Proposed Insured:

Ms. RICA MAE DELOS REYES MARQUEZ

Age 24, Female, Non-smoker

Policyowner or Payor:
Ms. RICA MAE DELOS REYES MARQUEZ
Age 24, Female

Dear RICA MAE,

Thank you for your interest in AXA’s insurance products. Health MaX is a lifetime health plan which provides coverage for major and
minor critical conditions to ensure that you will have the necessary funding for treatment and recovery. It also gives you lifetime insurance
coverage so you can be sure that your loved ones will be financially protected when the unexpected happens.

Enjoy the following benefits from Health MaX:

· Guaranteed Major Critical Conditions coverage* of PHP 1,200,000 if you are diagnosed with any of the 56 specified major
critical conditions.
· Guaranteed Minor Critical Conditions coverage** of PHP 240,000 is advanced if you are diagnosed with any of the 18
specified minor critical conditions. During the life of your policy, you can claim a maximum of two (2) minor critical conditions.
· Advanced Health Fund, in the form of guaranteed cash endowments, starting age 70, you have the option to withdraw up to
PHP 240,000 or leave it with AXA to accumulate with interest determined by Us.
· Guaranteed life insurance coverage* of PHP 1,200,000 from day one of policy issuance.
· Policy Loan , prior to the availability of the cash endowments, that can be used should there be unexpected needs for the fund.
* The Major Critical Conditions and Life Insurance Benefits are equal to 100% of the sum insured if there are no withdrawals made for the Advanced Health Fund and there are
no claims for Minor Critical Conditions benefit. Any claims, withdrawals, or policy loans will be deducted to the benefits payable accordingly.
** The payable Minor Critical Conditions Benefit should come from different Minor Critical Conditions except for (i) Angioplasty and Other Invasive Treatments for Coronary Artery,
and (ii) Carsinoma-in-situ.

BENEFITS

For You For Your Loved Ones

(Living benefits) (Major Critical Conditions Benefits) (Death Benefits)
When you reach Age 75 When you reach Age 75 If the Insured passes away at age 75

Total Living Benefit (Guaranteed Cash Value + Guaranteed Major Critical Conditions Benefit + Guaranteed Death Benefit + Accumulated
Accumulated Advanced Health Fund with Interest) Accumulated Advanced Health Fund with Interest Advanced Health Fund with Interest
Based on 3.00% Accumulation Based on 3.00% Based on 3.00%
Interest Rate……………PHP 939,426 Accumulation Rate…..……PHP 1,238,226 Accumulation Rate…..……PHP 1,238,226
Or Or Or
Based on 3.50% Accumulation Based on 3.50% Based on 3.50%
Interest Rate.…….......PHP 946,245 Accumulation Rate.….......PHP 1,245,045 Accumulation Rate.….......PHP 1,245,045

The above is only a summary of the benefits illustration. All the amounts shown are based on the assumption that Advanced Health Fund payouts are left with the Corporation
to earn interest. For more information on the above benefit details, please refer to the succeeding pages.

Page 1 of 11 of Proposal No. 57923-202302060756-2-02

Printed on: 2/6/2023 7:57:10 PM Created on: 02/06/2023 Expiry Date: 04/07/2023
Version Number: 6.2.0 Plan Code: HMXB20 / Rider Code: N/A Date for Next Insurance Age: 05/08/2023
HEALTH MAX 20-PAY
for: Ms. RICA MAE DELOS REYES MARQUEZ, 24, Female, Non-smoker

SUMMARY OF BENEFITS
Benefits Benefit Amount (PHP)
· Major Critical Conditions Benefit if the Insured is diagnosed 1,200,000
with one of the 56 covered Major Critical Conditions1
· Minor Critical Conditions Benefit if the Insured is diagnosed 240,000 up to a maximum of two (2) claims
with one of the covered Minor Critical Conditions2
· Death Benefit in the unfortunate event that the Insured 1,200,000
passes away, the beneficiary will receive this amount1
· Maturity Benefit if the Insured is alive at age 1003 1,200,000

· Accumulated Advanced Health Fund - receive guaranteed

cash endowments available on the 70th, 75th, 80th, or 85th
birthday of the insured4

