Paramount Direct

Premium HealthCare Plus Plan

I understand that this does not obligate me in any way and that I will have the opportunity to inspect my policy for up to 15 days before I accept it. I understand that the insurance will take effect when my policy is issued and I have paid my first premium during my lifetime and good health.

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My insurance needs match:

I want to pay:

Premium:

Policy Owner Information

Title

Name

Gender

Birthdate

Place Of Birth
(Optional)

Nationality

In order to continue with the processing your application, may we request you to send us the following requirements:

1. Copy of Permanent Resident Visa (Philippines)
2. Copy of valid I.D
3. Number of years stayed (Philippines)

Please send it to direct@paramount.com.ph, so we may process your application immediately.

Contact Information

Address

Mail to this address
Mail to a different address

Mailing Address

Mobile Number

Telephone Number

Area Code

Phone number

Email Address

Make sure your email address is updated to guarantee that you receive your policy and other important messages from us.

Other Information

Additional Benefits

BURIAL BENEFIT RIDER (BBR)

Add up to 100,000 Php death benefit in your plan. Protect your love ones future through our Burial Benefit Rider (BBR) option. Learn more about our Burial Benefit Rider option.

Add Burial Benefit Rider option

Benefit

Full Name

Relationship to you

Birthdate

Beneficiary

BURIAL BENEFIT RIDER (BBR)

General Provisions

This Rider becomes part of the policy to which it is attached if its Form Number is indicated in the Policy Schedule or Endorsement Form.

Coverage under this Rider shall take effect on the date this Rider is issued, or the date the initial premium thereof is paid, during your lifetime, whichever occurs later.

Benefit Provision

Upon receipt at its Head Office or such other of its duly authorized offices, of due proof of the death of the Insured while insured under the Policy and this Rider, PLGIC shall pay the amount of coverage under this Burial Benefit rider to Beneficiary(ies) to help recover expenses or settle outstanding debts and liabilities brought about by the death of the Insured.

The benefit under this Rider shall be payable after two years from it's Effective Date or date of last reinstatement to the designated Beneficiary(ies) entitled to receive the Insured's Life or Hospitalization Insurance in accordance with Policy Provisions.
If death occurs within the first two years from the Effective Date or date of last reinstatement, an amount equal to the total premiums you have paid for this Rider plus compound interest at the rate of 10% per annum will be payable.

Premium Rate

The initial premium for this Rider shall be as indicated in the Policy Schedule or Endorsement Form. This additional premium shall be payable in the same manner and at the same time as the premium of the Policy to which this Rider is attached.

Net Surrender Value

If you no longer wish to pay the premium or continue the effectivity of this Rider, and there are available cash values under your Rider as shown in the Schedule of Surrender Values, you may, by written request during the grace period, surrender this Rider for its Cash Surrender Value.

Termination of Insurance

This rider shall automatically end and our liability and your payment of additional premium shall stop:

If the policy to which this Rider is attached has lapsed, been surrendered or converted under any of its non-forfeiture provisions, or otherwise ended; or,
Once this Rider is cancelled by the Insured as of any Premium Due Date by giving written notice to PLGIC; or
If the Policy Anniversary after the Insured's 80th birthday is reached.

Termination of this Rider shall not defeat any claim arising before such termination. Upon termination, additional premium shall no longer be payable. Further payment or acceptance of any premium shall not create liability under this Rider except for the refund of such premiums. Any cash value, if available, shall be paid to the Insured upon.

Notice of Claim

This Burial Benefit Rider contact must be presented to us at our Head Office for the payment of any benefit. In case of the death of the Insured, we must receive statisfactory proof of the death at our Head Office within thrithy (30) days after the date of death.

Failure to give notice within this time shall not invalidate a claim if it was shown not to have been reasonably possible to give such notice. In this case, notice must be given as soon as reasonably possible.

Non-Participation

This Rider is non-participating and does not share in the surplus earnings of the Company.

Payor Information

Is Payor is the same with the Insured?

Name

Contact Number

Email Address

Relationship

Other

Please confirm that the details provided below are true and complete.

Premium HealthCare Plus Plan

Personal Information Edit

Name:

Gender:

Birthdate:

Place of Birth:

Nationality:

Contact InformationEdit

Address:

Mailing Address:

Mobile Number:

Telephone Number:

Email Address:

We will send a confirmation email on this email address. Please make sure this email address is correct.

Insured PersonEdit

Additional BenefitsEdit

LIFELINE RESCUE'S EMERGENCY QUICK RESPONSE PROGRAM (EQRP)

BURIAL BENEFIT RIDER (BBR)

Full Name

Relationship to you

Birthdate

No Additional Benefit

Payor Information Edit

Is Payor is the same with the Insured?

Name:

Contact Number:

Email Address:

Relationship:

I understand that the Premium HealthCare Plus Plan policy will be issued based on the statements that I disclosed in the application form, which I represent as true and complete with all material information related to my application. I hereby authorize Paramount Life & General Insurance Corporation (PLGIC), its employees, officers and directors, to keep, record, use, and process my personal information, including the disclosure of the same to such other employees, officers, directors, affiliates, partners, contractors and/or sub-contractors of PLGIC, for the evaluation and assessment of my application for insurance and other insurance-related services. I further understand that PLGIC will dispose, delete and/or modify the said personal information upon my express request.

I hereby agree to all terms and conditions stated under Data Privacy Consent Statement.

Data Privacy Consent Statement

I hereby consent to the processing of the personal data stated above whether manually or via electronic channels, including but not limited to the collection, usage, storage, customer/client profiling, and disclosure to third parties, by Paramount Life & General Insurance Corporation (hereafter, “PLGIC”), its subsidiaries, affiliates, directors, officers, employees, and agents (a) to verify and/or confirm any or all the information provided or representation made, (b) to provide, facilitate, monitor, improve the quality of, or otherwise service my account and such products, services, and facilities and/or channels availed by me or may be offered by PLGIC, (c) for marketing purposes, and (d) to comply with legal, regulatory or other obligations of PLGIC under applicable local or foreign laws, rules and regulations.

I likewise consent to the processing of the personal data stated above whether manually or via electronic channels, including but not limited to the collection, usage, storage, and customer/client profiling, by authorized third parties for the foregoing purposes.

Such processing may be conducted for the duration of my availment of PLGIC’s products, services, facilities and/or channels. I further consent that the personal data stated above shall be retained by PLGIC for an additional period of at least five (5) years, or for a longer period if the personal data is related to or required to be preserved for litigation or to comply with legal or regulatory requirement. I likewise consent to the correction, amendment, deletion and/or disposal by PLGIC, its subsidiaries, affiliates, directors, officers, employees, agents, and authorized third parties, of my personal data which may be inaccurate or incorrect.

I attest that I have been made aware of and understood my rights as data subject and how these can be exercised, and that I was informed of the nature, extent and processing of the personal data I provided. I understand and agree that the consent hereby given may be revoked or withdrawn though formal written notice to PLGIC.

Finally, I authorize PLGIC, its subsidiaries, affiliates, directors, officers, employees, agents, and authorized third parties to obtain such other information they may deem necessary to verify or confirm the personal data declared or the documents furnished in relation to this application, and that I agree that such documents may remain in the possession of PLGIC whether or not this application is granted, for the purposes above mentioned.

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