Policy Acknowledgement Receipt

OWNER : ATTY. KAREN RODRIGUEZ DE LEON

PROPOSED INSURED : ATTY. KAREN RODRIGUEZ DE LEON

POLICY NUMBER : 51486013

PLAN NAME : Set For Health

ADDRESS : 450 MONTILLA ST CARIG SUR TUGUEGARAO CAGAYAN PHILIPPINES 3500

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 :
Dear ATTY. KAREN DE LEON,

Set For Health 51486013

Thank you for choosing FWD Life Insurance for your insurance needs.

You have taken an important step by taking charge of Your financial readiness for unexpected life
events with Set For Health. This policy allows you to celebrate life by providing you with multiple
critical illness claim coverage making you confidently secured when you need protection that most.
Your cover is effective as from 30 DECEMBER 2019.

Attached is Your Policy Contract which provides the features and benefits of Set For Health along with
the terms and conditions.

Ensure to email the enclosed Policy Acknowledgement Form to CustomerConnect.ph@fwd.com to

acknowledge receipt of your Policy Contract.

Your Financial Wealth Planner / Financial Solutions Consultant FLEURDELIZ APOSTOL COLOMA is
available on 9957904180 to assist You with Your queries. You can also contact Customer Connect on
(632) 8888-8388 Monday to Friday between 8am to 5pm.

Again, welcome to FWD. We look forward to helping You meet Your life insurance needs now and in
the future.

Get ready to live!

Yours truly,

Jasper Hendrik Cheng

Chief Financial Officer
 Policy Data Page
Policy Information
POLICY NUMBER 51486013 POLICY EFFECTIVE DATE 30 DECEMBER 2019
INSURED ATTY. KAREN RODRIGUEZ DE LEON ISSUE AGE 25
PLAN NAME Set For Health PREMIUM PAYMENT FREQUENCY QUARTERLY
MODAL PREMIUM 6,747.00 YEARS PREMIUM IS PAYABLE 10 YEARS
SUM ASSURED 500,000.00 CURRENCY PHILIPPINE PESOS
GENDER FEMALE RISK CLASS STANDARD
OWNER ATTY. KAREN RODRIGUEZ DE LEON EXPIRY DATE 30 DECEMBER 2069

Schedule of Benefits
BENEFIT AS PERCENTAGE FORM
BENEFIT DESCRIPTION BENEFIT PERIOD OF SUM ASSURED / BENEFIT AMOUNT
NUMBER
TOTAL PREMIUMS

Major Critical Illness Benefits 50 Years 100% of Sum Assured per claim PHP 500,000.00 per claim;
up to 3 claims
Minor Critical Illness Benefit 50 Years 20% of Sum Assured or PHP PHP 100,000.00
500,000, whichever is lower
Waiver of Premium Benefit 10 Years Included Included SFH.AG.2020.01

Death Benefit 50 Years 100% of Sum Assured PHP 500,000.00

Healthy Life Benefit 50 Years 100% of Total Premiums PHP 269,880.00

Schedule of Policy Premiums

PREMIUM PAYMENT ANNUAL SEMI-ANNUAL QUARTERLY MONTHLY
FREQUENCY

PREMIUM PHP 24,095.00 PHP 12,770.00 PHP 6,747.00 PHP 2,289.00

Every 30th of DECEMBER Every 30th of JUNE and DECEMBER Every 30th of MARCH, JUNE, Every 30th of the
Premium Due Dates SEPTEMBER and DECEMBER month

THE DOCUMENTARY STAMP TAX OF THIS POLICY HAS BEEN PAID.

THIS POLICY DOES NOT PARTICIPATE IN THE DISTRIBUTION OF SURPLUS OF FWD LIFE INSURANCE CORPORATION.
 Set For Health Policy is issued by
FWD Life Insurance Corporation
with Policy Number 51486013

FWD Life Insurance Corporation will pay the Benefits in this Policy to:

· the Owner if the Insured is alive upon occurrence of an

Insured Event, or;
· the surviving Beneficiary/ies if the Insured dies

Subject to the terms and conditions of this Set For Health Policy (the “Policy”)

Jasper Hendrik Cheng

Chief Financial Officer

Form Number: SFH.AG.2020.01 Page 2

Table of Contents

Definitions 4
General Provisions 6
Documents That Make Up Your Policy 6
Basis For Issuing Your Policy 6
Policy Effective Date 6
Rights As A Policy Owner 6
Naming A Contingent Owner 6
Naming Beneficiary/ies 7
Assigning This Policy 7
Benefit Limit 7
Surplus Participation 7

Benefits 8
Major Critical Illness Benefits 8
Minor Critical Illness Benefit 8
Requirements To File A Major Or Minor Critical Illness Claim 8
Situations Where Major Critical Illness Benefit/s or Minor Critical Illness Benefit Are Not Payable 9
Waiver of Premium Benefit 9
Death Benefit 9
Requirements To File A Death Claim 9
Situation Where The Death Benefit Is Not Payable 9
Healthy Life Benefit 9

Premiums 10
Premiums That You Need To Pay 10

Non-Forfeiture 10
Non-Forfeiture Options 10
Table of Non-Forfeiture Values 11

Other Provisions 12
Policy Loan 12
Policy Termination 12
Reinstatement 12
Governing Laws And Currency 12
FWD Customer Support Contact Details 12
Important Notice 13

Appendix 14
Eligible Major Critical Illnesses 14
Eligible Minor Critical Illnesses 20

FWD Life Insurance Corporation I T: (632) 8888 8388 I F: (632) 8558 7393 Form Number: SFH.AG.2020.01 Page 3
Definitions
We define the following words as used in this Policy:
“Accident” or “Accidental” means any unforeseen and unexpected event or series of related events, caused by external and visible
means and which results to death, bodily injury or illness solely and independently of any other means.
“Activities of Daily Living” refer to the activities 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. Transferring: The ability to move from a bed to an upright chair or wheelchair and vice versa
ii. Mobility: The ability to move indoors from room to room on level surfaces
iii. Toileting: The ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a satisfactory
level of personal hygiene
iv. Dressing: The ability to put on, take off, secure and unfasten all garments and as appropriate, any braces, artificial limbs or
surgical appliances
v. Washing: The ability to wash in the bath or shower (including getting into and out of the bath or shower) or to wash
satisfactorily by any other means
vi. Feeding: The ability to feed oneself once food has been prepared and made available
“Benefit” means any of the Benefits listed in the Schedule of Benefits.
“Benefit Amount” means the amount payable under a Benefit.
"Beneficiary/ies” means the Beneficiary/ies of this Policy nominated by You in the Application Form or any Endorsement.
“Expiry Date” means the Policy anniversary following the Insured’s attainment of age seventy-five (75).
“Cancer-Free for Five Years” means that the Insured has been cancer-free continuously in the last five (5) years as confirmed by
the Insured’s Medical Practitioner and supported by clinical, radiological, histological and laboratory evidence. The cancer-free
period shall start on the date of completion of treatment of cancer, which shall include any surgery, chemotherapy, radiation
therapy, immunotherapy, monoclonal antibody therapy or other conventional cancer treatments that have been used as
prescribed by the Insured’s Medical Practitioner.