Age Accumulated Advance % of the Sum Insured

Health Fund
70 240,000 20% of Insured
75 420,000 35% of Insured
80 540,000 45% of Insured
85 600,000 50% of Insured
1 The benefit amount for Major Critical Conditions and Death Benefit are reduced by any claim on Minor Critical Conditions Benefits, any withdrawals from Advanced Health Fund,
and/or Policy Loans. Note that the benefit amount for Major Critical Conditions and Death Benefit indicated on the illustration assumes that there are no claims made for Minor Critical
Conditions Benefit and there no withdrawals from the Advanced Health Fund.
2 The amount of benefit paid or payable will be deducted from the Major Critical Conditions Benefit and Death Benefit payable under the Basic Plan. Please refer to the conditions

stated on the subsequent pages for the covered illnesses. The payable Minor Critical Conditions Benefit should come from different Minor Critical Conditions except for (i) Angioplasty
and Other Invasive Treatments for Coronary Artery, and (ii) Carcinoma-in-situ.
3 The benefit amount for the Maturity Benefit assumes that there are no claims made on Major and Minor Critical Conditions Benefits, and no withdrawals from Advanced Health Fund.
4 The benefit amount for Advanced Health Fund assumes that there are no withdrawals made until age 85. Any withdrawals made will reduce the actual accumulated Advance Health

Fund. The Advanced Health Fund may increase if left with the Company to accumulate with interest.

The succeeding pages of this proposal provide more details on the benefits and features of Health MaX.

Again, thank you for your interest in our products. If you have questions, please call me at the number specified below or call the
AXA Customer Care Hotline at Tel. No. 85815-292 or 83231-292

EBBAH, NURTALEEB AMINULA

218525
57923
639260038310

Page 2 of 11 of Proposal No. 57923-202302060756-2-02

Printed on: 2/6/2023 7:57:10 PM Created on: 02/06/2023 Expiry Date: 04/07/2023
Version Number: 6.2.0 Plan Code: HMXB20 / Rider Code: N/A Date for Next Insurance Age: 05/08/2023
HEALTH MAX 20-PAY
for: Ms. RICA MAE DELOS REYES MARQUEZ, 24, Female, Non-smoker

PREMIUMS
Plan/Supplements Cover up Sum Insured / Annual Premium
to Age* Coverage (PHP) (PHP)
HEALTH MAX 20-PAY 100 1,200,000 26,232.00

Total Initial Annual Premium 26,232.00

Semi-Annual Premium 13,640.64
Quarterly Premium 7,082.64
Monthly Premium 2,492.04

*Cover up to Age refers to Termination Age

Notes:

The premium rates for Health MaX are not guaranteed and the Company reserves the right to review and adjust the premium rates from time to time. We will
communicate any change in premium rates by mail or in any other applicable form.

For the premium term of the supplement/s, if any, please refer to the supplement definition indicated in the Summary of the Riders attached to this Proposal.

Page 3 of 11 of Proposal No. 57923-202302060756-2-02

Printed on: 2/6/2023 7:57:10 PM Created on: 02/06/2023 Expiry Date: 04/07/2023
Version Number: 6.2.0 Plan Code: HMXB20 / Rider Code: N/A Date for Next Insurance Age: 05/08/2023
HEALTH MAX 20-PAY
for: Ms. RICA MAE DELOS REYES MARQUEZ, 24, Female, Non-smoker
ILLUSTRATION OF LIVING BENEFITS
3.00% Accumulation Rate 3.50% Accumulation Rate
End of Attained Guaranteed Accumulated Accumulated Total Living Benefit Accumulated Total Living Benefit
Year Age Cash Value Advanced Health Advanced Health Advanced Health
Fund Fund with Interest Fund with Interest
1 25 0 0 0 0 0 0
2 26 0 0 0 0 0 0
3 27 1,200 0 0 1,200 0 1,200
4 28 13,200 0 0 13,200 0 13,200
5 29 32,400 0 0 32,400 0 32,400
6 30 52,800 0 0 52,800 0 52,800
7 31 74,400 0 0 74,400 0 74,400
8 32 96,000 0 0 96,000 0 96,000
9 33 118,800 0 0 118,800 0 118,800
10 34 142,800 0 0 142,800 0 142,800
15 39 283,200 0 0 283,200 0 283,200
20 44 426,000 0 0 426,000 0 426,000
25 49 486,000 0 0 486,000 0 486,000
46 70 554,400 240,000 240,000 794,400 240,000 794,400
51 75 481,200 420,000 458,226 939,426 465,045 946,245
56 80 433,200 540,000 651,209 1,084,409 672,327 1,105,527
61 85 406,800 600,000 814,930 1,221,730 858,514 1,265,314
66 90 446,400 600,000 944,727 1,391,127 1,019,645 1,466,045
71 95 450,000 600,000 1,095,198 1,545,198 1,211,019 1,661,019
76 100 600,000 600,000 1,269,634 1,869,634 1,438,310 2,038,310

