Proposed Insured:

LHEN ADAP
Age 44, Female, Non-smoker

Policyowner or Payor:
LHEN ADAP
Age 44, Female

Dear LHEN,

Thank you for your interest in AXA products. Life BasiX is a regular-pay variable life insurance product that addresses life's essential
needs for basic protection with opportunities for long-term investment. But unlike most investments, it provides multiple benefits as
follows:

KEY BENEFITS:

1. Guaranteed Death Benefit equivalent to at least 500% of the annual premium if no withdrawal is made.
2. Potential upsides from the portion of the premium placed in bonds, equities and/or money market instruments, depending on your
risk appetite.
3. Guaranteed loyalty bonus as a reward for keeping your investments with AXA.
4. Supplement benefits from riders that provide other forms of protection.
• CRITICAL CONDITIONS RIDER provides additional benefit of PHP 500,000 if you get afflicted with any of the 57 identified critical
illnesses.
• WAIVER OF PREMIUM waives all future premiums if you become totally and permanently disabled before age 60.
For a premium of PHP 29,700.00 annually, you get to enjoy the following benefits:
BENEFITS
For You For Your Loved Ones
(Living Benefits) (Death Benefits)

When insured reaches age 65 Upon death of the Insured

Based on (PHP) Based on 8% annual rate (PHP)
4% annual rate of return, Account Value 515,989 Age 50 500,000
Or 8% annual rate of return, Account Value 828,636 Age 60 500,000
Age 70 1,378,842
Or 10%annual rate of return, Account Value 1,055,418

Notes:
1. The values above are based on the projected performance of your chosen fund/s. Since the fund performance may vary, the values of your
units are not guaranteed and will depend on the actual investment performance at that given period. The illustrated returns on investments
are based on assumed annual rates of 4%, 8%, and 10%. These rates are for illustration purposes only and do not represent maximum or
minimum return on your fund.
2. If after purchasing the variable life insurance contract, you realize that it does not fit your financial needs, you may return the
contract to AXA Philippines within 15 days from the time you receive it. AXA Philippines will return to you the account value, the
bid-offer spread, and all initial charges.
3. Any withdrawal from the Living Benefit will correspondingly reduce the Death Benefit payable.

This is not a deposit product. Earnings are not assured and principal amount invested is exposed to
risk of loss. This product cannot be sold to you unless its benefits and risks have been thoroughly
explained. If you do not fully understand this product, do not purchase or invest in it.

Page 1 of 13 of Proposal No. 31973-201804080143-4-02

Printed on: 4/8/2018 1:44:53 PM Created on: 4/8/2018 1:43:51 PM Expiry Date: 7/8/2018
Version Number: 3.10.11 Date for Next Insurance Age: 4/30/2018
Plan Code: BAX/ Rider Code: WP, CCRP55
 Philippine Peso
for: LHEN ADAP, 44, Female, Non-smoker

SPECIAL FEATURES

Top-up Subject to the rules set by AXA Philippines from time to time, you have the option to increase the
benefits of your Policy by paying additional premiums on top of your regular premium which will
be used to buy more units on your chosen investment fund(s).
Premium Holiday Premiums are paid throughout the life of your Policy, but you have the option to suspend
payment anytime as long as the Account Value is sufficient to cover these.
Loyalty Bonus As long as your Policy remains in force, a 5% Loyalty Bonus will be paid on the 15th and 25th
year to increase your Account Value. The Bonus will be equal to 5% of the average of the month-
end Account Values for the last 120 months.
Inflation Link You have the option to increase your insurance protection, with no further proof of insurability, at
a minimal cost of insurance deduction on each anniversary of your Policy, before age 60 with the
Inflation Index Endorsement (IIE). This also does not require that you provide further proof of
insurability. The amount by which you can increase your coverage is based on the current
Consumer Price Index subject to a minimum that AXA Philippines may determine from time to
time.

The succeeding pages of this proposal provide more details on the benefits and features of Life BasiX.

Again, thank you for your interest in AXA products. If you have questions, please call me at the number specified below, or call the AXA
Philippines Customer Care Hotline at Tel Nos: (02)5815-292 or (02)3231-292.

