I/We will inform FWD
of any discrepancy between the electronic copy and the original as soon as possible, and I/We understand that absent any correction within a reasonable period, FWD is entitled to rely
on the electronic copy exclusively.
14.
(Applicable for policies with Assignment clause) In relation to a policy where the policy owner has a right to assign the policy as a collateral for a loan in accordance with the policy
provisions, notwithstanding any provisions under such policy to the contrary, I/We (as policy owner) may assign the policy by completing (and procuring the proposed assignee to
complete) the required forms and providing (and procuring the proposed assignee to provide) all information and such document as the FWD may require.
For Unit Linked Policies

*** I/We have read and fully understood the brochure and the Sales Illustration for the policy applied for:
15.
My/Our Fund Allocation Instruction is based on my/our judgment and I/We have not relied on any advice provided by my/our Financial Wealth Planner/Financial Solutions Consultant:
16.
A Unit Linked insurance product involves risks. Values of units in Investment Funds may rise and fall. The benefits payable under such product are linked to the performance of the
Investment Funds according to my/our own Fund Allocation Instruction;
17.
While the policy is in effect, any premiums received by FWD, after deducting the relevant Premium Charges, is used to create units in Investment Funds for allocation to the policy and
such units will be created based on the unit price of the Investment Fund on the Valuation Date immediately following the Corporations receipt of such premiums in cleared funds;
18.
Premiums and all charges may be changed by FWD with the prior approval of the Insurance Commission;
19.
I/We have the right to cancel the new policy and obtain a refund equal to the fund value of my/our units plus the initial charges by giving a written notice. Such notice must be signed
and sent by me/us directly to and received by FWD at its office within 15 days from receipt of the policy;
20.
Any excess premium I/We have paid is considered such only if the regular premium of a regular pay policy has been fully paid; and for a single pay policy, only after paying the single
premium; and
21.
FWD may require evidence of insurability of the Proposed Insured with respect to payment of any top-up premium.
FWD has appointed a Data Privacy Officer to handle any inquiries relating to your personal information. If you would like to obtain a copy of the FWD Life Insurance Corporation Personal
Data Policy and Practices, please write to the Corporate Data Privacy Officer at 19/F,W Fifth Avenue Bldg., 5th Avenue cor. 32nd Street, Bonifacio Global City, Taguig City 1634, Philippines.
Note: A separate Temporary Life Insurance Certificate (TLIC) form will be forwarded to you as soon as the Initial Modal Premium has been completed.
PLEASE DO NOT SIGN ON A BLANK FORM

Signature (Proposed Insured)
Signature (Owner)
Jun/09/2015
Date of Signing: __________________________________
Jun/09/2015
Date of Signing: _________________________________
OZAMIZ
Place of Signing: _________________________________
OZAMIZ
Place of Signing: ________________________________
I/We certify that I/we have acted under the direction and authority of the Owner and that the Owner and/or Proposed Insured signed this Application Form in my/our
presence. I/We affirm the identity of the Proposed Insured and the Owner and I/we have seen the original of the identification type that is attached to this application and
confirm that is from the Proposed Insured and Owner of this application.
10000069

Signature of Financial Wealth Planner/Financial Solutions Consultant
Code
Signature over Printed Name of Financial Wealth Planner
Code
For Bancassurance only

BANK INFORMATION:
BANK REFFEROR CODE
: _________________________________________
BANK CODE
: _______________________________
BANK REFFEROR
: _________________________________________
BANK BRANCH: _______________________________
AUTHORIZATION TO SECURE INFORMATION

50028210
Policy No.________________
I/We hereby authorize FWD to request and obtain from third parties, any information relevant to this application, including my/our medical and financial information.
Any person, physician, clinic, hospital, insurance company, or other organization, insurance association, institution, that has any record or knowledge of my/our
health and/or financial information, may disclose or release to FWD or its authorized representatives and their affiliates or to any medical information sharing facility
of the insurance industry, or any governmental agency requiring such, for any legitimate purpose, including underwriting and administration of insurance coverage
and claims.
KET IAN COTALES

_______________________________________________________________________________________
Signature over printed name of Proposed Insured/Owner
Jun/09/2015
_________________________
Date of Signing
19/F W Fifth Avenue Bldg., 5th Avenue

Bonifacio Global City, Taguig City 1634, Philippines
T (632) 888 8393 F (632) 5587 - 393
Addendum/Correction to Application
Policy Number
50028210
Name of Owner
KET IAN COTALES
Name of Proposed Insured : KET IAN COTALES