“FWD”, “We”, “Our” and “Us” refer to FWD Life Insurance Corporation, a corporation organized and existing under Philippine law.
“Guaranteed Cash Value” refers to the Guaranteed Cash Values provided in the Table of Non-Forfeiture Values attached to this
Policy which are shown as at Policy anniversaries assuming Premiums are paid when due. Guaranteed Cash Values between Policy
anniversaries are calculated taking into account the number of days from last Policy anniversary, Premiums received by Us and
Benefit Amounts paid since the preceding Policy anniversary.
“Indebtedness” means the sum of any unpaid Premium, outstanding Policy Loan, outstanding Automatic Premium Loan and interest
accrued to date under this Policy.
“Injury” or “Injuries” refers to bodily damage caused solely and directly 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” or “His/Her” refer to the named Insured of this Policy shown on the Policy Data Page.
“Insured Event” means an event that results to payment of any Benefit Amount and/or that triggers any of the Benefits.
“Major Critical Illness” means any of the illnesses specified in the “Eligible Major Critical Illnesses” provision.
“Medical Practitioner” means a person licensed or registered in the Philippines with a medical degree and accredited by a medical
board or an equivalent organization, to render medical services and is neither the Owner or Insured, a member of the Owner or
Insured’s immediate family nor business partner of the Owner or Insured.
“Minor Critical Illness” means any of the illnesses specified in the “Eligible Minor Critical Illnesses” provision.
“Owner”, “You” and “Your” refer to the named Owner of this Policy shown on the Policy Data Page.

FWD Life Insurance Corporation I T: (632) 8888 8388 I F: (632) 8558 7393 Form Number: SFH.AG.2020.01 Page 4
“Permanent” means a health condition that is beyond the hope of recovery with current medical knowledge and technology as
attested by a Medical Practitioner.
“Policy Data Page” shows the Policy Information (including the Policy Number, Insured, Plan Name, Modal Premium, Sum Assured,
Gender, Owner, Policy Effective Date, Issue Age, Premium Payment Frequency, Years Premium Is Payable, Currency, Risk Class, and
Expiry Date), Schedule of Benefits (including the Benefit Description, Benefit Period, Percentage of Sum Assured/Total Premiums,
Benefit Amount, and Form Number) and Schedule of Policy Premiums (including Premium and Premium Due Dates).
"Pre-existing Condition" means either:
- A condition which presented signs or symptoms that started before the latest of the Effective Date, the date of the last
reinstatement, or the date of increase of Sum Assured (for the increased amount) of this Policy. The Insured may or may not know
the presence of such condition.
- A condition whose treatment, medication, advice, or diagnosis has been sought or received by the Insured before the latest of the
Effective Date, the date of the last reinstatement, or the date of increase of Sum Assured (for the increased amount) of this Policy.
“Reinstatement Date” is the date that We determine the requirements defined in the Reinstatement Provision are met.
“Sales Illustration” means the form attached to this Policy which provides information about this product and its Benefits based on
the Insured’s age, gender and occupation and the amount and duration that You elect to pay Premiums.

FWD Life Insurance Corporation I T: (632) 8888 8388 I F: (632) 8558 7393 Form Number: SFH.AG.2020.01 Page 5
General Provisions
DOCUMENTS THAT MAKE UP YOUR POLICY

Your Policy comprises of the following documents:

ü This Policy Contract

ü Your Application Form
ü The Policy Data Page
ü Any attached Endorsements

Only the President and Chief Executive Officer or officers duly authorized in writing by Us have the authority to modify this Policy,
subject to the approval of the Insurance Commission. Any modifications must be done in writing and duly signed by the authorized
officer, after which it becomes part of Your Policy.

Any unenforceable provision(s) in this Policy will in no way affect the enforceability of the remaining provisions.

BASIS FOR ISSUING YOUR POLICY

To issue this Policy, We have used the information that You provided in the Application Form.

If the Insured’s age, gender, or any other information provided in the Application Form is incorrect, We may adjust the Benefit
Amounts to reflect the correct information.

If an incorrect information is determined within two (2) years from the Policy Effective Date (or Reinstatement Date, whichever is
later) and if on the basis of the correct information, or on the basis of the rectified information We would not have offered You this
Policy in the first place, then We will terminate this Policy and the amount payable to You shall be the excess, if any, of the Total
Premiums received by Us over any Benefit Amount already paid by Us. After this 2-year period, We can no longer contest any claim
filed on this Policy, except for non-payment of Premiums and/or grounds recognized by law and jurisprudence.

No legal action on this Policy may be filed after five (5) years from the time the cause of action accrues.

POLICY EFFECTIVE DATE

The Policy Effective Date shown in the Policy Data Page is the date Your Policy takes effect and is used to determine Policy years
and Policy anniversaries.

We will provide you with this Policy in electronic form, and we will consider this Policy as delivered to you 10 days after the
Effective Date. You may also request a paper version to be provided to you.

You can cancel this Policy by sending us a written request within 15 days after it has been delivered to you. Upon cancellation,
we will return all your paid premiums for this Policy. No interest will be paid on the refunded amount. If a claim is payable for this
Policy before we received your written request for cancellation, we will not refund the premiums.

RIGHTS AS A POLICY OWNER

As Owner, You can exercise any and all other rights, interests and privileges under this Policy while in force. You have the right to
name or change a Contingent Owner and Beneficiary/ies, and assign this Policy.

Naming a Contingent Owner

A Contingent Owner is one who can act on Your behalf should You become mentally-incapacitated.

You can add or change the Contingent Owner of this Policy with Our written consent.

The Insured is considered to be the Contingent Owner if no Contingent Owner is nominated or if the nominated Contingent
Owner predeceases You.

FWD Life Insurance Corporation I T: (632) 8888 8388 I F: (632) 8558 7393 Form Number: SFH.AG.2020.01 Page 6
 Naming Beneficiary/ies

Your Beneficiary/ies are the surviving persons designated to receive the proceeds of this Policy upon death of the Insured.
Unless otherwise changed, the Beneficiary/ies are as designated in the Application Form.

If all the Beneficiary/ies are designated as “revocable”, You may delete any Beneficiary or designate new Beneficiary/ies. If any
Beneficiary is designated as “irrevocable”, the consent of all such irrevocable Beneficiary/ies while alive is required before You
can exercise any and all rights, interests and privileges under this Policy.

You have the right to change the Beneficiary/ies and/or their share upon written notice satisfactory to Us together with the
written consent of every irrevocable Beneficiary and any assignee of this Policy.

Any Benefit Amount is paid to You, if Insured is alive, otherwise to Your named Beneficiary. If both You and Your Beneficiary are
deceased, the Benefit Amount will be paid to Your surviving relations in the order of: (i) legal spouse, (ii) children, (iii) parents,
(iv) siblings, (v) Your estate

Assigning This Policy

This Policy may be assigned with Our and every irrevocable Beneficiary’s written consent. Your and any Beneficiary/ies’ rights
and privileges will be subject to the terms of the assignment. The rights of an assignee will be subject to any Indebtedness by
the Owner to Us. We are not responsible for the validity of any assignment and have the right not to endorse any reassignment
by any assignee.
BENEFIT LIMIT
If the Insured suffers a Major Critical Illness and/or Minor Critical Illness as a direct result of participation in any dangerous sports
or hobbies such as racing on wheels, glider flying, sailing or other hobbies which are comparably dangerous and risky that We
would not normally cover on standard terms, the total amount payable from this Policy and all other insurance policies issued by
Us is subject to a limit of ten (10) million Philippine Pesos.
SURPLUS PARTICIPATION

This Plan does not participate in the distribution of surplus of FWD Life Insurance Corporation.