ESPANO, KATRINA MENDOZA

214002
31973

Page 2 of 13 of Proposal No. 31973-201804080143-4-02

Printed on: 4/8/2018 01:44:54 PM Created on: 4/8/2018 1:43:51 PM Expiry Date: 7/8/2018
Version Number: 3.10.11 Date for Next Insurance Age: 4/30/2018
Plan Code: BAX/ Rider Code: WP, CCRP55
 Philippine Peso
for: LHEN ADAP, 44, Female, Non-smoker

Life BasiX is a regular-pay variable life insurance product where a portion of the premiums, net of the company’s charges, is invested
into your choice of funds. Subject to the rules set by AXA Philippines from time to time, you can increase your investment anytime by
paying top-up premiums, but the value of the funds (and your policy benefits) may go up or down depending on market conditions. The
death benefit option you have elected is Level. The minimum Death Benefit in this proposal is PHP 106,2501.
Below are important details of the proposal along with how your investment will be allocated between the available funds. You may
change this allocation anytime depending on your investment goals and/or risk appetite.

Basic Plan and Supplements Cover up to Age Sum Insured (PHP) Annual Premium (PHP)

Basic
Life BasiX 100 500,000 21,250.00
Supplements
WAIVER OF PREMIUM 60 500,000 1,615.00
CRITICAL CONDITIONS RIDER (UP TO AGE 55) 56 500,000 6,835.00
Total² 29,700.00

You may also pay your premium in the following modes:

Modes of Payment Modal Premium Fund Name ³ Fund Allocation
(PHP)
Semi-Annual 14,850.00 Opportunity Fund 50%
Quarterly 7,425.00 Chinese Tycoon Fund 50%
Monthly 2,475.02

Notes:
1. This is the minimum Death Benefit at policy inception. The minimum Death Benefit for any policy year is equal to 500% of the annual regular Life Basix premium, plus
125% of each paid top-up premium, if any, less 125% of each partial withdrawal, if any.
2. Premiums for all products are payable up to termination age. 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".
3. See Product Notes for description of the funds.

Page 3 of 13 of Proposal No. 31973-201804080143-4-02

Printed on: 4/8/2018 01:44:54 PM Created on: 4/8/2018 1:43:51 PM Expiry Date: 7/8/2018
Version Number: 3.10.11 Date for Next Insurance Age: 4/30/2018
Plan Code: BAX/ Rider Code: WP, CCRP55
 Philippine Peso
for: LHEN ADAP, 44, Female, Non-smoker

ILLUSTRATION OF BENEFITS

The illustrated benefits of your policy (subject to actual market performance) are shown below.
ILLUSTRATION OF BENEFITS
Total Cumulative Regular
End of 4.00 % Rate of Return 8.00 % Rate of Return 10.00 % Rate of Return
Basic Premium, Rider
Policy
Premiums and Top-up, if
Year Living Benefit Death Benefit Living Benefit Death Benefit Living Benefit Death Benefit
any, Paid
1 21,250 10,990 500,000 11,461 500,000 11,696 500,000
2 42,500 22,336 500,000 23,756 500,000 24,480 500,000
3 63,750 34,036 500,000 36,936 500,000 38,446 500,000
4 85,000 46,116 500,000 51,089 500,000 53,729 500,000
5 106,250 58,582 500,000 66,286 500,000 70,458 500,000
10 212,500 167,921 500,000 207,090 500,000 230,279 500,000
15 318,750 309,285 500,000 427,292 500,000 504,305 504,305
20 425,000 477,089 500,000 748,176 748,176 940,382 940,382
25 531,250 711,394 711,394 1,257,626 1,257,626 1,690,241 1,690,241
30 637,500 972,880 972,880 1,968,751 1,968,751 2,850,343 2,850,343
35 743,750 1,291,019 1,291,019 3,013,626 3,013,626 4,718,700 4,718,700
40 850,000 1,678,083 1,678,083 4,548,891 4,548,891 7,727,708 7,727,708
45 956,250 2,149,006 2,149,006 6,804,700 6,804,700 12,573,745 12,573,745
50 1,062,500 2,721,955 2,721,955 10,119,222 10,119,222 20,378,336 20,378,336
55 1,168,750 3,419,036 3,419,036 14,989,343 14,989,343 32,947,708 32,947,708

