Policy Acknowledgement Receipt: Received by Owner

Policy Acknowledgement Receipt
OWNER : MS. AMYLYNN BALUBAR ALBERTO
PROPOSED INSURED : MS. AMYLYNN BALUBAR ALBERTO
POLICY NUMBER : 51271448
PLAN NAME : Set for Life
ADDRESS : BLK 1 LOT 15 DASMARINAS TOWNSVILLE, SABANG, DASMARIñAS CAVITE 4114
This is to acknowledge the receipt of the above policy contract while the Proposed Insured and/or Owner are both alive
and in good health.
RECEIVED BY OWNER :
FULL NAME and SIGNATURE :
DATE RECEIVED :
RECEIVED BY OWNER's AUTHORIZED REPRESENTATIVE: :
RELATIONSHIP TO OWNER :
FULL NAME and SIGNATURE :
DATE RECEIVED :
DELIVERED BY :
FULL NAME and SIGNATURE of SOLICITING AGENT :
DATE OF DELIVERY :
THIS PORTION IS FOR COURIER SERVICES ONLY
Received at given address
Given address not found
Policy Owner moved out of given address
No person to receive at given address
Others (please specify) :
FULL NAME OF MESSENGER :
DATE OF DELIVERY :
August 13, 2019
MS. AMYLYNN BALUBAR ALBERTO
TOWNSVILLE, SABANG, DASMARIñAS

CAVITE 4114
Dear MS. ALBERTO,
SET FOR LIFE 51271448
On behalf of FWD, we'd like to take this opportunity to welcome you as a new customer.
You have taken an important step by looking after your financial well-being with SET FOR LIFE.
Your cover is effective as from August 13, 2019.
Attached is a copy of your Policy Contract which provides the features and benefits of SET FOR LIFE along with the terms and
conditions. You will receive the Unit Statement within thirty (30) days from the date of this letter.
Kindly email [email protected] or send back the Policy Acknowledgement Form enclosed herein to acknowledge
receipt of this Policy Contract. If SET FOR LIFE does not meet your needs, you may cancel your policy in writing within fifteen (15)
days from receipt of your Policy Contract.
Your Financial Planner / Financial Solutions Consultant LOUISE ELIESSE BALDEA GO is available on to assist you with your
queries. You can also contact Customer Connect on (632) 888-8388 Monday to Friday between 8am to 5pm.
Again, welcome to FWD. We look forward to helping you meet your financial needs now and in the future.
Get ready to live!
Sincerely yours,
Peter Karl Grimes

President and CEO
FWD Life Insurance Corporation
This is a system-generated correspondence. If issued without alteration, this does not require a signature.
Cc: LOUISE ELIESSE BALDEA GO

10005300
AGENCY
Policy Data Page
Date: 13 AUGUST 2019
POLICY OWNER: MS. AMYLYNN BALUBAR ALBERTO PLAN NAME: SET FOR LIFE
INSURED: MS. AMYLYNN BALUBAR ALBERTO POLICY NUMBER: 51271448
POLICY INFORMATION
Years Premium Payment Form
Plan Name Risk Class Issue Age Status
Payable Frequency Number
SET FOR LIFE 10 Years Monthly STANDARD 36 RPVULAG.03.2017 Active
SUPPLEMENTARY BENEFITS
FWD CRITICAL ILLNESS BENEFIT STANDARD 36 CIBVUL.01.2017 Active
RIDER FOR UL
POLICY BENEFITS
Benefit Description Benefit Period Effective Date Expiry Date Sum Assured (in PHP)
SET FOR LIFE* To Age 100 13 AUG 2019 13 AUG 2083 1,000,000.00
SUPPLEMENTARY BENEFITS
FWD CRITICAL ILLNESS BENEFIT RIDER To Age 70 13 AUG 2019 13 AUG 2053 500,000.00
FOR UL
*The Death Benefit is subject to the provisions of Section 15.
SCHEDULE OF POLICY PREMIUMS (in PHP)

Annual Semi-Annual Quarterly Monthly
REGULAR PREMIUMS PAYABLE 42,000.00 21,000.00 10,500.00 3,499.00
FWD CRITICAL ILLNESS BENEFIT RIDER FOR UL
TOTAL PREMIUMS 42,000.00 21,000.00 10,500.00 3,499.00
TOTAL PREMIUM FOR MODE CHOSEN & DUE DATE PHP 3,499.00 Every 13th of the month
INVESTMENT FUND DETAILS