Product Notes:

1. The Illustration of Living Benefits presents the amounts payable to the Owner once he/she decides to surrender/terminate the plan.
2. The Accumulation Rates (3.00% & 3.50%) are assumed annual rates and are for illustration purposes only, and do not represent maximum or
minimum cash returns.
3. The plan provides Guaranteed Cash Value , which can be paid to the Owner upon termination of the policy prior to death. Any Minor Critical
Conditions benefit claims paid are deductible from the Guaranteed Cash Value. At any time the total Minor Critical Conditions benefit paid is
higher than the Guaranteed Cash Value, the surrender amount is reduced to zero.
4. The Accumulated Advanced Health Fund refers to the sum of the cash endowment benefits available on the 70th, 75th, 80th, and 85th
birthdays of the Insured. Illustration assumes that there were no withdrawals made.
5. The Accumulated Advanced Health Fund with Interest refers to Your accumulated cash endowment, with no withdrawals made, and taking
into account the accumulation rates provided by the Company.
6. The Total Living Benefit is the sum of the Guaranteed Cash Value, and the Accumulated Advanced Health Fund with Interest (if any). The
Advanced Health Fund benefits are to be available 1 day after the end of the policy year.
7. Interest rates on Accumulated Advanced Health Fund are not guaranteed, as these are dependent on the investment performance of the
Corporation.
8. The Illustration assumes that your Advanced Health Fund payouts are left with the Corporation to earn interest. If you decide to withdraw your
Advanced Health Fund, the total living benefits will be reduced accordingly.
9. The plan offers Extended Term Insurance and Premium Loan as premium default options.
10. All amounts are in the currency indicated in the Summary of Benefits page.
11. This proposal is only an illustration of the key features, benefits and assumptions of the recommended insurance plan and does not form part
of the contract. For the complete terms, conditions and limitations of the plan please refer to your policy.

Page 4 of 11 of Proposal No. 57923-202302060756-2-02

Printed on: 2/6/2023 7:57:10 PM Created on: 02/06/2023 Expiry Date: 04/07/2023
Version Number: 6.2.0 Plan Code: HMXB20 / Rider Code: N/A Date for Next Insurance Age: 05/08/2023
HEALTH MAX 20-PAY
for: Ms. RICA MAE DELOS REYES MARQUEZ, 24, Female, Non-smoker
ILLUSTRATION OF DEATH BENEFITS / MAJOR CRITICAL CONDITIONS BENEFIT

3.00% Accumulation Rate 3.50% Accumulation Rate

Guaranteed
Death
End of Attained Benefit / Accumulated Accumulated Total Death Benefit Accumulated Total Death Benefit
Year Age Major Critical Advanced Health Advanced Health /Major Critical Advanced Health /Major Critical
Conditions Fund Fund with Interest Conditions Benefit Fund with Interest Conditions Benefit
Benefit

1 25 1,200,000 0 0 1,200,000 0 1,200,000

2 26 1,200,000 0 0 1,200,000 0 1,200,000
3 27 1,200,000 0 0 1,200,000 0 1,200,000
4 28 1,200,000 0 0 1,200,000 0 1,200,000
5 29 1,200,000 0 0 1,200,000 0 1,200,000
6 30 1,200,000 0 0 1,200,000 0 1,200,000
7 31 1,200,000 0 0 1,200,000 0 1,200,000
8 32 1,200,000 0 0 1,200,000 0 1,200,000
9 33 1,200,000 0 0 1,200,000 0 1,200,000
10 34 1,200,000 0 0 1,200,000 0 1,200,000
15 39 1,200,000 0 0 1,200,000 0 1,200,000
20 44 1,200,000 0 0 1,200,000 0 1,200,000
25 49 1,200,000 0 0 1,200,000 0 1,200,000
46 70 960,000 240,000 240,000 1,200,000 240,000 1,200,000
51 75 780,000 420,000 458,226 1,238,226 465,045 1,245,045
56 80 660,000 540,000 651,209 1,311,209 672,327 1,332,327
61 85 600,000 600,000 814,930 1,414,930 858,514 1,458,514
66 90 600,000 600,000 944,727 1,544,727 1,019,645 1,619,645
71 95 600,000 600,000 1,095,198 1,695,198 1,211,019 1,811,019
76 100 600,000 600,000 1,269,634 1,869,634 1,438,310 2,038,310