Age60 340,000 339,739 500,000 481,683 500,000 575,733 575,733

Age65 446,250 515,989 515,989 828,636 828,636 1,055,418 1,055,418
Age70 552,500 759,671 759,671 1,378,842 1,378,842 1,880,262 1,880,262
The rates of return shown above are for illustration purposes and are not based on past performance nor guarantee future performance. The actual
return may differ. The illustrated values are net of premium charges of 35%/35%/35%/35%/35% of the basic premium for the 1st to 5th policy years; all top-ups
shall be subject to a premium charge of 2%; Cost of Insurance has been deducted monthly from the illustrated values as well as Administration Charge amounting
to Php1,200 p.a. The Annual Premiums for any attached Supplement shall be deducted monthly from the illustrated values if the Policy is under Premium Holiday.
An Asset Management Charge of 2% p.a. for Philippine Wealth Bond, Philippine Wealth Balanced and Philippine Wealth Equity Funds and 2.5% p.a. for
Opportunity, Chinese Tycoon and Spanish American Legacy Funds have already been deducted from the illustrated values. The illustrated values are still
subject to a surrender charge for withdrawals (partial or full) transacted up to the 5th policy year. The surrender charge is equal to the amount withdrawn multiplied
by a surrender factor of 100%/100%/25%/10%/5% for the 1st to 5th years respectively.

This illustration shall form part of the insurance contract once the Policy is issued.

Page 4 of 13 of Proposal No. 31973-201804080143-4-02

Printed on: 4/8/2018 01:44:54 PM Created on: 4/8/2018 1:43:51 PM Expiry Date: 7/8/2018
Version Number: 3.10.11 Date for Next Insurance Age: 4/30/2018
Plan Code: BAX/ Rider Code: WP, CCRP55
 Philippine Peso
for: LHEN ADAP, 44, Female, Non-smoker

ILLUSTRATION OF BENEFITS (with Premium Holiday on Year 10)

You can choose to suspend payment for regular premium and top-ups as long as the Account Value of your Policy is sufficient to cover
the charges and pay for the premium of any supplement. This feature is called a Premium Holiday which you can apply for. Note that
under this feature, there is a possibility that your Account Value may be depleted and may result to your policy being terminated.

The following table is an example of the impact of a premium holiday at year 10 and/or withdrawals from the fund assuming different
rates of return. However, note that the rates of return are for illustration purposes only. They are not based on past performance nor
guarantee future returns.

Total Cumulative ILLUSTRATION OF BENEFITS (with Premium Holiday on Year 10)

End of Regular Basic 4.00 % Rate of Return 8.00 % Rate of Return 10.00 % Rate of Return
Policy Premium, Rider
Year Premiums and Top Living Benefit Death Benefit Living Benefit Death Benefit Living Benefit Death Benefit
-up, if any, Paid
1 21,250 10,990 500,000 11,461 500,000 11,696 500,000
2 42,500 22,336 500,000 23,756 500,000 24,480 500,000
3 63,750 34,036 500,000 36,936 500,000 38,446 500,000
4 85,000 46,116 500,000 51,089 500,000 53,729 500,000
5 106,250 58,582 500,000 66,286 500,000 70,458 500,000
10 212,500 167,921 500,000 207,090 500,000 230,279 500,000
15 212,500 181,500 500,000 283,736 500,000 352,233 500,000
20 212,500 191,142 500,000 395,012 500,000 552,043 552,043
25 212,500 202,916 500,000 588,247 588,247 908,755 908,755
30 212,500 190,679 500,000 856,987 856,987 1,455,842 1,455,842
35 212,500 138,835 500,000 1,251,853 1,251,853 2,336,931 2,336,931
40 212,500 *** *** 1,832,042 1,832,042 3,755,933 3,755,933
45 212,500 *** *** 2,684,529 2,684,529 6,041,251 6,041,251
50 212,500 *** *** 3,937,112 3,937,112 9,721,777 9,721,777
55 212,500 *** *** 5,777,568 5,777,568 15,649,303 15,649,303

Age60 212,500 182,551 500,000 301,269 500,000 383,041 500,000

Age65 212,500 192,622 500,000 423,853 500,000 605,983 605,983
Age70 212,500 202,234 500,000 634,056 634,056 998,366 998,366
The rates of return shown above are for illustration purposes and are not based on past performance nor guarantee future performance. The actual
return may differ. The illustrated values are net of premium charges of 35%/35%/35%/35%/35% of the basic premium for the 1st to 5th policy years; all top-ups
shall be subject to a premium charge of 2%; Cost of Insurance has been deducted monthly from the illustrated values as well as Administration Charge amounting
to Php1,200 p.a. The Annual Premiums for any attached Supplement shall be deducted monthly from the illustrated values if the Policy is under Premium Holiday.
An Asset Management Charge of 2% p.a. for Philippine Wealth Bond, Philippine Wealth Balanced and Philippine Wealth Equity Funds and 2.5% p.a. for
Opportunity, Chinese Tycoon and Spanish American Legacy Funds have already been deducted from the illustrated values. The illustrated values are still
subject to a surrender charge for withdrawals (partial or full) transacted up to the 5th policy year. The surrender charge is equal to the amount withdrawn multiplied
by a surrender factor of 100%/100%/25%/10%/5% for the 1st to 5th years respectively.