FWD Life Insurance Corporation I T: (632) 8888 8388 I F: (632) 8558 7393 Form Number: SFH.AG.2020.01 Page 7
Benefits
MAJOR CRITICAL ILLNESS BENEFITS
While this Policy is in force, We will pay a first Major Critical Illness Benefit equal to the Major Critical Illness Benefit Amount specified
in the Policy Data Page less any Indebtedness upon claim, if each of the following conditions are met:
i. The Insured is diagnosed by a Medical Practitioner acceptable to Us as having suffered an Eligible Major Critical Illness after
considering all medical and other evidence that the Medical Practitioner requires, which are to be provided at Your expense;
ii. The Major Critical Illness first occurs, is first diagnosed or, symptoms leading to the diagnosis of the Major Critical Illness are
first experienced by the Insured at least ninety (90) days after the Effective Date or Reinstatement Date (whichever is later);
and,
iii. The Insured survives for at least fourteen (14) days following the diagnosis of the Major Critical Illness.
While this Policy is in force and if the first Major Critical Illness Benefit described above has been paid, We will pay a second and,
where appropriate, a third Major Critical Illness Benefit as specified in the Policy Data Page less any Indebtedness upon claim, if
each of the following conditions is met:
i. The Insured is diagnosed by a Medical Practitioner acceptable to Us as having suffered an Eligible Major Critical Illness after
considering all medical and other evidence that the Medical Practitioner requires, which are to be provided at Your expense;
ii. The Insured has not previously been diagnosed with and received a Major Critical Illness Benefit due to “Loss of Independent
Existence” or “Terminal Illness”;
iii. The Major Critical Illness suffered by the Insured first occurs or manifests at least one (1) year after the diagnosis of the
preceding Major Critical Illness Benefit claimed;
iv. Each Major Critical Illness Benefit claimed must belong to a different Major Critical Illness group. In the case of Group One
(Cancer), up to two (2) Major Critical Illnesses Benefit may be claimed provided that the Insured is Cancer-Free for Five-Years
prior to the diagnosis of the second Cancer; and,
v. The Insured survives for at least fourteen (14) days following the diagnosis of a Major Critical Illness.

MINOR CRITICAL ILLNESS BENEFIT

While this Policy is in force, We will pay one Minor Critical Illness Benefit as specified in the Policy Data Page if each of the following
conditions are met:
i. The Insured is diagnosed by a Medical Practitioner acceptable to Us as having suffered an Eligible Minor Critical Illness after
considering all medical and other evidence that the Medical Practitioner requires, which are to be provided at Your expense;
ii. The Minor Critical Illness first occurs, is first diagnosed or symptoms leading to the diagnosis of the Minor Critical Illness are
first experienced by the Insured at least ninety (90) days after the Effective Date or Reinstatement Date (whichever is later);
iii. The Minor Critical Illness does not first occur or manifest within one (1) year from the date of diagnosis of a Major Critical Illness
as defined within this Policy; and,
iv. The Insured survives for at least fourteen (14) days following the diagnosis of the Minor Critical Illness.

REQUIREMENTS TO FILE A MAJOR OR MINOR CRITICAL ILLNESS CLAIM

To apply for either a Major Critical Illness Benefit or a Minor Critical Illness Benefit, the following will have to be provided to Us at
Your expense:
i. Claimant’s Statement
ii. Attending Physician’s Statement(s)
iii.Complete medical consultation and hospital records of confinement, if applicable, including all diagnostic exam results
iv. Any medical requirements specified in the ‘Eligible Major Critical Illnesses’ and ‘Eligible Minor Critical Illnesses’ sections as
appropriate
v. Evidence of Accident, if applicable, and
vi. Any additional relevant information that We believe is necessary to confirm that a Benefit is payable.
We must receive the above within ninety (90) days from the date the Insured Event occurred. If You are unable to submit within
such 90-day period, We will not invalidate nor reduce the claim if We determine that it was not practical to submit the requirements
within the allowable time.

FWD Life Insurance Corporation I T: (632) 8888 8388 I F: (632) 8558 7393 Form Number: SFH.AG.2020.01 Page 8
SITUATIONS WHERE MAJOR OR MINOR CRITICAL ILLNESS BENEFIT/S ARE NOT PAYABLE
No Benefit will be payable from this Policy if the Major or Minor Critical Illness results primarily or secondarily, wholly or partly,
from any of the following circumstances:
i. Attempted suicide or intentional self-inflicted act by the Insured;
ii. The willful participation of the Insured, Beneficiary/ies or the Owner in illegal and/or unlawful acts and/or omissions;
iii.Alcohol or drug abuse;
iv. Human Immunodeficiency Virus (HIV) and or any HIV–related illness including Acquired Immune Deficiency Syndrome (AIDS)
and/or any mutations, derivations or variations thereof (except “Occupationally Acquired HIV/AIDS” and “HIV/AIDS due to Blood
Transfusion” as stated in the ‘Eligible Major Critical Illnesses’ provision); or
v. War or any act of war (whether declared or not), civil or military insurrection and civil commotion amounting to a popular
uprising.
vi. Pre-existing conditions. We will only pay the benefit if you have declared the pre-existing condition in your Application Form and
we have included it in our assessment of your application.

WAIVER OF PREMIUM BENEFIT

We will waive all Premiums for this Policy as they become due from the date of diagnosis of the first Major Critical Illness.

DEATH BENEFIT
If the Insured dies while this Policy is inforce, We will pay the Death Benefit specified in the Policy Data Page less any Indebtedness
to the nominated Beneficiary/ies, after which the Policy terminates.

REQUIREMENTS TO FILE A DEATH CLAIM

To file a claim, the following documents must be submitted within ninety (90) days from the occurrence of death:
i. Claimant’s Statement
ii. Death Certificate, and
iii. Any additional information that We believe is necessary to confirm death and its cause.

If You are not able to submit within the 90-day period, We will not invalidate nor reduce the claim if We determine that it was not
practical to submit the requirements within the allowable time.

For more information, you may call our Claims Hotline at (632) 8888-8388 or visit www.fwd.com.ph/en/claims-support/claims.

SITUATION WHERE THE DEATH BENEFIT IS NOT PAYABLE

If the Insured commits suicide while sane within the first two (2) years from the Policy Effective Date or Reinstatement Date
(whichever is later), the amount payable shall be the excess, if any, of the Total Premiums received by Us over any Benefit Amount
already paid by Us.
Suicide committed in a state of insanity will be compensable regardless of the date of commission.

HEALTHY LIFE BENEFIT

If this Policy is inforce at the Expiry Date and no Major Critical Illness Benefit has been paid, We will return to You the Total
Premiums less any Indebtedness.

FWD Life Insurance Corporation I T: (632) 8888 8388 I F: (632) 8558 7393 Form Number: SFH.AG.2020.01 Page 9
Premiums
PREMIUMS THAT YOU NEED TO PAY
To enjoy the Benefits provided by this Policy, please pay the Premiums when they become due at Our designated offices, or through
Our duly authorized representatives and collection facilities. You have a grace period of thirty-one (31) days from the Premium Due
Dates after which, if We have neither received the Premium nor loaned Premiums under the Automatic Premium Loan provision
below, this Policy will terminate subject to the ‘Non-Forfeiture’ and ‘Policy Termination’ provisions below. Any amount due to Us
under this Policy will be deducted from any Benefit that becomes payable prior to the end of the 31-day grace period.
You may request in writing to change the Premium Payment Frequency shown in the Policy Data Page except if the Premium is
being waived through the Waiver of Premium Benefit. We will confirm Our approval to You in writing together with the date from
which the Premium Payment Frequency change will be effective.
FWD shall have the right to review and adjust the premium under this Policy due to our adverse health claims experience during
the remaining period when premiums are payable, subject to approval by the Insurance Commission. A notice of any change in
premium basis on this policy will be sent to you forty-five (45) days before your anniversary date. FWD's acceptance of premium
shall constitute the consent to renewal. If you opt not to pay the renewal premium then due, the Non-Forfeiture Option Provision
will apply.