The Total Death Benefit / Major Critical Conditions Benefit is (1) the sum of the Guaranteed Death Benefit / Major Critical Conditions
Benefit , and the Accumulated Advanced Health Fund with Interest (if any) payable upon the demise of the Insured or the Insured’s diagnosis
of any of the 56 Major Critical Conditions (2) less any Minor Critical Conditions paid, any cash endowments paid, and any indebtedness. The
Advanced Health Fund payable on the 70th, 75th, 80th and 85th birthdays will be credited 1 day after the end of the policy year following the
70th, 75th, 80th and 85th birthdays.
The figures presented are based on the key features, benefits and assumptions listed on the Product Notes portion found in the Illustration of
Living Benefits page.

Page 5 of 11 of Proposal No. 57923-202302060756-2-02

Printed on: 2/6/2023 7:57:11 PM Created on: 02/06/2023 Expiry Date: 04/07/2023
Version Number: 6.2.0 Plan Code: HMXB20 / Rider Code: N/A Date for Next Insurance Age: 05/08/2023
HEALTH MAX 20-PAY
for: Ms. RICA MAE DELOS REYES MARQUEZ, 24, Female, Non-smoker

MAJOR CRITICAL CONDITIONS COVERED

Major Critical Conditions
Group 1 Cancer Group 6 Critical Conditions related to the digestive system
1. Cancer 39. Chronic Relapsing Pancreatitis
40. Fulminant Hepatitis
41. Severe Crohn’s Disease
42. Severe Ulcerative Colitis
Group 2 Critical Conditions related to organ failure Group 7 Critical Conditions related to immunology and rheumatology
2. Chronic Adrenal Insufficiency (Addison's Disease) 43. Severe Rheumatoid Arthritis
3. Chronic and Irreversible Kidney Failure 44. Systemic Lupus Erythematosus (S.L.E.) with Lupus Nephritis
4. Chronic Liver Disease 45. Systemic Scleroderma
5. Coma
6. End Stage Lung Disease
7. Loss of Independent Existence#
8. Major Organ Transplantation
9. Medullary Cystic Disease
Group 3 Critical Conditions related to heart and blood vessels Group 8 Critical Conditions related to neurological degeneration
10. Cardiomyopathy 46. Alzheimer’s Disease
11. Coronary Artery Disease Requiring Surgery 47. Parkinson’s Disease
12. Dissecting Aortic Aneurysm 48. Severe Creutzfeld-Jacob Disease (CJD)
13. Eisenmenger’s Syndrome
14. Heart Attack
15. Heart Valve Surgery
16. Primary Pulmonary Arterial Hypertension
17. Severe Infective Endocarditis
18. Surgery to Aorta
Group 4 Critical Conditions related to the nervous system Group 9 Critical Conditions related to the musculoskeletal system
19. Amyotrophic Lateral Sclerosis 49. Amputation of Both Feet due to Complication from Diabetes
20. Apallic Syndrome 50. Major Burns
21. Bacterial Meningitis 51. Necrotizing Fasciitis
22. Benign Brain Tumor 52. Severance of Limbs
23. Blindness
24. Brain Damage^
25. Encephalitis
26. Motor Neuron Disease
27. Multiple Sclerosis
28. Muscular Dystrophy
29. Paralysis
30. Poliomyelitis
31. Progressive Bulbar Palsy
32. Progressive Supranuclear Palsy^
33. Spinal Muscular Atrophy
34. Stroke
35. Tuberculosis Meningitis
Group 5 Critical Conditions related to blood Group 10 Other Critical Conditions
36. AIDS / HIV due to Blood Transfusion 53. Deafness (loss of hearing)
37. Aplastic Anemia 54. Elephantiasis
38. Occupationally Acquired AIDS / HIV 55. Loss of Speech
56. Terminal Illness
#To be eligible to receive a benefit under this Major Critical Condition, the Insured must be between age 15 and age 75 at the time of first diagnosis.
^To be eligible to receive a benefit under this Major Critical Condition, the Insured must be above age 5 at the time of first diagnosis.