Investment Fund Allocation Rate
FWD Peso High Dividend Equity Fund 100.00%
POLICY CHARGES
Premium Charge rate (as % Regular Premium)
First Year 90.00%
Second Year 60.00%
Third Year 35.00%
Fourth Year and Subsequent Policy Years 0.00%
Premium Charge rate (as % of Regular Top-Up Premium and % of Lump Sum Top-Up Premium) 5.00%
Fund Switching Charge rate (as % of amount switched)
First to Sixth per policy year via online facility Free
All others 1.00%
Fund Management Charge (as % of Account Value per annum)
FWD Peso Balanced Fund 2.00%
FWD Peso Fixed Income Fund 1.75%
FWD Peso Equity Fund 2.00%
FWD Peso Stable Fund 2.00%
FWD Peso Bond Fund 1.75%
FWD Peso Growth Fund 2.00%
FWD Peso High Dividend Equity Fund 2.00%
FWD Peso Equity Index Fund 1.50%
Surrender Charge rate (as % of amount withdrawn)
For all Policy Years NIL
THE DOCUMENTARY STAMP TAX OF THIS POLICY HAS BEEN PAID.
Page | i
Regular Pay Variable Life Insurance Plan
Policy Contract
FWD Life Insurance Corporation shall pay the Benefits provided by this Policy to:
· the Owner if the Insured is alive, or;
· the surviving Beneficiaries if the Insured dies
subject to the terms and conditions set forth in this Policy.
Peter Karl Grimes

President and Chief Executive Officer
Table of Contents
PAGE
POLICY DATA PAGE i
INSURANCE BENEFIT 1
DEFINITIONS 3
GENERAL PROVISIONS
1 Entire Insurance Contract 5
2 Effectivity of the Policy 5
3 Ownership 5
4 Non-Participating 5
5 Currency and Place of Payment 5
6 Cooling Off Period 5
7 Assignment 6
8 Misstatement of Age and/or Sex 6
9 Incontestability 6
10 Suicide 6
11 Beneficiary 7
12 Premiums 7
13 Reinstatement 8
14 Charges 9
15 Death Benefit 10
16 Claim Settlement 10
17 Termination of the Policy 11
18 Funds 11
19 Deferment and Limitation 12
20 Surrender and Withdrawals 13
21 Fund Switch 13
22 Change of Fund Allocation Rate 14
23 Loyalty Bonus 14
24 Disclosures of Conflict of Interest 14
25 Limitation of Action 14
IMPORTANT NOTICE 15
Form Number: RPVULAG.03.2017 Page | 2