Non-Forfeiture
NON-FORFEITURE OPTIONS
When applying for this Policy and any time thereafter, You can nominate in writing for one of the following options to be applied
on Your Policy should You discontinue paying Premiums after Your Policy has attained a Guaranteed Cash Value. Your nominated
option will come into effect thirty-one (31) days after a Premium becomes due but not received by Us.

i. Reduced Paid-up Insurance: You can nominate for this Policy to continue without paying further Premiums but with reduced
Benefit Amounts. When this option takes effect, the Benefit Amounts will be adjusted to the amount that would be purchased
by the Guaranteed Cash Value of this Policy less any Indebtedness as a net single premium at the then attained age of the
Insured. Total Premiums of the Policy as basis of Healthy Life Benefit is adjusted based on the reduced Sum Assured. The rights
and privileges provided by this Policy will remain unchanged.
ii. Automatic Premium Loan: You can nominate for Premiums due to be automatically borrowed from the Guaranteed Cash Value.
We will notify You in writing when We lend You the Premium due. However, the amount lent will not exceed the Guaranteed
Cash Value less any Indebtedness. When this option takes effect, Your Policy will continue to be inforce for as long as the
Guaranteed Cash Value is sufficient to pay the Premium due. Otherwise, the next smaller Modal Premium will be paid instead
until the remaining Guaranteed Cash Value becomes less than a monthly Premium on the next Premium Due Date. When this
happens, your Policy will remain inforce only for that proportion of the month the remaining Guaranteed Cash Value can sustain
the Policy and We will notify You in writing the remaining term of coverage.
iii. Policy Surrender: You can nominate to surrender this Policy and receive the Guaranteed Cash Value of this Policy less any
Indebtedness.
If no option is nominated, the Reduced Paid-Up Insurance option will apply.

FWD Life Insurance Corporation I T: (632) 8888 8388 I F: (632) 8558 7393 Form Number: SFH.AG.2020.01 Page 10
TABLE OF NON-FORFEITURE VALUES

Without Major Critical Illness Claim With Major Critical Illness Claim
POLICY
AGE
YEAR Reduced Paid-Up Reduced Paid-Up
Guaranteed Cash Values Guaranteed Cash Values
Insurance Insurance
1 25 - - - Policy is paid up *
2 26 5.32 24.48 1.51 Policy is paid up *
3 27 45.92 205.08 12.24 Policy is paid up *
4 28 70.07 303.81 18.67 Policy is paid up *
5 29 95.04 400.07 25.29 Policy is paid up *
6 30 120.83 493.99 32.10 Policy is paid up *
7 31 147.50 585.88 39.14 Policy is paid up *
8 32 174.99 675.64 46.37 Policy is paid up *
9 33 203.32 763.61 53.81 Policy is paid up *
10 34 233.17 Policy is paid up 61.48 Policy is paid up *
11 35 240.08 62.85
12 36 246.87 64.21
13 37 253.69 65.58
14 38 260.54 66.95
15 39 267.43 68.30
16 40 274.39 69.66
17 41 281.42 71.01
18 42 288.46 72.34
19 43 295.55 73.65
20 44 302.62 74.92

31 55 385.54 84.84
41 65 464.93 72.74
50 74 481.90 -
*Policy is paid-up since Waiver of Premium is applied upon claim of Major Critical Illness

The values shown in this Table of Non-Forfeiture Values are for every PHP 1,000.00 of Sum Assured and are guaranteed for the number of Policy
years for which Premiums shall have been paid in full and where no Indebtedness is assumed. Values at the end of the Policy years not shown in
this Table shall be provided by Us upon request of the Owner.

FWD Life Insurance Corporation I T: (632) 888 8388 I F: (632) 558 7393 Form Number: SFH.AG.2020.01 Page 11
MCCIBaby&Me.01.2016
Other Provisions
POLICY LOAN
In addition to the Automatic Premium Loan option described above, You may request a cash loan unless the Policy has been
converted to Reduced Paid-up Insurance. This Policy Loan is subject to Our prevailing rules and regulations at that time.
Interest will accrue daily on any outstanding Policy Loan balance and/or Automatic Premium Loan balance at the interest rate set
by Us in effect on that date with any unpaid interest increasing the principal of the loan at each Policy anniversary.
You can repay all or part of any Indebtedness at any time. This Policy automatically terminates if the outstanding Indebtedness
(including interest accrued to date) exceeds the Guaranteed Cash Value of the Policy.

POLICY TERMINATION

This Policy will automatically terminate on the earliest of the following:

i. The death of the Insured;
ii. The Policy being surrendered for its Guaranteed Cash Value;
iii. We do not receive Premium within thirty-one (31) days after the Premium Due Date subject to the Non-Forfeiture Option
provisions;
iv. Indebtedness exceeds the Guaranteed Cash Value of this Policy; or,
v. The Expiry Date of this Policy.
Termination of this Policy will not invalidate any claim arising before the date this Policy terminates.

REINSTATEMENT
If Your Policy has been converted automatically to Reduced Paid-up Insurance, You may reinstate this Policy any time. If the Policy
has been terminated due to non-payment of Premiums, You may reinstate this Policy within three (3) years from the date of
termination. To reinstate this Policy, You have to provide Us with the completed Reinstatement Form together with:
i. Evidence that is satisfactory to Us that the Insured is insurable,
ii. Any unpaid Premiums with interest, and
iii. Any Indebtedness with interest.
This Policy will be reinstated on the date that We confirm in writing that the requirements have been satisfactorily met. If Your
Policy is reinstated, We will only cover Insured Events which occurred after the Reinstatement Date, subject to the Provision ‘Basis
For Issuing Your Policy.’

GOVERNING LAWS AND CURRENCY

This Policy is governed by and interpreted according to Philippine law. All amounts payable to or from Us in relation to this Policy
will be in Philippine Pesos. All amounts payable by Us will be paid in the Philippines.

Article 1250 of the Civil Code of the Philippines (Republic Act No. 386) stated in part below is understood and agreed not to
apply to any amounts paid or amounts to be paid either to or by Us.

“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.”

CUSTOMER CONNECT HOTLINE

No inquiry is too big or small for FWD. Should you have any queries about your policy, you may contact FWD Customer Connect
from Monday to Friday between 8am to 5pm with the following contact details:
1. Hotline: (632) 8888-8388
2. Email: CustomerConnect.ph@fwd.com

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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 intermediaries. 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, Manila with telephone numbers
+632-5238461 to 70 and email address publicassistance@insurance.gov.ph. The official website of the Insurance Commission is
www.insurance.gov.ph.

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APPENDIX
ELIGIBLE MAJOR CRITICAL ILLNESSES
A Major Critical Illness means any of the conditions specified below. Subject to proper notice in writing, We reserve the right to change
these definitions from time to time to reflect changes in medical terminologies and practices, subject to Insurance Commission
approval. All diagnosis must be confirmed by an appropriate Medical Practitioner acceptable to Us.

GROUP ONE - CANCER

1. Major Cancers
A malignant tumor characterized 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.
The following are not classified as Major Cancers but, instead, are classified as Early Stage Cancers under the ‘Eligible Minor Critical
Illnesses’ section:
i. Early Bladder Cancer: Papillary carcinoma (Ta) of bladder
ii. Early Chronic Lymphocytic Leukaemia: Chronic Lymphoctic Leukaemia (CLL) RAI Stage 1 or 2
iii. Early Prostate Cancer: Prostate Cancer histologically described using the TNM Classification as T1a or T1b or Prostate cancers
described using another equivalent classification
iv. Early Thyroid Cancer: Thyroid Cancer histologically described using the TNM Classification as T1N0M0 including Papillary
micro-carcinoma of thyroid where the tumour is less than 1 cm in diameter
v. Early Invasive Melanomas: Invasive melanomas of less than 1.5 mm Breslow thickness or less than Clark Level 3
vi. Carcinoma in situ: as defined in the ‘Eligible Minor Critical Illness’ section.
Non-melanoma skin cancer and all carcinoma in-situ of skin or earlier stages do not meet the definition of Major Cancers nor Early
Stage Cancers.