MINOR CRITICAL CONDITIONS COVERED

Minor Critical Conditions
Group 1 Children Minor Critical Conditions~ 1. Dengue Hemorrhagic Fever (Grades III and IV)
2. Hemophilia A and Hemophilia B
3. Insulin Dependent Diabetes Mellitus
4. Kawasaki Disease
5. Osteogenesis Imperfecta
6. Rheumatic Fever with Valvular Impairment
7. Still’s Disease
8. Wilson’s Disease
Group 2 Carcinoma-in-situ / Early Stage Cancer 9. Carcinoma-in-situ at Breast, Cervix Uteri, Uterus, Ovary, Fallopian Tube,
Vagina or Testicles
10. Early Stage Cancer of Prostate
Group 3 Angioplasty 11. Angioplasty and Other Invasive Treatments for Coronary Artery Disease
Group 4 Other Minor Critical Conditions 12. Aortic Aneurysm
13. Chronic Auto-immune Hepatitis
14. Facial Reconstructive Surgery for Injury due to Accident
15. Hepatitis with Cirrhosis
16. Insertion of Pacemaker or Defibrillator
17. Skin Transplantation due to Accidental Burning
18. Systemic Lupus Erythematosus (S.L.E.)
~Only an Insured aged under 22 on the 1st diagnosis of these minor Critical Conditions is eligible to claim for the relevant benefit.
Note : The critical condition must occur 60 days after the policy’s effective date for the corresponding Major Illness or Minor Illness Benefit to be payable. Benefits relating to Major
and Minor Critical Conditions are payable according to the definitions of Major and Minor Critical Conditions Benefits as set out in the policy contract.