The contract term is specified in the illustration of benefits in this proposal. Please refer to the assumptions below used in the above
example.
Other Assumptions:
1. This example assumes that all premiums shown in the above table are paid in full when due and as planned with no premium holiday in the first
10 policy years. It assumes the current scale of charges remains unchanged.
2. A loyalty bonus estimated to be 5% of the average Account Value from 6th to 15th policy years on the 15th year, 5% of the average Account
Value from the 16th to 25th policy years on the 25th year is included in this illustration. The bonus will be equal to 5% of the average of the
month-end Account Values over the last 120 months.
3. The proposed policy charges used in this illustration summary are based on the standard risk class without taking into account your own
circumstances (e.g. occupation and health condition, etc). Risk class will be determined according to our underwriting guidelines. The
investment gains/risks associated with this plan are solely to your account.

Page 5 of 13 of Proposal No. 31973-201804080143-4-02

Printed on: 4/8/2018 01:44:54 PM Created on: 4/8/2018 1:43:51 PM Expiry Date: 7/8/2018
Version Number: 3.10.11 Date for Next Insurance Age: 4/30/2018
Plan Code: BAX/ Rider Code: WP, CCRP55
 Philippine Peso
for: LHEN ADAP, 44, Female, Non-smoker

Notes on the illustration of Benefits

1. All payments and benefits shown are in Philippine pesos. Payments are acceptable in policy currency only.
2. AXA Philippines reserves the right to adjust the Basic and Supplement premiums, and any charges in this plan.
3. The quoted values are illustrations only of the key features, benefits and assumptions of the chosen insurance plans. If your
application is accepted, you will receive a policy contract, which will include detailed terms, conditions, and exclusions. A new
Illustration of Benefits will be provided in the contract, which may differ from this proposed illustration.
4. The benefits and premiums of the Index-linked Increase Endorsement, if any, are not included in the summary in the previous page.
5. The benefits are based on the projected performance of your chosen fund/s. Since fund performance may vary, the values of your
units are not guaranteed and will depend on the actual investment performance at that given period. The illustrated returns on
investments are based on assumed annual rates of 4.00%, 8.00%, and 10.00%. These rates are for illustration purposes only and do
not represent maximum or minimum return on your fund value.
6. A bid-offer spread, which is the difference between the bid price and the offer price units, may be determined by AXA Philippines from
time to time. The above illustration is based on a bid-offer spread of 5%.
7. This illustration summary relates to your Life BasiX only, and excludes any Supplements in this proposal. It assumes that all premiums
are paid in full when due and as planned with no premium holiday and the current scale of charges remains unchanged. Any deviation
from this will change the illustrated values accordingly.
8. A loyalty bonus, credited on the 15th and 25th policy years, is included in the illustration. The bonus is estimated to be 5% of the
average of the month-end Account Values over the last 120 months.
9. The proposed policy charges used in this illustration summary are based on the standard risk class without taking into account your
own circumstances (e.g. occupation and health condition, etc). Risk class will be determined according to our underwriting guidelines.
The investment gains/risks associated with this plan are solely to your account.