1. Addendum
If Beneficiary designated is not a minor, please provide additional details

DELIA CAJOTE
Contact Details: 09206267699
Address : PUROK 2, CARANGAN, OZAMIZ CITY, Ozamis City, Misamis
Occidental,Misamis Occidental,7200, Philippines
2. Correction to Application Form
From
To
(Please indicate specific item)
3.
Declaration Section
I/We the undersigned, declare and agree that the above additional information are complete, true, correctly recorded and
shall form part of the Application for Insurance bearing the same policy number as above. This additional information
shall also form the basis for the insurance contract applied for.
Signature of Owner
Date of Signing
06 09 2015
m m
Place of Signing
d d
Signature of Proposed Insured
Date of Signing
y y y y
OZAMIZ
06-09-2015
m m
Place of Signing
d d
OZAMIZ
Signature of Agent over printed name

:
Agent Code : 10000069
Signature of Agent over printed name
y y y y
Agent Code :
ADDV206112014
RISK PROFILE QUESTIONNAIRE

17/F 6750 Offices Tower, Ayala Avenue, Makati City 1200
1. Personal Information
Title
First Name
Mr.
Middle Name
KET IAN
m m
Date of Birth:
d d
/
Industry :
Country Code
Occupation :
Teacher
School Instructor
Business / Office No.

Area Code
Telephone Number
Mobile No.
63
Extension Name
y y y y
Residential No.
Country Code
Last Name
COTALES
CAJOTE
Country Code
Area Code
Telephone Number
Email Address
918
9930227
Area Code
ketianc@yahoo.com
Mobile Number
2. Risk Profile Questionnaire (For Variable Life Insurance Policies)

1. What is your educational level?
Elementary (2)
High School (4)
Vocational Training (6)
2. How many years of investment experience do you have?

Less than a year (2)
1 to 5 years (4)
University or College (8)

Post-Graduate Studies (10)
6 to 10 years (8)
More than 10 years (10)
3. What is your current investment objective?

Security of capital is most important (2)
Growth of capital is important (8)
Security of capital is important (4)
Growth of capital is most important (10)
Balance between security and growth of capital is important (6)
4. How many months of your normal expenses could be covered by your current reserved liquid assets
in case of an unexpected event?
Less than 3 months (2)
7 to 9 months (8)
3 to 6 months (4)
More than 9 months (10)
5. When do you plan to retire?
Already retired (2)
Within 5 years (4)
6 to 10 years later (6)
11 to 15 years later (8)

At least 16 years later (10)
6. What percentage of your current monthly income on average could be invested in investment
linked products?
0% (2)
21% to 30% (8)
1% to 10% (4)
More than 30% (10)
11% to 20% (6)

7. Which of the following statements best describes your feelings and attitude about risks?
I cannot accept any risks. (2)
I will try my best to avoid risks, though minor ones are still acceptable (4)
I am trying to strike a balance between risks and returns (6)
I am willing to accept more risk, as I am for more returns. (8)
Risks are never my consideration. Only the amount of return will be my focus. (10)
8. Which of the following investments do you currently hold?
I have cash and bank deposits only (2)

I have cash, bank deposits and foreign currencies. (4)
I have cash, bank deposits, foreign currencies and funds (8)
I have cash, bank deposits, foreign currencies, funds, stocks and derivatives. (10)
9. What would you do if there is a 20% loss in your investment?
I will sell. (2)
I will switch to safer investment vehicle. (4)
Price fluctuation is common. I will wait for a moment before making any changes. (6)
I will continue my long-term investment plan and maintain my asset mix. (8)
I will subscribe more units when the unit price is low. (10)
10. What is your expected return of investments?
Cannot bear any losses. (2)
Meet the inflation standard. (4)
Slightly above the inflation rate. (6)
Moderately above the inflation rate. (8)
Significantly above the inflation rate. (10)
TOTAL SCORE (Question 1 to 10):

Total Score
Risk Level
58
Suitable Product Risk
Investor Risk Profile and Investment Policy Statement

Refers to investors who are suitable for relatively low risk asset classes
and price fluctuation which achieve better yield than deposits and
20-49
Conservative
Low
inflation rate. Investors with this profile may invest in funds which
targets long term growth through investments in a diverse mix of high
quality, medium to long term fixed securities such as government
securities, corporate bonds and notes.
Refers to investors who are suitable for medium risk asset classes and
price fluctuation which achieve long term capital gain. Investors with this
50-74
Balanced
Medium
profile may invest in funds which targets long term growth through
investments in a balanced diversity of high quality equities listed in the
Philippine Stock Exchange and fixed income securities such as
government securities, corporate bonds and notes.
Refers to investors who are suitable for relatively high risk asset classes
and significant price fluctuation which achieve high growth of capital.
75-100
Aggressive
High
Investors with this profile may invest in funds which optimize growth
over the long term from a diversified portfolio of equities listed in the
Philippine Stock Exchange and money market securities.