Page 6 of 11 of Proposal No. 57923-202302060756-2-02

Printed on: 2/6/2023 7:57:11 PM Created on: 02/06/2023 Expiry Date: 04/07/2023
Version Number: 6.2.0 Plan Code: HMXB20 / Rider Code: N/A Date for Next Insurance Age: 05/08/2023
HEALTH MAX 20-PAY
for: Ms. RICA MAE DELOS REYES MARQUEZ, 24, Female, Non-smoker
QUICK GUIDE TO COMMON CRITICAL CONDITIONS
COVERED UNDER YOUR HEALTH PLAN
Health Max covers a total of 56 major and 18 minor critical conditions. Here is a quick reference for the 15 most common major critical
conditions and 5 minor critical conditions.
TOP 15 ILLNESSES COVERED UNDER MAJOR CRITICAL CONDITIONS
CONDITION WHAT IS COVERED
1. Cancer First unequivocal diagnosis of any malignant tumour
characterised by the uncontrolled growth of malignant cells
and invasion of tissue, and positively diagnosed with
histological confirmation by an appropriate specialist
and/or by Our medical director or authorized medical
consultant.
The term malignant tumor includes leukemia, sarcoma and
lymphoma except cutaneous lymphoma (lymphoma
confined to the skin).
Breast carcinoma in situ with subsequent radical
mastectomy and radiotherapy is covered.
2. Stroke Death of brain tissue caused by hemorrhage, embolism or
thrombosis resulting in permanent neurological deficit with
persistent clinical symptoms. There must be clear and
obvious abnormalities of sensory or motor functions during
the physical examination performed by a neurologist and/or
by Our medical director or authorized medical consultant.
3. Heart Attack Occurrence of death of a portion of the heart muscle as a
result of inadequate blood supply to the relevant area.
4. Coronary Artery Bypass The undergoing of surgery requiring median sternotomy
Graft Surgery (CABG) (surgery to divide the breastbone), which is considered
medically necessary to correct narrowing or blockage of one
or more coronary arteries with bypass grafts.
5. Heart Valve Surgery An open heart valve surgery should have already
been done to replace or repair one (1) or more heart
valves, as a consequence of defects.
6. Major Organ Recommendation from a specialist to undergo
Transplantation transplant for any of the following organs:
• heart, lung, liver, kidney, pancreas, or human
bone marrow
7. Chronic and Irreversible The following symptoms must be present:
Kidney Failure • Both kidneys are characterized with
irreversible failure to function
• Has already started regular renal dialysis
• Is either awaiting or has already undergone
kidney transplant
8. Alzheimer’s Disease Evident deterioration or loss of cognitive and/or
intellectual capacity, due to irreversible failure of
brain function.
Note: The critical condition must occur 60 days after the policy’s effective date for the corresponding Major Illness or Minor Illness Benefit to be payable.
Benefits relating to Major and Minor Critical Conditions are payable according to the definitions of Major and Minor Critical Conditions Benefits as set out
in the policy contract.
Page 7 of 11 of Proposal No. 57923-202302060756-2-02
Printed on: 2/6/2023 7:57:11 PM Created on: 02/06/2023 Expiry Date: 04/07/2023
Version Number: 6.2.0 Plan Code: HMXB20 / Rider Code: N/A Date for Next Insurance Age: 05/08/2023
WHAT IS NOT COVERED
• Tumors defined as benign, carcinoma in situ,
pre-malignant, non-invasive, having borderline
malignancy or having low malignant potential
• Tumors treated by endoscopic procedures
alone and urinary bladder tumors that have not
invaded the muscle layer (Tis and Ta)
• Tumors of the skin with the exception of
malignant melanoma greater than 0.7 mm
Breslow and/or histologically described by the
AJCC seventh edition TNM classification greater
than stage T1aN0M0
• All prostate tumors unless histologically
classified as having a Gleason score greater
than 6 or having progressed to at least clinical
TNM classification T2N0M0
• Thyroid tumor in its early stages that measures
less than 2cm in diameter and histologically
described as T1N0M0 from TNM classification
of the AJCC Seventh Edition
• Chronic lymphotic leukemia unless
histologically classified as having progressed to
at least Binet Stage A
• Transient Ischaemic Attacks (TIA) or temporary
stroke-like signs and symptoms
• Brain tissue damage caused by head injury
• Death of tissue of the optic nerve or retina /
eye stroke
• Other acute coronary syndromes
• Angina without myocardial infarction
• Angioplasty
• Intra-arterial procedures
• Laser techniques
• Other non-surgical techniques
• All repairs conducted through intra-
arterial catheter procedures
• Other transplants for organs not
mentioned in the list
• At least one kidney is still functioning and
regular dialysis is not required.
• Dementia relating to alcohol, drug abuse
or AIDS
HEALTH MAX 20-PAY
for: Ms. RICA MAE DELOS REYES MARQUEZ, 24, Female, Non-smoker
TOP 15 ILLNESSES COVERED UNDER MAJOR CRITICAL CONDITIONS (continuation)
CONDITION WHAT IS COVERED WHAT IS NOT COVERED
9. Parkinson’s Disease Definitive signs of progressive and permanent • Drug induced, accidental, or toxic
neurological impairment, evidenced by permanent causes of Parkinson’s Disease
inability to perform at least three (3) out of six (6)
Activities of Daily Living (ADLs)1, in spite of being on
optimal medication.
10. Bacterial Meningitis Evidence of inflammation of the brain membranes or • Viral Meningitis
spinal cord, resulting in significant and permanent
neurological deficit.
11. Benign Brain Tumor Presence of a life threatening, non-cancerous tumor in • Cysts, granulomas (inflammations),
the brain. If it cannot be removed through surgery, the malformations in, or of, the arteries
tumor should cause significant and permanent or veins of the brain, hematomas
neurological deficit persisting for at least 6 consecutive (collection of blood outside the
months. blood vessels) and tumors in the
pituitary gland or spinal cord
12. Paralysis Inability of two (2) or more limbs to function totally and • Paralysis in 1 limb
permanently due to injury or disease of the spinal cord or
brain.

Those classified as Diplegia (paralysis affecting like parts

on both sides of the body, such as both arms or both
legs), Hemiplegia (paralysis of one side of the body), and
Quadriplegia (paralysis of all four limbs) are included.
13. Loss of Independent Permanent inability to perform at least three (3) Activities • Independent capability to perform 4
Existence of Daily Living (ADLs)1, as certified by a medical specialist or more ADLs
and/or AXA’s medical director.

*Only Insured aged between 15 and 75 on first diagnosis

is eligible to receive a benefit under this illness
14. Severe Rheumatoid Evidence of extensive joint deformity of two (2) or more of • Only one joint area is affected and
Arthritis the following joint areas: hands, wrists, elbows, knees, the Insured can still perform 3 or
hips, ankle, cervical spine or feet; and inability to perform more ADLs.
at least 2 Activities of Daily Living (ADLs)1.

The condition must be present for at least six (6) months.