Product Notes
1. Life Basix is a regular-pay variable life insurance plan. Only the minimum Death Benefit is guaranteed while the Policy is in-force. The
rest of the benefits, namely the partial and full withdrawal values and the actual Death Benefit at time of death, all depend on the
investment experience of separate account(s) linked to the Policy.
Under the INCREASING DEATH BENEFIT OPTION, your beneficiaries will receive the Policy Sum Insured plus the Account Value at time
of death. While under the LEVEL DEATH BENEFIT option, your beneficiaries will receive the Policy Sum Insured less the partial
withdrawals made for the past twelve (12) months, or the Account Value at time of death, whichever is higher.
2. The living benefits shown in the illustration summary are equal to the Account Value of the Policy.
3. The client may choose from the following funds. If client chooses to invest in more than one fund, a minimum allocation of 10% on
one fund is required. The total allocation should always be 100%.
a. Philippine Wealth Bond Fund - This Bond Fund is an actively managed fixed income fund that seeks to capitalize on
capital and income growth through investments in interest-bearing securities issued by the Philippine Government and
money market instruments issued by banks.
b. Philippine Wealth Balanced Fund - This Balanced Fund is designed to achieve long-term growth through both interest
income and capital gains with an emphasis on providing a modest level of risk. It seeks to manage risk by diversifying asset
classes and industry groups through investment in bonds issued by the Philippine government and equities issued by
Philippine corporations comprising the Philippine Stock Exchange Index.
c. Philippine Wealth Equity Fund - This Equity Fund seeks to achieve long-term growth of capital by investing mainly in
equities of Philippine corporations comprising the Philippine Stock Exchange Index. The fund aims to provide access to a
diversified portfolio of equities from different industries.
d. Opportunity Fund - This equity fund aims to achieve long term growth through capital gains and dividends by investing in
equities of Philippine corporations that will provide access to a diversified portfolio of equities from different industries.
e. Chinese Tycoon Fund - This equity fund aims to achieve medium to long term growth through capital gains and dividends
by investing in equities that will provide access to a management themed-portfolio reflective of the Chinese-Filipino
entrepreneurial spirit through strategic investments in Philippine companies from different industries.
f. Spanish American Legacy Fund - This equity fund aims to achieve medium to long term growth through capital gains and
dividends by investing in equities that will provide access to a management themed-portfolio through strategic investments
in Philippine companies from different industries with Spanish/American heritage.
4. The Bid Price of an Investment Fund is the price for cancelling a Unit of the Investment Fund as determined in accordance with the
Valuation provision.
5. The Offer Price of an Investment Fund is the price for creating a Unit of the Investment Fund as determined in accordance with the
Valuation provision.

Page 6 of 13 of Proposal No. 31973-201804080143-4-02

Printed on: 4/8/2018 01:44:54 PM Created on: 4/8/2018 1:43:51 PM Expiry Date: 7/8/2018
Version Number: 3.10.11 Date for Next Insurance Age: 4/30/2018
Plan Code: BAX/ Rider Code: WP, CCRP55
 Philippine Peso
for: LHEN ADAP, 44, Female, Non-smoker

Attached Supplements
Summary of the Riders Attached to this Proposal
1. CRITICAL CONDITIONS RIDER allows you to protect yourself from the unexpected cost of critical illness.

If you are diagnosed of having any of the following critical illnesses before age 55, AXA will pay the rider Sum Insured. This
advanced benefit will not in any way diminish your basic life insurance coverage.

CRITICAL CONDITIONS RIDER Premiums are payable up to age 55.

CRITICAL CONDITIONS COVERED

Group 1 Cancer Group 4 Critical Conditions related to the Group 7 Critical Conditions related to
1. Cancer nervous system immunology and rheumatology
19. Amyotrophic Lateral Sclerosis 44. Severe Rheumatoid Arthritis
Group 2 Critical Conditions related to organ 20. Apallic Syndrome 45. Systemic Lupus Erythematosus (S.L.E.)
failure 21. Bacterial Meningitis with Lupus Nephritis
2. Chronic Adrenal Insufficiency (Addison's 22. Benign Brain Tumor 46. Systemic Scleroderma
Disease) 23. Blindness
3. Chronic and Irreversible Kidney Failure 24. Brain Damage^ Group 8 Critical Conditions related to
4. Chronic Liver Disease 25. Encephalitis neurological degeneration
5. Coma 26. Motor Neuron Disease 47. Alzheimer’s Disease
6. End Stage Lung Disease 27. Multiple Sclerosis 48. Parkinson’s Disease
7. Loss of Independent Existence# 28. Muscular Dystrophy 49. Severe Creutzfeld-Jacob Disease (CJD)
8. Major Organ Transplantation 29. Paralysis
9. Medullary Cystic Disease 30. Poliomyelitis Group 9 Critical Conditions related to the
31. Progressive Bulbar Palsy musculoskeletal system
Group 3 Critical Conditions related to heart 32. Progressive Supranuclear Palsy^ 50. Amputation of Both Feet due to
and blood vessels 33. Spinal Muscular Atrophy Complication from Diabetes
10. Cardiomyopathy 34. Stroke 51. Major Burns
11. Coronary Artery Disease Requiring Surgery 35. Tuberculosis Meningitis 52. Necrotizing Fasciitis
12. Dissecting Aortic Aneurysm 53. Severance of Limbs
13. Eisenmenger’s Syndrome Group 5 Critical Conditions related to blood
14. Heart Attack 36. AIDS / HIV due to Blood Transfusion Group 10 Other Critical Conditions
15. Heart Valve Surgery 37. Aplastic Anemia 54. Deafness (loss of hearing)
16. Primary Pulmonary Arterial Hypertension 38. Occupationally Acquired AIDS / HIV 55. Elephantiasis
17. Severe Infective Endocarditis 39. Dengue Hemorrhagic Fever (Grades III 56. Loss of Speech
18. Surgery to Aorta and IV) 57. Terminal Illness

