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    Financial Questionnaire

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    Fluellen Besitan
    This document is a personal financial questionnaire to be filled out for life insurance applications over 10 million pesos. It collects information about the proposed insured and owner/payor's income, assets, liabilities, existing insurance coverage, estate tax obligations, amount of insurance applied for, and purpose of insurance. The applicant must provide details about their capital needs, estate plan, and loans. Both the proposed insured and owner/payor must sign to confirm the accuracy of the information provided, which will become part of the life insurance application.

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    Download as PDF, TXT or read online from Scribd

    Financial Questionnaire

    Uploaded by

    Fluellen Besitan
    52 views1 page
    This document is a personal financial questionnaire to be filled out for life insurance applications over 10 million pesos. It collects information about the proposed insured and owner/payor's income, assets, liabilities, existing insurance coverage, estate tax obligations, amount of insurance applied for, and purpose of insurance. The applicant must provide details about their capital needs, estate plan, and loans. Both the proposed insured and owner/payor must sign to confirm the accuracy of the information provided, which will become part of the life insurance application.

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    Financial Questionnaire

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    This document is a personal financial questionnaire to be filled out for life insurance applications over 10 million pesos. It collects information about the proposed insured and owner/payor's income, assets, liabilities, existing insurance coverage, estate tax obligations, amount of insurance applied for, and purpose of insurance. The applicant must provide details about their capital needs, estate plan, and loans. Both the proposed insured and owner/payor must sign to confirm the accuracy of the information provided, which will become part of the life insurance application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    52 views1 page

    Financial Questionnaire

    Uploaded by

    Fluellen Besitan
    This document is a personal financial questionnaire to be filled out for life insurance applications over 10 million pesos. It collects information about the proposed insured and owner/payor's income, assets, liabilities, existing insurance coverage, estate tax obligations, amount of insurance applied for, and purpose of insurance. The applicant must provide details about their capital needs, estate plan, and loans. Both the proposed insured and owner/payor must sign to confirm the accuracy of the information provided, which will become part of the life insurance application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    PERSONAL FINANCIAL QUESTIONNAIRE

    To be filled out for total amount at risk above Php10 Million, including coverage/s from other Insurer/s

    Name of Proposed Insured: ________________________________________________________

    Name of Owner/Payor: ________________________________________________________


    (if other than the Proposed Insured)

    Policy Number: _______________________________________________


    Proposed Insured Financial Info (Amount in Pesos) Owner/Payor Financial Info (if other than the
    Proposed Insured) (Amount in Pesos)
    1. Earned annual income from all sources 1. Earned annual income from all sources
    (salaries, commissions, others):________________________ (salaries, commissions, others):________________________

    Unearned income Unearned income


    (dividends, rent, others) : _____________________________ (dividends, rent, others) : _____________________________

    2. Net worth (assets minus liabilities). Provide details in 2. Net worth (assets minus liabilities). Provide details in
    Question 7. Question 7.

    3. Existing insurance coverage: 3. Existing insurance coverage:


    Personal Insurance ________________________ Personal Insurance ________________________

    Business Insurance ________________________ Business Insurance ________________________


    4. Potential Estate Tax Liabilities: 4. Potential Estate Tax Liabilities:

    5. Amount of insurance currently applied for: 5. Amount of insurance currently applied for:

    6. Purpose of insurance (please tick all that apply): 6. Purpose of insurance (please tick all that apply):
    □ Family protection □ Family protection
    □ Children’s education fund □ Children’s education fund
    □ Estate planning (provide details in Question 7) □ Estate planning (provide details in Question 7)
    □ Mortgage loan (provide name of lender, address □ Mortgage loan (provide name of lender, address
    of property, amount, tern and purpose of loan in of property, amount, tern and purpose of loan in
    Question 7) Question 7)

    □ Business insurance □ Business insurance


    □ Others (provide details in Question 7) □ Others (provide details in Question 7)
    7. Please indicate Capital Needs Analysis and additional 7. Please indicate Capital Needs Analysis and additional
    remarks that may be relevant to the application: remarks that may be relevant to the application:
    __________________________________________ __________________________________________

    ______________________________________ ______________________________________

    ______________________________________ ______________________________________

    I/We have read the above questions, statements and answers and they are complete and true based on my/our personal knowledge.
    I/We understand that this will form part of my/our application for insurance with The Manufacturers Life Insurance Company (Phils).

    ______________________________________________________ ________________________________________________________
    Proposed Insured’s signature over printed name Owner/Payor’s signature over printed name
    (if other than the Proposed Insured)
    ___________________________________________________________
    Financial Advisor’s signature over printed name / FA code

    Date signed: ____________________________ Place signed: _________________________________________

    Form No. NB PFQ MP (v05/2016) Application No.

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