3. Client Waiver and Client Disclaimer

I have carefully read and understood this Investment Policy Statement which corresponds to my preferred
investment and risk profile. I agree with the investment profile and the recommendation of FWD Life Insurance
Corporation on the specific funds and insurance plan suited to my risk profile. I have made an informed decision to
invest and purchase the plan after having read and understood the general features of said fund and insurance plan.
If I choose to avail of funds suited for investors with a higher risk profile, I agree to hold FWD Life Insurance
Corporation, its principals, their representatives, and successors in interest free and harmless from any and all
liabilities, claims, opportunity cost and/or causes of action of whatever kind or nature, that may affect me as a result
of or due to this choice.
I hereby authorize FWD Life Insurance Corporation to use and exchange information about me as necessary to the
conduct of performing investment-related services on my behalf, and the release of this information to its affiliates
and subsidiaries only where services extend to savings and insurance planning.
May/27/2015
KET IAN COTALES
Owner's Full Name and Signature

Date Signed
May/27/2015
Agent's Full Name and Signature
Date Signed
Agent's Code
Agent's Unit
Agent's Full Name and Signature
Date Signed
Agent's Code
Agent's Unit
10000069
Please be advised that your Risk Profile may change anytime there is a change in your circumstances or
preferences. As such, it is recommended that you have regular review of your Risk Profile with your agent.

This Risk Profile Questionnaire is valid from
Aug 24, 2015
May 27, 2015 to ____________.
____________

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Policy Acknowledgement Receipt

: MR. KET IAN CAJOTE COTALES

: MR. KET IAN CAJOTE COTALES

: Set for Life

: PUROK 2, CARANGAN OZAMIS CITY MISAMIS OCCIDENTAL PHILIPPINES 7200

FULL NAME and SIGNATURE

RECEIVED BY OWNER's AUTHORIZED REPRESENTATIVE:

FULL NAME and SIGNATURE

FULL NAME and SIGNATURE of SOLICITING AGENT

THIS PORTION IS FOR COURIER SERVICES ONLY

FULL NAME OF MESSENGER

June 11, 2015

Dear MR. COTALES,

Peter Karl Grimes

LANIE MAY FAITH LUZON FERRER

Policy Data Page

MR. KET IAN CAJOTE COTALES

SET FOR LIFE

NUMBER OF YEARS PAYABLE

MODE OF PREMIUM PAYMENT

POLICY DATA PAGE DATE

REGULAR TOP-UP PREMIUM

MR. KET IAN CAJOTE COTALES

FWD Critical Illness Benefit Rider for UL

FWD Hospital Cash Benefit Rider for UL

Regular Top-Up Premiums Payable

Total Modal Premium Chosen

Every 9th of the month

Premium Due Dates

Investment Fund Details

Fund Allocation Rate

Third Year and Subsequent Policy Years

Fund Switching Charge rate (as % of amount switched)

FWD Peso Fixed Income Fund

FWD Peso Equity Fund

FWD Peso Stable Fund

FWD Peso Bond Fund

FWD Peso Growth Fund

FWD Peso High Dividend Equity Fund

Surrender Charge rate (as % of amount withdrawn)

* Subject to the provisions of Section 15 Death Benefit.

THE DOCUMENTARY STAMP TAX OF THIS POLICY HAS BEEN PAID.

Regular Pay Variable Life Insurance Plan

Lucia Chona Sevilla Ventura

Form Number: RPVUL.07.2014

Form Number: RPVUL.07.2014

Form Number: RPVUL.07.2014

2. EFFECTIVITY OF THE POLICY

5. CURRENCY AND PLACE OF PAYMENT

6. COOLING OFF PERIOD

Form Number: RPVUL.07.2014

On such cancellation, the amount refundable shall be the sum of:

Premium Charges and Insurance Charges; plus

8. MISSTATEMENT OF AGE AND/OR SEX

Premium Charges and Insurance Charges; plus

Premium Charges and Insurance Charges; plus

Effective Date or approval date of last reinstatement of this Policy; and

Form Number: RPVUL.07.2014

Premium Charges and Insurance Charges; plus

Legal spouse; then

Form Number: RPVUL.07.2014

Payment of Regular Top-Up Premium

Payment of Lump Sum Top-Up Premium