Mutual Savings and Credit Cooperatives of the Philippines

307 Magdiwang Street, Noveleta, Cavite Contact us @ (046) 438 7275 09156886218 for globe subscribers 09086570622 for smart subscribers Visit our website @ www.msccp.ph Or E-mail us at nov@msccp.ph

SURVEY QUESTIONS
1. How many in your family are 18 years old to 60 and are MSCCP members? _______ 2. Are you interested in acquiring an affordable insurance plan with MSCCP? _________ YES ________ No 3. Please choose among the following packages:

COVERAGE Life Insurance Accidental Insurance Burial Assistance Medical Reimbursemen t
ANNUAL PREMIUM

PACKAGE A P20,000 P20,000 P2,000 P2,000

PACKAGE B P30,000 P30,000 P3,000 P3,000

PACKAGE C P50,000 P50,000 P5,000 P5,000

P 234.00

P351.00

P585.00

Please check your chosen premium _____ package A _____ package B _____ package C Insurable age: 18 – 60 years old Protection: 24 hrs a day, 365 days a year For Members, Officers and Employees of MSCCP only. Initial # of lives to be insured: 50

FILLED BY: ________________________________ CODE: __________ .

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