GROUP TWO – MAJOR ORGAN FAILURE

2. Aplastic Anaemia
Chronic persistent bone marrow failure which results in anaemia, neutropenia and thrombocytopenia requiring treatment with at
least one (1) of the following:
i. Blood product transfusion
ii. Marrow stimulating agents
iii. Immunosuppressive agents, or
iv. Bone marrow transplantation.
3. Chronic Liver Disease
End-stage liver failure as evidenced by each of Permanent jaundice, ascites and hepatic encephalopathy.
4. Chronic Lung Disease
End-stage lung disease, causing chronic respiratory failure, as evidenced by all of the following:
i. FEV1 test results consistently less than one (1) litre
ii. The requirement for Permanent supplementary oxygen therapy for hypoxemia
iii. Arterial blood gas analyses with partial oxygen pressures of 55mmHg or less (PaO2 < 55mmHg), and
iv. Dyspnoea at rest.
5. Chronic Recurrent Pancreatitis
The Chronic Relapsing Pancreatitis as a result of progressive severe destruction with all of the following characteristics:
i. Recurrent acute pancreatitis for a period of at least two (2) years
ii. Generalize calcium deposits in pancreas from imaging study, and
iii. Chronic continuous pancreatic function impairment resulting in mal-absorption of intestine (high fat in stool) or diabetes.

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6. Crohn’s Disease
A chronic, transmural inflammatory disorder of the bowel, as evidenced with continued inflammation in spite of optimal therapy,
with all of the following having occurred:
i. Stricture formation causing intestinal obstruction requiring admission to hospital
ii. Fistula formation between loops of bowel, and
iii. At least one (1) bowel segment resection.
The diagnosis must be proven histologically on a pathology report and/or the results of sigmoidoscopy or colonoscopy.
7. Fulminant Viral Hepatitis
A sub-massive 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. A rapidly decreasing liver size
ii. Necrosis involving entire lobules, leaving only a collapsed reticular framework
iii. Rapid deterioration of liver function tests
iv. Deepening jaundice, and
v. Hepatic encephalopathy.
8. Loss of Hearing (Deafness)
The irreversible loss of hearing at least eighty (80) decibels in all frequencies in both ears as a result of illness or accident. The
inability to hear must be established for a continuous period of 6 months and must (at the end of that period) be deemed Permanent
on the basis of audiometric and sound-threshold test results.
9. Loss of Sight (Blindness)
Total and irreversible loss of sight in both eyes as a result of illness or accident.
10. Major Organ and Bone Marrow Transplant
The actual undergoing (as a recipient) of a transplant, solely as a result of irreversible end-stage failure, of either:
i. One of the following human organs: (a) heart, (b) lung, (c) liver, (d) kidney or (e) pancreas, or
ii. Human bone marrow replaced by haematopoietic stem cells only and which is preceded by total bone marrow ablation.
11. Medullary Cystic Disease
A progressive hereditary disease of the kidneys characterized by the presence of cysts in the medulla in both kidneys, tubular
atrophy and intestitial fibrosis with the clinical manifestations of anemia, 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.
12. 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 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 ml/min
iii. Cardiac involvement showing evidence of either congestive heart failure, cardiac arrhythmia requiring medication, or
pericarditis with moderate to large pericardial effusion.
Localized scleroderma (linear scleroderma or morphea), eosinophilic fasciitis and CREST syndrome do not meet the definition of
Progressive Scleroderma.
13. Renal Failure
Chronic irreversible failure of both kidneys, requiring either Permanent renal dialysis or kidney transplantation.
14. Terminal Illness
Means the conclusive diagnosis by a Medical Practitioner that the Insured is suffering an illness that is expected to result to his/her
death within twelve (12) months. The Insured must no longer be receiving active treatment other than that for pain relief.
Terminal illness in the presence of HIV infection is specifically excluded.

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15. Ulcerative Colitis
Acute fulminant ulcerative colitis with life threatening electrolyte disturbances meeting the following criteria:
i. The entire colon is affected with severe bloody diarrhea, and
ii. The necessary treatment is total colectomy.
as diagnosed based on histopathological features.

GROUP THREE – HEART AND BLOOD VESSEL RELATED

16. Cardiomyopathy
An impaired function of the heart muscle, unequivocally diagnosed as Cardiomyopathy by a cardiologist, and which results in
Permanent physical impairment to the degree of New York Heart Association classification Class III or Class IV, or its equivalent, for
at least six (6) months based on the following classification criteria:
i. Class III - Marked functional limitation. Affected patients are comfortable at rest but performing activities involving less than
ordinary exertion will lead to symptoms of congestive cardiac failure.
ii. Class IV - 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.
The diagnosis of Cardiomyopathy should be supported by echographic findings of compromised ventricular performance.
17. Coronary Artery Disease
Severe coronary artery disease in which at least three (3) major coronary arteries are individually occluded by a minimum of 60%or
more, as proven by coronary angiogram only (non-invasive diagnostic procedures excluded).
For purposes of this definition, “major coronary artery” means any of the left main stem artery, left anterior descending artery,
circumflex artery and right coronary artery (but not including their branches).
18. Heart Attack (Myocardial Infarction)
Death of a portion of the heart muscle arising from inadequate blood supply to the relevant area. This diagnosis must be supported
by three or more of the following four criteria which are consistent with a new heart attack:
i. New electrocardiogram (ECG) changes proving infarction
ii. History of typical chest pain for which the insured is admitted to hospital
iii. Left ventricular ejection fraction less than 50% measured 3 months or more after the event
iv. Diagnostic elevation of cardiac enzyme CK-MB or diagnostic elevation of Troponin T > 1 mcg/L (1 ng/ml) or AccuTnl > 0.5ng/ml
or equivalent threshold with other Troponin I methods.
All other acute coronary syndromes, including, but not limited to, unstable angina, micro infarction and minimal myocardial damage
do not meet the definition of ‘Heart Attack (Myocardial Infarction)’.
19. 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.
Repair via intra-vascular procedure, key-hole surgery or similar techniques do not meet the definition of ‘Heart Valve Surgery’.
20. 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 IV of the New York Heart Association
classification of cardiac impairment.
Class IV 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.

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21. 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. The procedure must be considered medically necessary by a cardiologist.
Surgery performed using only minimally invasive or intra-arterial techniques do not meet the definition of ‘Surgery to Aorta’.

GROUP FOUR – NEURO-MUSCULAR RELATED

22. Alzheimer’s 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 Activities of Daily Living.
The diagnosis must be clinically confirmed by Medical Practitioner who specializes in Alzheimer’s disease. Non-organic diseases such
as neurosis and psychiatric illnesses, and alcohol related brain damage are excluded.
23. Apallic Syndrome
Universal necrosis of the brain cortex with the brainstem intact. The definite diagnosis must be evidenced by specific findings in
neuro-radiological tests and medically documented for at least one (1) month.
24. Benign Brain Tumor
A benign tumor in the brain as evidenced by all of the following:
i. the tumor 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 tumor must be supported by findings on Magnetic Resonance Imaging, Computerised Tomography,
or other reliable imaging techniques.
Cysts, granulomas, vascular malformation, haematomas and tumors of the pituitary gland or spine do not meet the definition of
‘Benign Brain Tumor’.
25. Cerebral Aneurysm Requiring Surgery
Actual undergoing of brain surgery with craniotomy 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 millimeter in size or increasing by at least 0.95 millimeter per
year and the need for surgery must be confirmed by a neuro-surgeon as evidenced by the results of cerebral angiography.
Infection aneurisms, mycotic aneurisms, limited craniotomy and burr-hole procedures do not meet the definition of ‘Cerebral
Aneurism Requiring Surgery.’
26. Coma
A coma that persists for a continuous period of at least ninety-six (96) hours and evidenced by all of the following:
i. There is no response to external stimuli for at least ninety-six 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 at least thirty (30) days after the onset of the coma.
27. Loss of Independent Existence
Inability to perform without the continuous assistance of another person at least three (3) of the Activities of Daily Living for a
continuous period of at least six (6) months and leading to a Permanent inability to perform the same.
The benefit for Loss of Independent Existence will automatically cease after the Insured attains age 65. Furthermore, all psychiatric
related causes are excluded.
28. 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.

