CORPORATE SOLUTIONS

REQUEST FOR PROPOSAL

Source of Business CSE/CRE Code Intermediary Franchise No.

Agency

1 GENERAL INFORMATION
1.1 Company Information
Company Name* Local
MNC
Business Address*

City/Province* Country Zip Code

Business Phone Facsimile No. Website

Exact Nature of Business* No. of Years in Business Total No. of Employees*

Contact Person* Designation* Email Address *

1.2 Affiliates and Subsidiaries

Name of Affiliates/Subsidiaries* Exact Nature of Business* Est. No. of Employees*

2 INFORMATION ON INSURANCE POLICIES

A. LIFE/ACCIDENT
Does the company have an existing Group Life/Personal Accident plan?*
If yes, who is the present carrier?
Is there an intermediary?* None/Direct
If yes, who?
Type of Policy:*
What are the riders under the plan?

Renewal Date of Policy:* / / No. of insured yrs:

yyyy/mm/dd
Current Benefit Schedule:*

Claims experience for the past years:*

For us to provide the most effective quote, please provide details as stated in Part 5.
Otherwise, please provide all acquired data in the space below:

* Required field
If the space provided above is insufficient, please use a separate sheet and append to the form.
 B. MEDICAL
Does the company have an existing Group Medical plan?* No
If yes, who is the present carrier?
Is there an intermediary?* None/Direct
If yes, who?
Type of Policy:*
What are the riders under the plan?

Renewal Date of Policy:* / / No. of insured yrs:

yyyy/mm/dd

Current Benefit Schedule:*

Claims experience for the past years:*

For us to provide the most effective quote, please provide details as stated in Part 5.
Otherwise, please provide all acquired data in the space below:

3 INFORMATION ON INSURANCE POLICIES

What insurance plan/s do you want us to quote?
Group Term Life (Please accomplish GTL-Pages 2 to 4)
Corporate Personal Accident (Please accomplish CPA-Pages 2 to 4)
Group Medical (Please accomplish GM-Pages 2 to 4)

* Required field
If the space provided above is insufficient, please use a separate sheet and append to the form.
 3 POLICY INFORMATION (cont'd)
Proposed Plan: GROUP TERM LIFE
What riders shall be included? Please check the requested benefits:*
Total & Permanent Disability - Lumpsum
Total & Permanent Disability - Income Benefit
Accidental Death & Dismemberment (Short-Scale ADD)
Accidental Death, Dismemberment & Disablement (Long-Scale ADD)
Accidental Medical Reimbursement
Accidental Daily Hospital Income
Accidental Burial Expense
Terminal Illness Benefit / Living Benefit Rider
Hospital Income Benefit (Accident & Illness)
Family Assistance Benefit
Critical Illness Benefit (please select specification)
How many illnesses to be covered? How long is the waiting period?
Cancer Only 90 days
7 Critical Illnesses 180 days
15 Critical Illnesses
35 Critical Illnesses
Who will insured under the plan?*
Employees Members
If we will not cover for Employees, please submit a Non-Employer-Employee Questionnaire (NEEQ).
Shall the coverage be extended to Dependents of the Principal? No

For us to provide the most effective quote, please provide a list of employees/member containing the
following information (in Excel file):*
1. Name and/or unique identification number
2. Date of Birth
3. Gender
4. Occupation
5. Rank or Level (if coverage is based on an employee's job rank)
6. Salary of the Employee (if coverage is based on multiples of salary)
Who will pay for the premium?* Employer/Group Shared with the Employee/Member
What will be the participation of the plan?* Compulsory Voluntary
What is the proposed mode of payment?*
Annual Semi-Annual Quarterly Monthly
Will we take over their existing insurance plan?* No
If yes, which are the items we will take over? (Please append a copy of their existing insurance plan.)
Coverage of the existing employees. Please provide last policy year's billing with medical rating.
Suicide clause and contestability period
No Evidence Limit NEL
Others (Please specify on the Additional Notes/Remarks portion below.)
If the proposed Assured is a special risk, please accomplish the following form/s:
» Aviation Questionnaire
» Oil & Gas Questionnaire

