Paramount Direct

Sure Savings 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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Where did you hear about us?

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.

Weight

Height

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.

Employment Information

Occupation

Specific duties

Office Address

Zipcode

Office Tel. No.

Area Code

Phone number

Source of Funds

TIN

GSIS / SSS

Other Information

Beneficiaries

Full Name

Relationship to you

Birthdate

Revocable ^?

Revocable & Irrevocable

A REVOCABLE beneficiary on a policy is usually the best course of action, as it allows you to change the beneficiary on the policy should certain circumstances change. It is harder to change the beneficiary on an irrevocable policy because it requires the consent of the current beneficiary.

If a parent wanted to leave money to a child, the parent could designate that child as an IRREVOCABLE beneficiary, thus ensuring the child will receive the compensation of the life insurance policy or the segregated fund contract.

Non-forfeiture Options ^?

If premium is unpaid on expiry of grace period, apply cash value, if any, to effect:

Non-Forfeiture Options

The AUTOMATIC PREMIUM LOAN option automatically borrows from the available Cash Value to pay for your premium due.

The PAID-UP INSURANCE option allows you to stop paying premiums and still keep insurance coverage at reduced benefit value.

The SURRENDER OPTION lets you cash-in your policy. However, please note that once you choose to surrender your policy, your coverage is terminated.

With the EXTENDED TERM INSURANCE, the face amount of the policy stays the same, but it is flipped to an extended term insurance policy. The equity you built is used to purchase a term policy that equals the number of years you paid premiums.

Declaration on Existing Policy(ies)

Do you have other life insurance policies inforce with other insurance companies?

If yes, please provide details.

a. Total Life Insurance inforce on:

Insurance Company

Basic / Cover

Accident Rider / Year Issued

b. Is the policy applied for intended to change or replace any existing inforce policies? If yes, please complete Repleacement Notification Form that we will send you.

Reminder: It is usually disadvantageous to REPLACE existing life insurance policy(ies) with a new one. Some disadvantages are: You may not be insurable on standard terms; You may have to pay a higher premium in view of higher age; You may lose financial benefits accumulated over the years. 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 careful comparison. You can then be sure that you are making a decision in your best interest.

Here are the benefits included:

Learn more about the Benefits.

Life Benefit	100,000.00
Hospital Income Benefit	500.00
Accidental Death Benefit	100,000.00
Waiver of Premium	Yes

Benefits

The Life Benefit

The Life Benefit shall be payable to the Owner if the Policy is in force and the Insured is alive on the Maturity Date. In case of the insured's sudden death due to natural causes, the beneficiaries will receive the lump sum cash benefits.

Hospital Income Benefit Rider

This is an additional benefit that provides daily hospital cash assistance in casethe Insured is hospitalized due to sickness, injury or dread disease.

This benefit is directly paid to you and provides you the privilege to choose how and where to spend it - whether to pay for medical expenses or any additional expenses incurred during hospital confinement.

Accidental Death Benefit Rider

This is an additional benefit that is payable to the beneficiary/ies when the Insured dies due to an accident.

Accidental Death Benefit rider saves your family from financial losses caused by your sudden demise.

Waiver of Premium due to Disability Rider

This is an additional benefit that waives premium in the event the Insured becomes seriously injured or disabled.

Waiver of Premium on Disability rider gives you and your family peace of mind knowing that you are still protected during this trying times.

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.

Sure Savings Plan

Personal Information Edit

Name:

Gender:

Birthdate:

Place of Birth:

Nationality:

Height:

Weight:

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.

Employment InformationEdit

Company:

Occupation:

Specific duties:

Office Address:

Zipcode:

Office Telephone Number:

Philhealth:

Insured PersonEdit

BeneficiaryEdit

Full Name

Relationship to you

Birthdate

Is Revocable

Non-forfeiture OptionsEdit

Payor Information Edit

Is Payor is the same with the Insured?

Name:

Contact Number:

Email Address:

Relationship:

I understand that the Sure Savings 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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Non-forfeiture Options ^?