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The condition must result in the Insured being unable to perform without the continuous assistance of another person at least three
(3) of the Activities of Daily Living for a continuous period of at least three (3) months and must (at the end of that period) be
confirmed by a neurologist as progressive and resulting in Permanent disability and neurological deficit.
29. Multiple Sclerosis
The definite occurrence of multiple sclerosis, 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, solely and directly due to the
diagnosis of multiple sclerosis, and
iii. There is a well-documented history of exacerbations and remissions of said symptoms or neurological deficits.
30. Muscular Dystrophy
A group of hereditary degenerative diseases of muscle, characterized by weakness and atrophy of muscle. The diagnosis of muscular
dystrophy must be unequivocal.
The condition must result in the Insured being unable to perform without the continuous assistance of another person at least three
(3) of the Activities of Daily Living 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.
31. Paralysis
Total and irreversible loss of use of at least two (2) entire limbs due to Injury or disease. This condition 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.
32. Parkinson’s Disease
The unequivocal diagnosis of idiopathic Parkinson’s Disease by a consultant neurologist, as evidenced by all of the following:
i. Cannot be controlled with medication
ii. Shows signs of progressive impairment, and
iii. Results in the Insured being unable to perform without the continuous assistance of another person at least three (3) of the
Activities of Daily Living.
The disability must have persisted for a continuous period of at least six (6) months and at the end of that period must be deemed
Permanent by a consultant neurologist.
33. 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. There is evidence of Permanent neurological damage confirmed by a neurologist at least six (6) weeks after the event, and
ii. There are findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques
consistent with the diagnosis of a new stroke.
The following do not meet the definition of ‘Stroke’:
i. Transient ischaemic attacks
ii. Brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease
iii. Vascular disease affecting the eye or optic nerve, and
iv. Ischaemic disorders of the vestibular system.

GROUP FIVE – OTHERS

34. 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. Confirmation 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.

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35. Encephalitis
Severe inflammation of brain substance, resulting in Permanent neurological deficit which is documented for a minimum of thirty
(30) days. Encephalitis as a result of HIV Infection is excluded.
36. 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. The infection was due to a blood transfusion that was medically necessary or given as part of a medical treatment
ii. The blood transfusion was received in Philippines after the Effective Date or date of Reinstatement of this Policy (whichever
is later)
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.
37. Loss of Limbs
Severance of 2 limbs at or above wrist or ankle as a result of illness or Injury.
38. Loss of Speech
Total and irrecoverable loss of the ability to speak as a result of injury or disease 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 Specialist.
All psychiatric related causes are excluded.
39. Major Burns
Third degree (full thickness of the skin) burns covering at least 20% of the surface of the Insured’s body. Diagnosis must be evidenced
by specific results using the Lund Browder Chart or equivalent burn area calculators.
40. Major Head Trauma with Severe Brain Damage
Accidental head injury resulting in the Insured being unable to perform without the continuous assistance of another person at least
three (3) of the Activities of Daily Living.
The neurological deficit must have persisted continuously for at least 6 weeks and must (at the end of that period) be deemed
Permanent by a consultant neurologist, as supported by unequivocal findings on Magnetic Resonance Imaging, Computerised
Tomography, or other reliable imaging techniques.
For the avoidance of doubt, head injuries due to any other cause and spinal cord injuries do not meet the above description.
41. Occupationally Acquired HIV/AIDS
Infection with the Human Immunodeficiency Virus (HIV) which resulted from an Accident occurring after the Effective Date or date
of Reinstatement of this Policy (whichever is later) and while the Insured was carrying out the normal professional duties of His/Her
occupation in Philippines. The following proofs must be submitted to Our satisfaction:
i. The Accident giving rise to the infection must be reported to Us within thirty (30) days of the Accident taking place;
ii. The Accident involved a definite source of the HIV infected fluids; and
iii. The 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.
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 licensed medical center or clinic (in the 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.
42. Severe Rheumatoid Arthritis
Severe rheumatoid arthritis, with the diagnosis confirmed by a consultant rheumatologist 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 6 months, and

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 iii. At least three of the following groups of joints are involved and deformed: (a) finger joints, (b) wrist joints, (c) elbow joints,
(d) knee joints, (e) hip joints, (f) ankle joints or (g) spine.
The condition must result in the Insured being unable to perform without the continuous assistance of another person at least
three (3) of the Activities of Daily Living 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.