Group 6 Critical Conditions related to the

digestive system
40. Chronic Relapsing Pancreatitis
41. Fulminant Hepatitis
42. Severe Crohn’s Disease
43. Severe Ulcerative Colitis
#To be eligible to receive a benefit under this 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 Critical Condition, the Insured must be above age 5 at the time of first diagnosis.

Notes:
1. The rates shown, if any, are those currently in effect. The rates applicable upon renewal of this Rider will be those in effect at
the date of renewal
2. For a detailed description including exclusions and other provisions, please refer to the rider contract.

Page 7 of 13 of Proposal No. 31973-201804080143-4-02

Printed on: 4/8/2018 01:44:54 PM Created on: 4/8/2018 1:43:51 PM Expiry Date: 7/8/2018
Version Number: 3.10.11 Date for Next Insurance Age: 4/30/2018
Plan Code: BAX/ Rider Code: WP, CCRP55
 Philippine Peso
for: LHEN ADAP, 44, Female, Non-smoker

Critical Conditions Rider covers a total of 57 critical conditions. Here is a quick reference for the 16 most common critical conditions.

TOP 16 COVERED CRITICAL CONDITIONS

CONDITION WHAT IS COVERED WHAT IS NOT COVERED
1. Cancer Cancer, beginning stage 1* to stage 4, which meets • Tumors defined as benign, or pre-
the following criteria: malignant
• A malignant tumor • Non-invasive cancers in situ (pre-
• Confirmed by biopsy report cancer or Stage 0 cancer)
• Certified by an appropriate specialist • Certain Stage 1 cancer classifications
Types of Cancer include: Leukemia, Malignant in the contract for the following organs:
Lymphoma, Hodgkin’s Disease, Malignant bone ovary, prostate, urinary bladder, and
marrow disorders, Metastatic cancers thyroid
• Any skin cancer other than malignant
*except for certain stage 1 cancer classifications in melanoma
specified organs • Chronic Lymphocytic Leukemia less
than Rai Stage 3.
2. Stroke Evidence of irreversible death of brain cells due to a • Transient Ischaemic Attacks (TIA) or
blocked artery or ruptured blood vessel. temporary stroke-like signs and
symptoms
• Brain damage due to an accident or
injury, infection, vasculitis
(inflammation of blood vessels),
inflammatory disease or migraine
• Disorders of the blood vessels
affecting the eye including infarction of
the optic nerve or retina
• Ischemic disorders of the vestibular
system
• Silent stroke with no symptoms
3. Heart Attack Occurrence of death of a portion of the heart muscle • Any chest pain (i.e. angina) without
as a result of inadequate blood supply to the evidence of death or injury of the heart
relevant area. muscle
4. Coronary Artery Bypass An open heart surgery should have already been • All other procedures which do not
Graft Surgery (CABG) done to correct the narrowing or blockage of one or require open chest surgery and actual
more coronary arteries with bypass grafts. placement of bypass graft
5. Heart Valve Surgery An open heart valve surgery should have already • All repairs conducted through intra-
been done to replace or repair one (1) or more heart arterial catheter procedures
valves, as a consequence of defects.
6. Major Organ Recommendation from a specialist to undergo • Other transplants for organs not
Transplantation transplant for any of the following organs: mentioned in the list
• heart, lung, liver, kidney, pancreas, or human
bone marrow
7. Chronic and The following symptoms must be present: • At least one kidney is still functioning
Irreversible Kidney Failure • Both kidneys are characterized with and regular dialysis is not required.
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 • Dementia relating to alcohol, drug
intellectual capacity, due to irreversible failure of abuse or AIDS
brain function.
Note: The critical condition must occur 60 days after the policy’s effective date for the benefit to be payable. Benefits relating to Critical Conditions
are payable according to the definitions set out in the Rider contract.