15. Severance of Limbs Total and irrecoverable loss of two (2) or more limbs due • Loss of either one (1) hand or one
to illness or accident only. This includes the loss of use of (1) foot only.
both hands or both feet or the use of one (1) hand and
one (1) foot.
1 Activities of Daily Living are as follows: (1) Washing - wash in the bath or shower (including getting into and out of the bath or shower) or wash
satisfactorily by other means; (2) Dressing - put on, take off, secure, and unfasten all garments and, as appropriate, any braces, artificial limbs, or other
surgical appliances; (3) Transferring - move from a bed to an upright chair or wheelchair or vice versa; (4) Mobility - move indoors from room to room on
level surfaces; (5) Toileting - use lavatory or otherwise manage bowel and bladder functions so as to maintain a satisfactory level of personal hygiene;
and (6) Feeding - feed oneself once food has been prepared and made available.

Note: The critical condition must occur 60 days after the policy’s effective date or last reinstatement date, whichever is later for the corresponding Major Illness or
Minor Illness Benefit to be payable. Benefits relating to Major and Minor Critical Conditions are payable according to the definitions of Major and Minor Critical
Conditions Benefits as set out in the policy contract.

NOTE: Benefits relating to major and minor Critical Conditions are payable according to the definitions set out in the policy contract.

Pre-Existing Conditions as defined is permanently excluded.

Major and Minor Critical Conditions Benefits are not payable under any of the following conditions:
(1) for illnesses relating to congenital abnormalities; or
(2) any act of war, declared or not, or while in military, naval or air service for any country at war, declared or not, or any acts of terrorism; or
(3) nuclear, biological or chemical (NBC) contamination; or
(4) any self-inflicted injury or suicide or any attempt thereat, whether sane or insane; or
(5) any unprescribed drug or alcohol abuse.

“Pre-existing condition” means a condition (a) for which the Insured received medical advice, consultation or treatment, or (b) whose signs or symptoms are
evident, or should have been evident to the Insured, even if the Insured did not seek medical advice, consultation or treatment for it prior to the Effective Date or
the date of last reinstatement, if any. “Condition” means any type of illness, specific injury, disease, or infirmity including all underlying or related conditions and
any manifestation thereof, whether in one (1) or more than one body system.

Cooling-off Period: You may return or cancel the contract within 15 days from the date you receive the contract. You will receive a full refund of your Premium. No
refund can be made when you have already made a claim on your rider.

Page 8 of 11 of Proposal No. 57923-202302060756-2-02

Printed on: 2/6/2023 7:57:11 PM Created on: 02/06/2023 Expiry Date: 04/07/2023
Version Number: 6.2.0 Plan Code: HMXB20 / Rider Code: N/A Date for Next Insurance Age: 05/08/2023
HEALTH MAX 20-PAY
for: Ms. RICA MAE DELOS REYES MARQUEZ, 24, Female, Non-smoker

TOP 5 ILLNESSES COVERED UNDER MINOR CRITICAL CONDITIONS

CONDITION WHAT IS COVERED WHAT IS NOT COVERED
1. Carcinoma-in-situ (CIS) Cells on biopsy have not yet spread and invaded • Carcinoma-in-situ located in organs not
commonly known as Pre- surrounding tissues or are contained to the place of specified in the definition
Cancer or Stage 0 cancer origin.

Only CIS reported in any of the following organs may

be covered: Cervix Uteri, Uterus, Breast, Vagina,
Fallopian Tube, Ovary, Testicles

Maximum of 2 claims, with the 2nd CIS claim for any

2. Angioplasty and other
Invasive Treatments for
Coronary Artery Disease
of the other remaining organs listed and not from
the same organ as that of the 1st CIS claim.
Have already undergone Angioplasty (procedure to • Angioplasty, atherectomy, or laser
widen blocked or narrowed coronary arteries), treatment has not yet been performed
atherectomy (procedure to remove plaque from the • The procedure was done only for the
inside of a blood vessel) or laser treatment to correct branches of the major coronary arteries
narrowings.

Covered procedure should involve any of the

following coronary vessels: Left main stem artery,
Left anterior descending artery, Circumflex artery,
Right coronary artery except their branches

Maximum of 2 claims, with the 2nd procedure done

in a narrowed vessel of a major coronary artery.
3. Early Stage Cancer of A prostate malignant tumor histologically described • The condition does not satisfy all of the
Prostate as TNM classification T1a, T1b, T1c or which is of specified criteria.
another equivalent classification. Diagnosis must be
supported by a biopsy report.
4. Hepatitis with Liver Inflammation of the liver by the Hepatitis virus • Liver diseases due or related to alcohol
Cirrhosis leading to cirrhosis (healthy liver tissue is replaced abuse
with scar tissue, eventually preventing the liver from
functioning properly).