Definitions
“Application Form” refers to the form prescribed by FWD and completed and signed by the Owner and/or Insured, which
provides information about the physical and medical condition, any occupation and any avocation of the Insured. This form is
used to determine whether the Insured seeking insurance with FWD meets FWD’s underwriting requirements and to
determine the Insured’s appropriate risk class.
“Beneficiary” or “Beneficiaries” has the meaning set out in Section 11 Beneficiary.
“Benefit” refers to the Basic Plan and Supplementary Benefit/s if any.
“Contract Debt” has the meaning set out in Section 14 Charges.
“Death Benefit” has the meaning set out in Section 15 Death Benefit.
“Fund” or “Investment Fund” or “Variable Unit Linked Investment Fund” refers to any of the separate funds created by FWD
wherein the Owner’s Reg ular Premium , Regular Top-Up Premium/s if any and/or Lump Sum Top-Up Premium/s if any are
invested as defined in Section 18 Funds.
“Fund Account Value” has the meaning set out in Section 18 Funds.
“FWD” and “We” refer to “FWD Life Insurance Corporation”, a corporation organized and existing under Philippine law.
“Insurance Charges” has the meaning set out in Section 14 Charges.
“Insured” refers to the named Insured of this Policy as shown on the Policy Data Page.
“Lump Sum Top-Up Premium” refers to any unscheduled additional premium for this Policy which is paid by the Owner on top
of the Regular Premium and any Regular Top-Up Premium due.
“Monthly Anniversary” refers to the anniversary date of this Policy on succeeding calendar months determined fro m the
Effective Date. If there is no such date in any of the succeeding calendar months that corresponds to the same day as the
Effective Date, the Monthly Anniversary shall be on the last calendar day of such month.
“Next Valuation Date” refers to the Va luation Date that comes immediately after the approval date of any particular
transaction. Such transactions include, but are not limited to, creation of Units, lapsation, full withdrawal, partial withdrawal,
cancellation, and deduction of Charges, and should occur before the cut-off schedule determined by FWD.
“Owner”, “You” and “Your” refer to the Owner of this Policy as shown on the Policy Data Page.
“Policy Data Page” shows the Policy Information, the Schedule of Benefits of the Basic Plan and Supplementary Benefit/s if
any, the Schedule of Premiums, the Investment Fund Details, and the Charges Details. The Policy Information includes the
Insured, Owner, Regular Premium, Regular Top-Up Premium, Sum Assured, and Effective Date. The Schedule of Benefits
includes the Benefits, Benefit Amount, Expiry Date and Form Number of the Basic Plan and Supplementary Benefit/s if any.
The Schedule of Premiums include the Premium Due Dates. The Investment Fund Details includes the Funds and the Fund
Allocation Rate. The Charges Details includes the Premium Charge rate, the Fund Switching Charge rate and the Fund
Management Charge rate. FWD may update the contents of the Policy Data Page from time to time.
“Policy Year” refers to a period of twelve (12) months from the Effective Date of this Policy and every succeeding twelve (12)
month period thereafter.
“Premium Charge” has the meaning set out in Section 14 Charges.
“Regular Premium” refers to the scheduled premium payable for this Policy as shown in the Policy Data Page.

“Regular Top-Up Premium” refers to the scheduled additional premium for this Policy which is pa yable by the Owner in
addition to and at the same time as the Regular Premium.
“Sales Illustration” refers to the form attached to the Policy which p rovides information to the O wner about the product and
its Benefits. The Sales Illustration illustrates how the Death Benefit and the Total Account Value vary with assumed investment
return rates over specified Policy Years.
“Supplementary Benefit/s” refers to additional Benefits purchased separately from the Basic Plan to enhance or modify the
terms of this Policy. Supplementary Benefit/s if any and their corresponding Form Number/s are shown in the Policy Data
Page.
“Top-Up Premium” refers to the sum of any Regular Top-Up Premium paid and any Lump Sum Top-Up Premium paid.
“Total Account Value” refers to the total of all Fund Account Values applicable to this Policy. The Total Account Value on any
Valuation Date is determined and calculated as the Unit Price of each Fund for such Valuation Date multiplied by the number
of Units the Policy has of each corresponding Fund.
“Unit” refers to the unit of ownership in the Investment Fund.
“Unit Price” refers to the value of a unit of a givenFund determined pursuant to Section 18 Funds. This is the basis of purchasing
Unit/s to the Fund/s as well as for cancelling Unit/s from such Fund/s.
“Valuation Date” refers to the date wherein FWD calculates the Unit Price/s of a Unit of the Fund/s applicable to this Policy.

