Proposal Date: September 25, 2020

Allianz eAZy Health Platinum

A life and health insurance plan with an enhanced protection against critical illnesses, impairments and disabilities.

Arceli M. Bolor
Age: 68
Gender: Female
WHAT AM I COVERED FOR?

We will pay the CI benefit upon diagnosis of a covered Critical Illness which first occurs or
manifests itself while policy is in force, after the waiting period of 90 days, and a minimum
of 30-day survival period from date of diagnosis. After payment of CI Benefit, this plan will
not be terminated and you will not have to pay the premium for this benefit anymore.
Critical Illness (CI) The covered Critical Illnesses are:
Benefit ● Cancer;

PHP 2,000,000 ● Heart Attack;

● Stroke;

● Coronary Artery By-pass Surgery;

● and other severe medical conditions that result in

a. Loss of Body Function and Independent Existence for Adults; or

b. Constant Medical Care for Children.

Accidental Death, We will pay the ADDD benefit if you suffer Injury due to accident and the said Injury
Disability and occurring within one hundred eighty (180) days from the date of accident resulted in death
Dismemberment or disability. A percentage of the benefit will also be provided when the accident resulted in
(ADDD) Benefit dismemberment. After the full payment of ADDD Benefit, this plan will not be terminated
PHP 2,000,000 and you will not have to pay the premium for this benefit anymore.

Death Benefit
PHP 600,000 We will pay the Death benefit upon death, either due to accidental or natural causes.

We will provide the Health Bonus at the end of every five (5) Policy Years starting from Policy
Health Bonus Date, if there is no paid or payable CI Benefit, ADDD Benefit or Death Benefit during the
30% of premiums paid
preceding five (5) Policy Years.

HOW MUCH ARE MY PREMIUMS?

Chosen Mode of Payment: Semi-Annual
Policy Year Insured's Age Base Plan CI Benefit ADDD Benefit Allianz eAZy Health Platinum
Policy Year 1 to 5 Age 68 to 72 PHP 64,365.00 PHP 26,197.50 PHP 525.00 PHP 91,087.50
The above premiums are computed based on the details you have provided as of proposal date. The above Insured's age is based on age nearest to Insured's birthday as of
proposal date. Please request for an updated illustration upon application.

We may revise these premiums every five (5) Policy Years effective at Policy Anniversary. We will write to tell you about any changes forty-five (45) days before the next Policy
Anniversary and will remain unchanged for the next five (5) Policy Years.

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IMPORTANT NOTES
Pre-existing Conditions
Please answer questions related to Pre-existing Conditions before buying this policy. Any inaccurate response may result in claim not being paid.
Pre-existing Condition is any condition, Illness or Injury which is diagnosed or which the Insured contracted prior to the Policy Date or latest
Reinstatement Date (if any). A condition, Illness or Injury is considered pre-existing if such condition, Illness or Injury was consulted for and/or
diagnosed or presented signs and symptoms which the Insured is aware of prior to the Policy Date or latest Reinstatement Date (if any).

Waiting Periods
Some benefits have waiting periods. Waiting Period is the period of time commencing on the Policy Date or latest Reinstatement Date (if any) before
a certain benefit or benefits become available under this Plan.

Exclusions
There are cases in which benefits of this plan will not be paid.
1. Suicide Exclusion
If the Insured’s death is due to suicide within two (2) years from the Policy Date or latest Reinstatement Date (if any), our liability is limited to
refund of the premiums we actually received, without interest, less all benefits we paid under this Policy. However, suicide committed in the state
of insanity will be compensable regardless of the date of commission.

2. Exclusions for CI Benefit and ADDD Benefit

We will not pay for any claim arising out of, directly or indirectly caused by, based on or related to or in presence of any of the following:
a. Pre-existing Condition and its complications;
b. Congenital Condition and its complications;
c. Drug addiction;
d. Alcoholism;
e. Suicide or self-inflicted Injury, or any attempt to commit them while sane or insane;
f. Mental disability, Psychiatric disorders, neuroses, psychosomatic or psychosis;
g. Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) or the presence of any Human Immunodeficiency Virus (HIV)
infection;
h. Atomic energy explosion, nuclear fission, or radiation of any nature;
i. Any Illness or Injury received:
• While in the service or being attached to the armed forces, the police forces or the opposing forces in any capacity in any declared or
undeclared war, civil war, or while under orders for any warlike operation, strike, riot, or any enforcement of public order.
• While participating in any brawl, or caused by war, whether declared or undeclared, strike, riot, civil war, revolution, insurrection, rebellion,
acts of terrorism, or any war-like operation, or any criminal violation or attempt of criminal violation of the law or resistance to arrest;
  • While entering, leaving, operating, servicing or being in, on, or about any aerial or submarine device or conveyance except as a passenger
or licensed pilot, maritime officer and authorized crew members in any aircraft or water conveyance being regularly and usually used for
commercial flight or navigation purposes.
• From an Accident occurring while or because the Insured is affected by alcohol or dangerous drug.

Beneficiaries
Your Beneficiary refers to the first surviving class of the following beneficiary classes in this order of preference:
a. Insured's widow or widower
b. Any of the surviving children born to or legally adopted by the Insured
c. Any of the surviving parents of the Insured
d. Any of the surviving brothers or sisters of the Insured
e. Executors or administrators
If you prefer to name your Beneficiary, please inform us upon application. You may also name or change any Beneficiary after issuance by writing to
us.

This is Only an Illustration

This document provides an illustration of the benefits and premiums of your chosen plan. This is not intended to be a contract of insurance. The
precise definitions and terms of the plan are specified in the Policy Provisions. Your benefit coverage and exclusions are detailed in the Policy
Contract.

Cooling-Off Period
After reading the Policy Contract and you don't agree to any of its terms or conditions, you have the option to cancel and return it to us within fifteen
(15) days from the date you received it. We will refund the initial premiums you have paid.

DECLARATION
I confirm that I have applied with Allianz PNB Life Insurance, Inc. for an Allianz eAZy Health Plan. I also confirm having read and understood the
information in this benefit illustration.

     
Applicant Owner/Proposed Insured's
Financial Advisor's Signature Over Printed Name Date
Signature Over Printed Name

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HEALTH DECLARATION FORM

Applicant Owner: Arceli M. Bolor

Proposed Insured: Arceli M. Bolor
Health Plan: Allianz eAZy Health Platinum

Please answer the following questions on the basis of your own medical history:

Height: 167 cm.

Weight: 56 kg.

BMI: 20

1. Have you ever had or been treated for heart disease, stroke, cancer, tumour, diabetes, chronic kidney Yes No
disease, chronic obstructive pulmonary disease (COPD), HIV, or seizures?
2. Other than the conditions mentioned above, have you ever been hospitalized or have you been Yes No
advised to have any operation, or treatment in the last 2 years?
(Cough, common colds, fever, and pregnancy-related can be ignored.)

DECLARATION
I agree and declare that the above information and statements are true and accurate, and that these information and statements shall be the basis of
the contract to be issued. I undertake to notify Allianz PNB Life Insurance, Inc. of any change in any of the above information or statements after
signing this document and prior issuance of the policy.

     
Applicant Owner's Signature Over Printed Name Financial Advisor's Signature Over Printed Name Date

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