Additional Notes/Remarks:

* Required field
If the space provided above is insufficient, please use a separate sheet and append to the form.
* Required field
If the space provided above is insufficient, please use a separate sheet and append to the form.
4 SCHEDULE OF BENEFITS
1 OPTION 1
Is this your current benefit schedule? No
1 2 3 4 5
Benefit
Option 1 Option 2 Option 3 Option 4
Group Term Life (GTL)
Total & Permanent Disability (TPD) -
Lumpsum Benefit
Total & Permanent Disability (TPD) -
Income Benefit
Accidental Death & Dismemberment
(short-scale ADD)
Accidental Death, Dismemberment & Disablement
(long scale-scale ADD)
Accidental Medical Reimbursement (AMR)
Accidental Daily Hospital Income (ADHI)
Accidental Burial Expense (ABE)
Terminal Illness Benefit (TIB) /
Living Benefit Rider (LBR)
Hospital Income Benefit (HIB) - Accident & Illness
Family Assistance Benefit (FAB)
Critical Illness Benefit (CIB)
Special Notes/Instructions on the benefits:
6
5 DETAILED CLAIMS HISTORY
Please provide Claims History (both paid and pending) for the most effective quote:

Claims (by product)

No. of
Policy Period Others Premium Total Sum Assured
insured LIFE/TPD ADD/ADDD
(provide details)

Example:
07/01/11 - 06/30/12 102 200,000.00 100,000.00 500.00 (ADHI) 25,631.24 10,200,000.00
07/01/12 - 01/22/13 125 300,000.00 0.00 10,000.00 (AMR) 28,006.61 12,500,000.00
 6 PROPOSAL - FRONT PAGE
Please provide the details in the Sales portion of the proposal (required items in red font):

======================================================================================

JUAN DELA CRUZ

President
ABC COMPANY
RGG Building, 71 Kamias Rd., Quezon City

Thru: AGENT NAME

AGENCY NAME

Dear Mr. Dela Cruz,

Thank you for giving us the opportunity to submit to you our Group Life Insurance Proposal for the benefit of
your company employees, for your review and consideration.

You can find in this proposal our product benefits, proposed rates and requirements. Details of our offer are on
the succeeding pages.

We are more than happy to meet with you at your most convenient date and time to discuss all of these in detail.
Should you have clarifications or need more information, please do not hesitate to get in touch with us at
09xx-xxxxxxx or xxxx-a.xxxx@PHILAMLIFE.COM.PH, through your servicing agent, Agent Representative.

It will be our privilege to serve the group insurance needs of your company.

Sincerely yours,

Julius Christian A. De Sagun

Corporate Sales Executive
Corporate Solutions

Noted by:
Justine Daguman
Head of Corporate Solutions Agency Sales
================

Proposal for the benefit of

Details of our offer are on

iscuss all of these in detail.

o get in touch with us at
ent Representative.
 QUESTIONNAIRE FOR NON-EMPLOYEE-EMPLOYER GROUP
Corporate Solutions

Name of Organization

Name of Contact Person Designation

Address Tel. No. Fax No.

1. Is the organization registered with Securities and Exchange Commission? Yes No

(If yes, Please fill in the necessary information)
Date of Registration SEC Registration Number
2. Please provide details about the nature if business of the organization. What services do they provide? What are the
objectives of the organization? What is the geographical extent of their operations?

3. How does the organization generate funds?

4. Who will shoulder the insurance expenses?

Others, please
The Organization The Members
specify
5. What is the average age of the members? years old

6. What are the occupations of the members?

7. What are the qualifications required and screening procedures done by the organization in accepting their
members?

8. How does one cease to be a member?

9. Does the organization have an office/admin staff?

If yes, are the staff:
Salaried Employees (not members) Member volunteers (not salaried)
Salaried Members (both a member and employee)

10. What benefits, if any, are enjoyed by the members/staff?

Certified True and Correct:

Signature over Printed Name/Designation

Note: This questionnaire is meant to assess the eligibility of your organization. It does not replace any requirements needed to generate a proposal.