General Provisions
1. ENTIRE INSURANCE CONTRACT
This Policy Contract in paper or electronic form including the Application Form, the Sales Illustration, the Policy Data Page and
attached Supplementary Benefit/s if any together with any endorsements made by FWD shall constitute this Policy. Statements
by the Insured, or on his or her behalf, shall be considered as representations and not warranties. Any form that may be issued
at any time during the life of this Policy also becomes part of this Policy.
Only the President and C hief Executive Officer or officers duly authorized in writing by FWD have authority to modify this
Policy. Any such modification must be in writing and duly signed by the authorized officer.
2. EFFECTIVITY OF THE POLICY
This Policy becomes effective only upon the payment of the initial Regular Premium and any Regular Top-Up Premium and this
Policy’s delivery to the Owner while the Insured is alive and in good health. The Effective Date of this Policy shall be used to
determine Premium Due Dates, Monthly Anniversaries, Policy Years and Policy anniversaries.
3. OWNERSHIP
While the Insured is alive, the Owner can exercise every right, title, interest and privilege given by this Policy and its
Supplementary Benefit/s if any or allowed by FWD even without the consent of any revocable Beneficiary. In case the Owner
dies before the Insured, every right, title and interest shall automatically vest to the Insured.
However, the written consent of every designated irrevocable Beneficiary while alive must be obtained by the Owner in order
to exercise any right under this Policy.
4. NON-PARTICIPATING
This Policy does not participate in any surplus distribution of FWD. This Policy participates only in the performance of the
Investment Fund/s to which the coverage of this Policy is linked.
5. CURRENCY AND PLACE OF PAYMENT
All amounts payable either to or by FWD in relation to this Policy and Supplementary Benefit /s if any shall be in the currency
stated in the Policy Data Page.
Article 1250 of the Civil Code of the Philippines (Republic Act No. 386) which reads in part:
"In case an extraordinary inflation or deflation of the currency stipulated should supervene, the value of the currency at the
time of establishment of the obligation shall be the basis of payment."
is understood and agreed not to apply to any payments made or to be made either to or by FWD. All amounts payable by FWD
shall be paid only in the Philippines. This Policy shall be governed by and interpreted according to Philippine law.
6. COOLING OFF PERIOD
This Policy and/or Supplementary Benefit/s if any may be cancelled by the Owner's written request to FWD within fifteen (15)
days after receipt of th is Policy. This Policy is considered delivered to and deemed received by the Owner on the date shown
in the acknowledgement receipt when it is delivered via email, or at the postal address shown in the Application Form and
received by a person of suitable age and competence then present therein. This Policy shall be considered as received within
ten (10) days from the date of delivery by FWD if delivered by post.

On such cancellation, the amount refundable shall be the sum of:
i. Premium Charges and Insurance Charges; plus

ii. the Total Account Value calculated based on the Unit Price/s of the relevant Fund /s, as of the Next Valuation Date
following the receipt of written request for cancellation of this Policy.
If a claim for any Benefit has been received by FWD at any of its offices, no refunds can be made under this provision.
7. ASSIGNMENT
FWD is not bound by any assignment of this Policy unless duly endorsed on this Policy. FWD assumes no responsibility for the
effect, sufficiency or validity of any assignment. FWD has the right not to endorse any reassignment by any assi gnee.
8. MISSTATEMENT OF AGE OR SEX
If the age or sex of the Insured has been misstated, the Insurance Charges deducted from the Total Account Value shall be
adjusted using the correct age and sex, applicable risk class and applicable Cost of Insurance rate s of this Policy.
If at the correct age and sex, the Insured is not eligible for coverage, this Policy and its Supplementary Benefit/s if any shall be
terminated and the liability of FWD shall be limited to a refund of:

ii. the Total Account Value calculated based on the Unit Price/s of the relevant Fund /s, as of the Next Valuation Date
following FWD’s termination of this Policy due to misstatement of age or sex.
9. INCONTESTABILITY
Except for non-payment of Regular Premiums, or if the Total Account Value is insufficient to cover the Insurance Charges, or
any other grounds recognized by law or jurisprudence, FWD cannot contest this Policy after it has been in force during the
lifetime of the Insured for two (2) consecutive years from the Effective Date of this Policy or approval date of its last
reinstatement, whichever is later. The contestability period of two (2) years shall also apply to any increase in Death Benefit
due to payment of Top-Up Premium/s if any.
Where the initial coverage and/or any increase in the Death Benefit is not payable, the liability of FWD corresponding to the
excluded coverage shall be limited to a refund of:

ii. the Total Account Value calculated based on the Unit Price/s of the relevant Fund/s as of the Next Valuation Date
following FWD’s termination of such excluded coverage on this Policy.
10. SUICIDE
If the Insured dies as a result of suicide whilst sane within two (2) years of the Effective Date or the date of reinstatement of
this Policy, no Death Benefit shall be paid and FWD shall refund any Premium Charges and Insurance Charges deducted in the
preceding two (2) years plus the Total Account Value calculated on the Next Valuation Date following FWD’s receipt of written
notice of the Insured's death. Suicide committed in a state of insanity will be compensable regardless of the date of
commission.
The same shall apply with respect to any increase in the Death Benefit that results from Top-Up Premiums being paid if the
Insured dies as a result of suicide whilst sane within two (2) years of the Effective Date of that increase.

