Withdrawal and Surrender Form (V. 03.2019)

The Manufacturers Life Insurance Co. (Phils.), Inc.
Head Office: 10th Floor NEX Tower, 6786 Ayala Avenue, Makati City, 1229, Philippines
Customer Care: (02) 884-7000
Withdrawal/Surrender
Domestic Toll-Free: 1-800-1-888-6268
Website: www.manulife.com.ph
Email:[email protected]
Form
General Information
Policy No. Name of Policyowner (Last, First, Middle)
Email Address Mobile Number (Country Code, Area Code, Telephone Number)
Details of Withdrawal
Withdrawal from Dividends: Amount in Words:
Full Withdrawal
Partial Withdrawal Amount in Figures:
Withdrawal from Paid-up Addition

Withdrawal from Variable Life Funds: If partial withdrawal, please choose one:
1. Fund Name: ________________________________________ Percentage: ____________________ Units: ____________________
Full Withdrawal Partial Withdrawal Amount: ______________________________________________________
2. Fund Name: ________________________________________ If partial withdrawal, please choose one:

Full Withdrawal Partial Withdrawal Percentage: ____________________ Units: ____________________
Amount: ______________________________________________________
3. Fund Name: ________________________________________

If partial withdrawal, please choose one:
Full Withdrawal Partial Withdrawal
Percentage: ____________________ Units: ____________________
Amount: ______________________________________________________
Full Withdrawal/Surrender of Policy

Reasons for surrender:
____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
Release Instructions
Pay for policy number: ________________________________________ Currency Account Name:
Premium Loan Both Peso (Php)
Dollar (USD) Account Number:
Deposit to my account: * Please make sure that your bank account details are updated and accurate
to avoid unnecessary delay in funds disbursement.
Bank: BPI China Bank Others
* Charges may apply for other banks.
BDO UnionBank ______________
_
Form No. MP CPA WS (v. 03/2019) Page 1 of 2

The Manufacturers Life Insurance Co. (Phils.), Inc.
Head Office: 10th Floor NEX Tower, 6786 Ayala Avenue, Makati City, 1229, Philippines
Customer Care: (02) 884-7000
Withdrawal/Surrender
Domestic Toll-Free: 1-800-1-888-6268
Website: www.manulife.com.ph
Email:[email protected]
Form
Reminders
1. Your Manulife policy is intended to secure your financial needs over the long term. If you surrender your policy, you will lose benefits in terms of price and other
features of your policy. If you have a traditional life policy, you may consider applying for a policy loan or conversion instead, if applicable. We strongly
encourage you to consult your Financial Advisor or any of our Customer Service Officers before you proceed.
2. Withdrawal depends on the type of policy you have. Withdrawal from Dividends and Paid-up addition will be applicable to traditional life products, while the
Withdrawal from variable life funds will be used for variable life products.
3. Partial withdrawals may have the minimum withdrawal amounts or maintaining balance requirements, depending on the product.
4. For Fund Withdrawals, please indicate the fund name and choose if you want to withdraw by percentage, units or amount.
5. Units will be cancelled at the bid prices applicable on the next valuation date provided this request is received on or before the cut-off schedule.
6. If your product has a Level Death Benefit Option (Type II), your Death Benefit may be reduced by at most 125% of the amount of your withdrawal.
Declaration and Agreement

1. The undersigned persons hereby certify that each of them is of legal age.
2. I confirm that the information I provided, including bank details, if applicable, are accurate and up to date. I will not hold Manulife responsible for any loss or
liability as a result of the information provided in this form.
3. I am not an undischarged bankrupt nor have committed any act of bankruptcy within the last twelve (12) months and that no receiving order or adjudication
order in bankruptcy has been made against me are currently pending during that period.
4. I agree that this transaction will be an amendment to the policy and will form part of the original application.
5. I am fully aware that partially withdrawing dividends may cancel the Self-Liquiditating Policy Option (if applicable) should the dividends become insufficient to
pay for premiums due.
6. I authorize Manulife to correct or complete this request should there be errors or omissions discovered by Manulife. I accept the changes to the
Policy/Agreement based on these corrections, which are stated in the space below.
7. I am releasing Manulife from any liability after the cash value/account value has been paid/released.
8. By signing on this form, I confirm that the information I provided is complete and true. I also agree and understand that Manulife collects and uses personal
and sensitive information to operate and insurance business. By signing this form and continuing avail of the company's products and services, I agree that the
information I provided and any subsequent changes to it (including the information of third parties) can be processed, shared, disclosed, transferred or used by
the company, including its shareholders, directors and employees, affiliates, subsidiaries, business partners, any member of the Manulife Group of Companies
(including those located overseas), advisors, representatives, industry associations and databases, local and foreign authorities having jurisdiction over
companies within Manulife Group of Companies, external auditors/counsels, and its third party service providers (whether within or outside the Philippines)
within the rules set by the Data Privacy Act of 2012, as may be amended from time to time, relevant regulations and the Company's privacy policy available at
www.manulife.com.ph/Customer-Privacy-Policy for purposes of:
§ underwriting and approving my application;
§ administering, serving and reinsuring my policy;
§ marketing (including marketing of products and services offered by any member of the Manulife Group of Companies and those of our business partners),
promoting, getting feedback on our products and services, and measuring client satisfaction;
§ conducting data analytics and doing automated data processing;
§ preventing money laundering or terrorist financing activities;
§ complying with repertorial and regulatory requirements of both local and foreign regulatory authorities (including local and foreign tax authorities and stock
exchanges) as well as other legal, regulatory or contractual obligations of any member within the Manulife Financial Group, relating to information sharing,
tax reporting or otherwise;
§ the Companys internal purposes such as governance, risk, actuarial, claims and underwriting management, and reporting; and for other reasonable purposes
related to the services provided.
Signatures over printed names:
_________________________________________________________ ____________________________ _________________________________

Policyowner Date Signed (mm/dd/yyyy) Place Signed
_______________________________________ _________________________________________ ________________________________________

Assignee (if any) Irrevocable Beneficiary (if any) Irrevocable Beneficiary (if any)
For Manulife use only

Valid IDs: Type: _____________________________ ID#___________________________________ Documents Presented: _______________________________________________________
Documents received and validated by: _______________________________________________________ _____________________________________________ ___________________________
Name of CSO Branch Date (mm/dd/yyyy)
Form No. MP CPA WS (v. 03/2019) Page 2 of 2

Withdrawal and Surrender Form (V. 03.2019)

Uploaded by

Copyright:

Available Formats

Withdrawal and Surrender Form (V. 03.2019)

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Withdrawal and Surrender Form (V. 03.2019)

Uploaded by

Copyright:

Available Formats

The Manufacturers Life Insurance Co. (Phils.), Inc.

Withdrawal from Paid-up Addition

2. Fund Name: ________________________________________ If partial withdrawal, please choose one:

3. Fund Name: ________________________________________

Full Withdrawal/Surrender of Policy

Form No. MP CPA WS (v. 03/2019) Page 1 of 2

Declaration and Agreement

Signatures over printed names:

_________________________ _

___________________ _ ____________________

For Manulife use only

Form No. MP CPA WS (v. 03/2019) Page 2 of 2

You might also like