The liver biopsy must show score 4 in Metavir

grading system or score 13-18 in Knodell score
system or any other imaging test establishing
existence of cirrhosis.
5. Dengue Hemorrhagic Dengue Grades III and IV • Dengue Hemorrhagic Fever I and II
Fever
*Only Insured aged 21 and below on first diagnosis
is eligible to receive a benefit under this illness.
Note: The critical condition must occur 60 days after the policy’s effective date for the corresponding Major Illness or Minor Illness Benefit to be payable.
Benefits relating to Major and Minor Critical Conditions are payable according to the definitions of Major and Minor Critical Conditions Benefits as set out
in the policy contract.

To see the complete list of the 56 covered major critical conditions and 18 covered minor critical conditions
and their detailed coverage, please visit http://axa.com.ph.

Page 9 of 11 of Proposal No. 57923-202302060756-2-02

Printed on: 2/6/2023 7:57:11 PM Created on: 02/06/2023 Expiry Date: 04/07/2023
Version Number: 6.2.0 Plan Code: HMXB20 / Rider Code: N/A Date for Next Insurance Age: 05/08/2023
HEALTH MAX 20-PAY
for: Ms. RICA MAE DELOS REYES MARQUEZ, 24, Female, Non-smoker

DECLARATIONS AND ACKNOWLEDGEMENTS

Declarations

I confirm having read and understood the information contained in the Illustration of Living Benefits Page and the Illustration of
Death Benefits / Major Critical Conditions Benefits Page.

Acknowledgement of Variability

I acknowledge that:

I have applied with AXA Philippines a Whole Life policy, and have reviewed the illustration(s) that shows how a life insurance
policy performs using the company’s assumptions based on Insurance Commission’s guidelines on interest rates.

I understand that only those values described as guaranteed, if any, are guaranteed. All other policy values can change and may
probably be different from those illustrated to me. Actual values may be higher or lower depending on the accumulation rate.

I understand that interest rate on accumulated Advanced Health Fund change from year to year and since these are affected
by the company’s mortality experience, investment returns, expenses, and taxes, and that AXA Philippines will advise me of the
actual amount of the interest rate, if any.

I understand that the illustration(s) given to me will not become part of any issued policy, as these are provided only to show
how policy benefits would change over time under a specific set of assumptions.

CONFORME: These declarations and acknowledgements are made with the

knowledge of the AXA representative whose signature appears below:

Applicant/Policy Owner Date Financial Advisor/Financial Executive Date

Signature over Printed Name Signature over Printed Name
General Disclaimer
All information and opinions provided are of a general nature and for information purposes only. The information and any opinions herein are based upon
sources believed to be reliable, and AXA Philippines, its officers and directors make no representations or warranty, expressed or implied, with respect to
the correctness, completeness of the information and opinions in this document. Please carefully read the policy and endorsements and consider the
risks, charges and expenses before buying the policy. You should seek independent professional advice from your financial, tax, accounting or legal
consultant before buying the Policy.

THIS FINANCIAL PRODUCT OF AXA PHILIPPINES IS NOT INSURED BY THE PHILIPPINE DEPOSIT
INSURANCE CORPORATION (PDIC) AND IS NOT GUARANTEED BY METROBANK OR PS BANK.

Page 10 of 11 of Proposal No. 57923-202302060756-2-02

Printed on: 2/6/2023 7:57:11 PM Created on: 02/06/2023 Expiry Date: 04/07/2023
Version Number: 6.2.0 Plan Code: HMXB20 / Rider Code: N/A Date for Next Insurance Age: 05/08/2023
 Reference Number: 57923-202302060756-2-02

FINANCIAL UNDERSTANDING SUMMARY

Dear RICA MAE,

Thank you for providing us with relevant information with regards to your financial needs.

Based on your current financial situation, which includes, among others, your personal
monthly gross income of 18,000.00, and after taking into consideration your objectives, risk
profile and priorities, you have selected Health MaX 20-Pay for your Health need.

The details of your insurance coverage and your insurance premium are summarized in your
Health MaX 20-Pay sales illustration.

EBBAH, NURTALEEB AMINULA

218525
57923
639260038310

This document is not intended to be a part of your sales illustration of your application form. This is a
summary of the financial needs that you have provided during assessment by your distributor.