ELIGIBLE MINOR CRITICAL ILLNESSES

A Minor Critical Illness means any of the conditions specified below. Subject to proper notice, We reserve the right to change these
definitions from time to time to reflect changes in medical terminologies and practices, subject to Insurance Commission approval.
All diagnosis must be confirmed by an appropriate Medical Practitioner acceptable to Us.
1. Accidental Fracture of Spinal Column
A new spinal fracture caused by an Accident, and requiring hospitalization for open surgical repair, resulting in a Permanent
neurological deficit in motor function or bladder function. The spinal column is defined as one bone as a whole, and the diagnosis
of the fracture of the spinal column must be based on an examination of an X-ray or any other similar imaging technology by a
specialist orthopaedic surgeon or a radiologist.
2. Angioplasty and Other Invasive Treatments for Coronary Artery Disease
Angioplasty and Other Surgeries for Coronary Artery means either of the following procedures:
i. Angioplasty and/or stenting, being the actual undergoing of balloon angioplasty and/or stenting to correct narrowing or
blockage of one or more coronary arteries, or
ii. The actual undergoing of atherectomy, laser relief, transmyocardial laser revascularisation or other intra-arterial techniques
to correct narrowing or blockage of one or more coronary arteries.
Angiographic evidence must be provided that at least one coronary artery has stenosis of 50% or higher and the procedure must be
certified as medically-necessary and performed by a cardiologist.
3. Diabetic Retinopathy
Diabetic Retinopathy means advanced changes to the retinal blood vessels as a consequence of diabetes mellitus. All of the following
criteria must be met:
i. Presence of diabetes mellitus at the time of diagnosis of Diabetic Retinopathy
ii. Visual acuity of both eyes is 6/18 or worse using Snellen eye chart, and
iii. Actual undergoing of treatment such as laser treatment to alleviate the visual impairment.
4. Early Stage Cancer
Early Stage Cancer is any of the below conditions.
i. Early Bladder Cancer: Papillary carcinoma (Ta) of Bladder
ii. Early Chronic Lymphocytic Leukaemia: Chronic Lymphoctic Leukaemia (CLL) RAI Stage 1 or 2
iii. Early Prostate Cancer: Prostate Cancer histologically described using the TNM Classification as T1a or T1b or Prostate cancers
described using another equivalent classification
iv. Early Thyroid Cancer: Thyroid Cancer histologically described using the TNM Classification as T1N0M0 Papillary
microcarcinoma of thyroid where the tumor is less than 1 centimetre in diameter
v. Early Invasive Melanomas: Invasive melanomas of less than 1.5 mm Breslow thickness, or less than Clark Level 3. Non-
melanoma skin cancer and all carcinoma in-situ of skin or earlier stages do not meet the definition of “Early Stage Cancer”, or
vi. Carcinoma in situ: as defined below.
Carcinoma in situ (CIS) means the focal autonomous new growth of carcinomatous cells confined to the cells in which it originated
and has not yet resulted in the invasion and/or destruction of surrounding tissues. 'Invasion' means an infiltration and/or active
destruction of normal tissue beyond the basement membrane. The CIS diagnosis must be supported by both a histopathological
report and microscopic examination of the fixed tissue and supported by a biopsy result.
In the case of the cervix uteri, pap smear results must be accompanied with cone biopsy or colposcopy with the cervical biopsy
report clearly indicating presence of CIS. Clinical diagnosis alone does not meet this definition of CIS.
Cervical Intraepithelial Neoplasia (CIN) classification which reports CIN I, CIN II and CIN III (where there is severe dysplasia without
CIS) does not meet the definition of CIS.
5. Loss of One Limb
Total and irreversible loss of use of one (1) entire limb (above elbow or above knee) due to illness or accident.
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6. Loss of One Lung
The complete surgical removal of a lung as a result of an illness of the Insured. Partial removal of a lung is excluded.
7. Removal of One Kidney
The complete surgical removal of one (1) kidney necessitated by any disease or accident of the Insured. The need for the surgical
removal of the kidney must be certified to be medically-necessary by a nephrologist and/or surgeon.
Kidney donation does not meet the definition of ‘Removal of One Kidney.’
8. Severe Osteoporosis
The occurrence of osteoporosis with fractures where the following conditions are met:
i. A fracture of the neck of femur or two vertebral body fractures, due to or in the presence of osteoporosis
ii. Bone mineral density measured in at least two sites by dual-energy x-ray densitometry (DEXA) or quantitative CT scanning is
consistent with severe osteoporosis (T-score of less than -2.5), and
iii. The Insured undergoes internal fixation or replacement of the fractured bone.
9. Surgical Removal of Pituitary Tumor
The actual undergoing of surgical excision of pituitary tumor necessitated as a result of symptoms associated with increased
intracranial pressure caused by the tumor, endocrinological disorder with pituitary origin or neurological deficit due to oppression
of pituitary tumor onto normal brain tissue. The presence of the underlying tumor must be confirmed by imaging studies such as
computed tomography scan or magnetic resonance imaging. The surgery must be certified to be medically necessary by a Medical
Practitioner who specializes in this field.
Surgical excision of pituitary microadenoma (tumor of 8mm in size or below in diameter) does not meet the definition of ‘Surgical
Removal of Pituitary Tumor’.
Juvenile Minor Critical Illnesses
The following Minor Critical Illnesses also apply while the Insured is aged seventeen (17) years or younger.
10. Hemophilia A and Hemophilia B
The Insured suffers from severe hemophilia with a clotting factor VIII or factor IX of less than 1%.
11. Type 1 Diabetes Mellitus - Insulin Dependent Diabetes Mellitus
This is characterized by polydipsia, polyuria, increased appetite, weight loss, low plasma insulin levels, episodic ketoacidosis, and
immunemediated destruction of pancreatic beta cells. Insulin therapy and dietary regulation are essential for survival. Total
dependence on insulin therapy must persist for not less than six (6) months.
Diagnosis of Type I Diabetes Mellitus (Insulin Dependent Diabetes Mellitus) must be confirmed by a specialist pediatrician or a
specialist pediatric endocrinologist.
12. Kawasaki Disease
The diagnosis of Kawasaki Disease with heart complications where there is persistent dilation or aneurysm formation in one or more
coronary arteries of at least 6 millimeters in diameter, and the dilation or aneurysm has persisted for at least 6 months following
initial diagnosis of this disease by a pediatric cardiologist.
13. Osteogenesis Imperfecta - Type III
This is characterised by brittle, osteoporotic, easily fractured bone. The Insured must be diagnosed as a Type III Osteogenesis
Imperfecta as confirmed by the occurrence of all of the following conditions:
i. The result of physical examination of the Insured by a Medical Practitioner who specializes in Osteogenesis Imperfecta that
the Insured suffers from growth retardation and hearing impairment
ii. The result of x-ray studies reveals multiple fracture of bones and progressive kyphoscoliosis, and
iii. Positive result of skin biopsy.
14. Severe Asthma
At least four (4) of the following five (5) criteria must be met:
i. History of status asthmaticus within the past two (2) years
ii. Significant and continuous reduction in exercise tolerance
iii. Chest deformities resulting from chronic hyperinflation
iv. The need for medically prescribed oxygen therapy at home
v. Continuous daily use of oral corticosteroids (for a minimum period of at least six (6) months)

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15. Systemic Juvenile Idiopathic Arthritis
The occurrence of Still’s Disease, a form of juvenile chronic arthritis, where there is widespread joint destruction as a result of the
disease necessitating hip or knee replacement.

FWD Life Insurance Corporation I T: (632) 8888 8388 I F: (632) 8558 7393 Form Number: SFH.AG.2020.01 Page 22
 Set For Health Application Form

Policy Number: 51486013

Importance of Truthful Disclosure: It's important that you provide truthful answers in the Application Form.
Concealment of any facts may cause FWD to deny a claim on this policy.

INDIVIDUAL PROPOSED OWNER AND INSURED INFORMATION

Full name Atty. KAREN RODRIGUEZ DE LEON
Gender Female
Date of Birth 01/08/1994
Marital Status Single
Country of Birth Philippines
Nationality Filipino
TIN Number 450882805000
Valid ID IBP ID
ID Number 73572
Current Address 450 Montilla St Carig Sur, Tuguegarao, Cagayan, Philippines, 3500
Permanent Address 450 Montilla St Carig Sur, Tuguegarao, Cagayan, Philippines, 3500
Email Address karendeleon_08@yahoo.com
Primary Contact Number 63-9365147838
FWD will use your policy delivery mode and contact details to update and notify you in relation to your policy such as
payments, billings, annual statement. It’s also important to let us know when your contact details change in order for
us to manage your account better.
Occupation Lawyer
Annual Income Php 240,000.00
Source of Funds Salary
Purpose of Insurance Protection
Employer's Name LAUIGAN LAW OFFICES
Industry Legal Profession
Business Address 13 Blumentritt St, Tuguegarao, Cagayan, Philippines, 3500
Policy Delivery Mode Post + Customer Portal
Delivery Address by Post 450 Montilla St Carig Sur, Tuguegarao, Cagayan, Philippines, 3500

Ver No. 001-REGAPP (08/08/2017) Page 1 of 7

 Set For Health Application Form

PLAN DETAILS
PLAN PAYMENT TERM SUM ASSURED
Set For Health 10 500,000.00
NON-FORFEITURE OPTION (By Default, if no option is selected, RPU will be applied.)
If premium is not paid by the end of the grace period, cash value will be applied to effect:
Reduced Paid-Up Insurance (RPU)
PAYMENT INFORMATION
Payment Mode Quarterly
Initial Payment Mode
Cash (Partner Banks)
APP No. 0101673401077

BENEFICIARY DETAILS
Full Name Date of Gender Relationship Allocation Type of Designation Trustee Name
Birth to the of Beneficiary
Proposed Benefits
Insured (%)
Mrs. LILIA
RODRIGUEZ DE 02/02/1962 Female Daughter 100.00 Primary Revocable
LEON
Please note:

If the "Allocation of Benefits" is left blank, benefits will be shared equally between Beneficiaries of the same
type.
If the "Type of Beneficiary" or "Designation" are left blank, the Beneficiary will be defined as "Primary" or
"Revocable" respectively.
FWD will require prior approval of all Beneficiaries designated as "Irrevocable" before processing any policy
transactions.
If there are no changes to the Beneficiary or his designation during the lifetime of the Proposed Insured, the
designation will automatically be deemed "Irrevocable".
If a designated Beneficiary is a minor, a legally recognized guardian or trustee may be required to enact a policy
transaction or file a claim.