Page 8 of 13 of Proposal No. 31973-201804080143-4-02

Printed on: 4/8/2018 01:44:54 PM Created on: 4/8/2018 1:43:51 PM Expiry Date: 7/8/2018
Version Number: 3.10.11 Date for Next Insurance Age: 4/30/2018
Plan Code: BAX/ Rider Code: WP, CCRP55
 Philippine Peso
for: LHEN ADAP, 44, Female, Non-smoker

TOP 16 COVERED 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 • Cysts, granulomas (inflammations),
in the brain. If it cannot be removed through surgery, malformations in, or of, the arteries or
the tumor should cause significant and permanent veins of the brain, hematomas
neurological deficit persisting for at least 6 (collection of blood outside the blood
consecutive months. vessels) and tumors in the pituitary
gland or spinal cord
12. Paralysis Inability of two (2) or more limbs to function totally • Paralysis in 1 limb
and 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) • Independent capability to perform 4 or
Existence Activities of Daily Living (ADLs)1, as certified by a more ADLs
medical specialist 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 • Only one joint area is affected and the
Arthritis more of the following joint areas: hands, wrists, Insured can still perform 3 or more
elbows, knees, hips, ankle, cervical spine or feet; ADLs.
and inability to perform 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 • Loss of either one (1) hand or one (1)
due to illness or accident only. This includes the foot only.
loss of use of both hands or both feet or the use of
one (1) hand and one (1) foot.
16. 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.
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 for the corresponding benefit to be payable. Benefits relating to all
Critical Conditions are payable according to the definitions set out in the Rider contract.

Page 9 of 13 of Proposal No. 31973-201804080143-4-02

Printed on: 4/8/2018 01:44:54 PM Created on: 4/8/2018 1:43:51 PM Expiry Date: 7/8/2018
Version Number: 3.10.11 Date for Next Insurance Age: 4/30/2018
Plan Code: BAX/ Rider Code: WP, CCRP55
 Philippine Peso
for: LHEN ADAP, 44, Female, Non-smoker

2. WAIVER OF PREMIUM waives premium payments in the event you are suddenly unable to work and pay for the premiums
because of a disability. In effect, with a Waiver of Premium supplement, your policy will be allowed to continue as if premiums
are regularly and continuously paid.

The premium term of the supplement for waiver of premium is the same as the premium term of the plan to which the
supplement for waiver of premium is attached.

3. The Index-linked Increase Endorsement (IIE) allows you to increase your insurance benefits at the rate of inflation with no
additional medical or processing requirements so you can be sure the value of your benefits cope with future costs.

NOTES:
1. The rates shown, if any, are those currently in effect. The rates may change subject to the approval of the Insurance Commission.
2. For a detailed description of the Supplements, including exclusions and other provisions, please refer to the policy contract.

Page 10 of 13 of Proposal N 31973-201804080143-4-02

Printed on: 4/8/2018 01:44:54 PM Created on: 4/8/2018 1:43:51 PM Expiry Date: 7/8/2018
Version Number: 3.10.11 Date for Next Insurance Age: 4/30/2018
Plan Code: BAX/ Rider Code: WP, CCRP55
 Philippine Peso
for: LHEN ADAP, 44, Female, Non-smoker

DECLARATIONS AND ACKNOWLEDGMENTS

DECLARATIONS

1. It is my understanding that the total premium I am going to pay when I purchase this plan shall consist of the Life BasiX premium, regular
top-up premium, and Supplement premiums shown above, if any. I was also made aware that only the Life BasiX premium and top-up
premiums will be allocated to purchase units of the investment fund/s I will choose.
2. I confirm having read and understood the information in this proposal. My Financial Advisor/Financial Executive fully explained to me the
features and charges that will be made on my plan, and that the actual variable plan benefits will reflect the actual investment experience of
the separate account into which my fund is invested. I also confirm that I will fully assume all investment gains / risks associated with the
purchase of this plan.
Acknowledgment of Variability
Variable Life Insurance Plan
I acknowledge that:

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

I understand that since fund performance may vary, the values of my units are not guaranteed and will depend on the actual performance at
that given period and that the value of my Policy could be less than the capital invested. The unit values of my Variable Life Insurance are
periodically published.

