Professional Documents
Culture Documents
Arceli M. Bolor PNB Eazy - Health PHP 09292020091753
Arceli M. Bolor PNB Eazy - Health PHP 09292020091753
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;
● Stroke;
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 1,000,000 and you will not have to pay the premium for this benefit anymore.
Death Benefit
PHP 300,000 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.
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.
Page 1 of 2
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.
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.
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
Page 2 of 2
HEALTH DECLARATION FORM
Please answer the following questions on the basis of your own medical history:
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
Page 1 of 1