EXISTING POLICIES/PENDING APPLICATIONS

Does the Proposed Insured have any existing inforce policy, pending application or
reinstatement for life, critical illness, disability, or accident policy with any other company No
outside of FWD?
OTHER DECLARATIONS
REPLACEMENT OF EXISTING POLICIES
Is the Policy applied for intended to change or replace any existing insurance inforce on the
No
Proposed Owner or Insured?
Will premiums for the insurance you are applying for be paid by a policy loan or surrender
No
value from any existing policies?
REMINDERS: REPLACING an existing life insurance policy with a new one is usually disadvantageous as you may lose
financial benefits you have accumulated over the years, or you may not even be insurable on standard terms, or you
may be required to pay a higher premium in view of higher age. Thus, for your own benefit and interest, please 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.

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US TAX DECLARATION
Are you a citizen, taxpayer, passport holder or green card holder of the U.S. or were you born
No
in the U.S ?

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HEALTH AND LIFESTYLE DECLARATIONS

Proposed Insured
Do you currently participate in an extreme or dangerous sport such as scuba No
diving deeper than 30 metres, motor racing, mountain climbing over 4,000
metres, sky diving or private flying other than as a fare paying passenger?
Do you smoke? No
Have you ever taken addictive or illegal drugs, received medical advice, No
counselling or treatment for alcohol consumption or addiction or been advised
to stop or restrict your alcohol intake?
Have you ever been active or intend to be active in politics as a candidate or in No
any other capacity?

MEDICAL INFORMATION AND HISTORY

Proposed Insured
Height 5 ft and 3 in OR 161 cm
Weight 132 lbs OR 60 kg
Have you ever had symptoms or been told to have or received medical advice or treatment for any of the following:
Heart attack, heart murmur, chest pain, high blood pressure, high No
cholesterol or any other disease or disorder of the heart or blood
vessels?
Stroke, epilepsy, paralysis, depression, psychiatric illness or any other No
disease or disorder of the brain or nervous system?
Cancer, tumour, cyst, lump or growth of any kind, HIV infection or No
Acquired Immunodeficiency syndrome (AIDS)?
Diabetes, elevated blood sugar, thyroid disorder, kidney or bladder No
stones or any other disease or disorder of the endocrine system,
kidneys, urinary tract or reproductive system?
Asthma, bronchitis, tuberculosis, chronic obstructive pulmonary No
disease, sleep apnea or any other disease or disorder of the respiratory
system (excluding upper respiratory tract infection, common cold, flu or
cough)?
Hepatitis B or C, pancreatitis, fatty liver, cirrhosis, ulcer, ulcerative No
colitis, Crohn's disease or any other disease or disorder of the liver,
gallbladder, pancreas or gastrointestinal tract?
Deafness, blindness or any other disease or disorder of the ear or eyes No
(excluding prescription lenses for vision correction)
Arthritis, recurrent back pain or any other injury, disease or disorder of No
the spine, muscles, tendons, limbs, bones or joints
Aside from what you have already told us, in the last 5 years, have you had a No
surgical operation; medical investigation or tests i.e. ultrasound, imaging scan,
biopsy, with abnormal results; or been diagnosed with any other disease,
disorder or injury which has resulted in hospitalization or continuous medical
treatment for 7 days or longer?
Are you currently experiencing any symptoms for which you are planning to No
seek medical advice or treatment or are you awaiting a surgical operation or
the results of any medical tests?
For Females:
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a. Are you currently pregnant? No

b. Do you currently have or have you had in a previous pregnancy, any No
complications such as high blood pressure, pre-eclampsia, gestational
diabetes or is there a risk of premature delivery?
FAMILY HISTORY
Proposed Insured
Has any of your natural parents, brothers or sisters been diagnosed before age No
60 with cancer of the breast, ovaries colon or rectum, heart disease, stroke,
diabetes, polycystic kidney disease, Alzheimer's Disease, Parkinson's disease,
Huntingtons' disease or any other hereditary disorder?

FWD'S HOME OFFICE ENDORSEMENTS AND SPECIAL INSTRUCTIONS

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DECLARATIONS MADE BY PROPOSED OWNER

I UNDERSTAND AND CONFIRM THAT:
1. I read the Sales Illustration before applying for the policy and am fully informed about the product's benefits &
charges and my obligations.
2. The information I have provided above and in any supporting documents or information (collectively defined as
this 'Application Form') are true and complete. I understand that providing inaccurate or incomplete information
may result in future policy benefits being denied.
3. In case of apparent errors or omissions in this Application Form, or if the policy cannot be issued based on
FWD's underwriting guidelines, FWD may amend this Application Form in the FWD's Home Office Endorsement
and Special Instructions and may issue the policy on the basis of such amendments. I understand that my
acceptance of the policy ratifies these amendments.
4. If the policy will replace any existing policies, I have read the Replacement of Existing Policies.
5. I may be subjected to HIV testing and/or a personal investigation for the purpose of underwriting this
application.
6. FWD may collect, store and use information provided in this Application Form and from Third Parties (including,
but not limited to, affiliates, medical/financial/insurance institutions, government agencies and medical
information sharing facilities) to process this application and to service my policies. The information gathered
may be shared with those Third Parties for purposes consistent with which it was obtained.
7. In accordance with the Insurance Commission's Circular Letter No. 2016-54, your medical information will be
uploaded to a Medical Information Database accessible to life insurance companies for the purpose of
enhancing risk assessment and preventing fraud. Once uploaded, all life insurance companies will only have
limited access to your information in order to protect your right to privacy in accordance with law. A copy of
Circular Letter No. 201-54 may be accessed at the Insurance Commission's website at www.insurance.gov.ph.
8. FWD and its affiliates may contact me to request or clarify information to process this application and to service
my policies. I also authorize FWD and its affiliates to send me policy information and promotional information
about their products, services and offers.
9. I have fully disclosed all of my citizenships, tax status, residencies, relevant taxpayer identification numbers and
agree to notify FWD within thirty days of any changes to the above information. For the purposes of ensuring
continued compliance, FWD may request information and/or documents from me including completed,
executed and, if necessary, notarized tax declarations or forms.
10. I authorize FWD to disclose my personal and financial information to any government or tax authority (within or
outside the Philippines) for the purposes of ensuring FWD's continual compliance with applicable laws,
regulations, guidelines and good market practices. I also agree that FWD has the right to require any of my
beneficiaries, claimants, assignees and/or payees 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 relevant Filipino and/or foreign
government and/or tax authorities.
11. The amounts invested in the policies have been declared to the relevant government and tax authorities (within
or outside the Philippines) and none were derived, directly or indirectly, from illegal activities, illegal sources or
tax evasion. I authorize FWD to withhold payment of any amounts due to myself, my beneficiaries, claimants,
assignees and/or payees if required by any relevant government or tax authorities (within or outside the
Philippines).

Note: A separate Temporary Life Insurance Certificate form will be forwarded to you as soon as the Initial Modal Premium has been received.

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Proposed Owner printed name and signature

KAREN RODRIGUEZ DE LEON

Date of Signing : 12/30/2019

DECLARATIONS MADE BY FINANCIAL WEALTH PLANNER

In signing below, I certify that :
I have fully answered any questions the Proposed Owner and/or the Proposed Insured asked in a language
which they understand;
I have acted under the direction and authority of the Proposed Owner;
The Proposed Owner and/or Proposed Insured (where appropriate) have signed this Application Form in our
presence;
I affirm the identity of the Proposed Owner and/or Proposed Insured; and
I have seen and verified the original copy of the identification documents submitted in connection with this
application for insurance.

Name and signature of Financial Wealth Planner

Fleurdeliz Apostol Coloma

Code : 10003040
Date of Signing : 12/11/2019

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