I understand that the investment risks under the Policy are to be borne solely by me, as the policyholder.
Product Transparency Declaration

By signing off on the items listed below, I acknowledge that the same have been discussed with and thoroughly explained to me.
· I understand that I am buying an investment-linked insurance product.
· I understand that the principal and earnings are not guaranteed and that the value of my unit investment (NAVPU) may go up or down depending on
the performance of the separate funds.
· I understand that the funds will be invested in Equities and/or Bonds or a combination thereof, and will be subject to changes in market conditions.
· The available funds and the risks that they bear have been thoroughly discussed with me, and I have made my Fund Allocation decision based on my
own judgment of and tolerance for these risks.
· I understand that this product is appropriate for a long-term investment horizon.
· I understand that I will have zero (0) withdrawal value during the first two (2) years of the policy because the amount withdrawn will be subject to
100% surrender charge on the first two (2) years.

CONFORME: These declarations and acknowledgments 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

TO BE FILLED UP BY AXA PHILIPPINES

_________________________ _________________________
These declarations and acknowledgments are valid for _________________________ _________________________
the following policy/ies with policy number/s: _________________________ _________________________
Disclosure of Conflict of Interest

The Company adopts a Conflict of Interest Policy and undertakes to disclose any material information which gives rise to actual or potential conflict of interest to
our customers. Company likewise takes all reasonable steps to ensure fair dealings with our customers.

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. 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. Investment or participation in the Fund(s) is subject to risk and possible loss of
principal. Please carefully read the policy and endorsements and consider the investment objectives, risks, charges and expenses before investing. You should
seek professional advice from your financial, tax, accounting or legal consultant before making an investment. Past performance is not indicative of future
performance.

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 11 of 13 of Proposal N 31973-201804080143-4-02

Printed on: 4/8/2018 01:44:54 PM Created on: 4/8/2018 1:43:51 PM Expiry Date: 7/8/2018
Version Number: 3.10.11 Date for Next Insurance Age: 4/30/2018
Plan Code: BAX/ Rider Code: WP, CCRP55
 Reference no.: 31973-201804080143-4-
02
INVESTMENT PORTFOLIO RISK ASSESSMENT
You prefer a growth investment portfolio
Growth Investment Portfolio : A growth investment portfolio is characterized by a willingness to accept higher than
average level of risks and price volatility in pursuit of above average returns.

- You understand that investing allows for higher returns than savings, but there is a risk that your investments
might yield negative returns and the value of your investments can even be lower than the amount you
invested
- You understand that diversifying your investments over different equity funds and bond funds reduce the
volatility of the average annual returns on your investments
- You understand that a market can be volatile and that a longer holding period in general reduces the risk of
negative average annual returns
- You prefer the possibility of a higher average annual return on your investments even if this means that there
is a probability of higher negative return in any given year.

INVESTMENT PORTFOLIO RISK ACKNOWLEDGMENT

I acknowledge that the descriptions above match the risk profile of my intended investment portfolio. I also
acknowledge that the recommended fund allocation ranges resulting from my investment portfolio risk profile is only
intended as reference to help me assess my investment portfolio’s risk appetite and investment objectives.

WAIVER FOR RISK PORTFOLIO RE-CLASSIFICATION (For Clients Investing in Products with Different Risks)

I waive the results of my investment portfolio risk profile assessment and have decided to invest instead in another
investment fund or a combination investment funds which falls outside of the recommended fund allocation ranges
indicated by my investment portfolio risk profile.

INVESTMENT POLICY STATEMENT

I acknowledge that my fund allocation represents the Investment Policy of my portfolio. I have carefully read and
understood the investment objective(s) of my selected fund(s) as well as the risk(s) that it(they) bear(s).

Conforme:

Applicant/Policy Owner Date

Signature over Printed Name
 Reference Number: 31973-201804080143-4-02

FINANCIAL UNDERSTANDING SUMMARY

Dear LHEN

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 60,000.00, and after taking into consideration your objectives, risk
profile and priorities, you have selected Life BasiX for your Income Protection need.

The details of your insurance coverage and your insurance premium are summarized in your
Life BasiX sales illustration.

ESPANO, KATRINA MENDOZA

214002
31973

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.