11. BENEFICIARY
The Beneficiaries are the surviving persons designated to receive the proceeds of this Policy upon the death of the Insured.
Unless otherwise changed, the Beneficiaries are as designated in the Application Form.
If all the Beneficiaries are designated as "revocable", the Owner may delete any Beneficiary or designate new Beneficiaries
and exercise any and all other rights, interests and privileges under this Policy while in force. If any Beneficiary is designated
as "irrevocable", the consent of all such irrevocable Beneficiaries while alive is required before the Owner can exercise any and
all rights, interests and privileges under this Policy.
Beneficiaries are classified either as a primary Beneficiary or as a contingent Beneficiary. Surviving Beneficiaries in the same
Beneficiary classification share equally in the Death Benefit proceeds for that Beneficiary classification, unless otherwise
specified.
The Death Benefit proceeds are payable to the primary Beneficiaries surviving at the death of the Insured. If no primary
Beneficiaries survive the Insured, the Death Benefit proceeds are payable to the contingent Beneficiaries surviving at the death
of the Insured.
If no contingent Beneficiaries survives the Insured, the Death Benefit proceeds are payable to the Owner, if alive, otherwise,
to any of the following surviving relations of the Insured as substitute Beneficiaries in the order named:
i. Legal spouse; then

ii. Legitimate child / children; then
iii. Illegitimate child / children; then
iv. Parent/s; then
v. Brother/s / Sister/s of the full blood; then
vi. Brother/s / Sister/s of the half blood.
If the primary Beneficiaries, contingent Beneficiaries, Owner, and substitute Beneficiaries do not survive the Insured, the Death
Benefits proceeds are then payable to the estate of the Insured.
The Owner can change any Beneficiary or Beneficiary designation by written notice satisfactory to FWD, together with the
written consent of all irrevocable Beneficiaries while alive, subject to any assignment of this Policy in the records of FWD. FWD
assumes no responsibility for the validity of any such written notice. If no change in Beneficiary or Beneficiary designation has
been made during the lifetime of the Insured, designation shall be deemed irrevocable.
A receipt for any Death Benefit proceeds under this Policy, signed by all Beneficiaries designated either in this Policy or in
accordance with this provision or by a duly authorized representative, shall be a good and valid discharge to FWD. The receipt
shall be final and conclusive evidence that such Death Benefit proceeds have been duly paid to and received by those lawfully
entitled to them, and that all claims and demands against FWD with respect to them have been fully satisfied.
12. PREMIUMS
Payment of Regular Premium

Regular Premiums shall be payable in accordance with the Schedule of Premiums. The Regular Premium, less any applicable
Premium Charges and any Contract Debt, shall be used to purchase Units at Unit Price/s of relevant Fund/s at the Next
Valuation Date following the date of receipt of such Regular Premium, in accordance with the Fund Allocation Rate specified
in the Policy Data Page or in any subsequent endorsement recorded with FWD.
Grace Period
All Regular Premium s, except for the Initial Regular Premium, must be paid not later than thirty-one (31) days after its due
date. Any outstanding Insurance Charges shall be deducted from any proceeds that may become payable during the thirty-one
(31) days Grace Period.

If Regular Premium payment is not received at the end of the thirty-one (31) days Grace Period and this Policy has a Total
Account Value, this Policy shall continue to be in force for the same Death Benefit for as long as the Total Account Value is
sufficient to pay for the Premium Charges and Insurance Charges. If this Policy's Total Account Value is insufficient to pay for
the Premium Charges and Insurance Charges , and Insurance Charges were not paid through Contract Debt, this Policy and
Supplementary Benefit/s if any shall immediately terminate at the end of the thirty -one (31) days Grace Period. A ny balance
remaining in the Total Account Value of this Policy shall be returned to the Owner.
Payment of Regular Top-Up Premium

Regular Top-Up Premium, if elected by the Owner, shall be due together with the Regular Premium. Regular Top-Up Premium,
less any applicable Premium Charges and any Contract Debt, shall be used to purchase Units at Unit Price/s of relevant Fund/s
at the Next Valuation Date following the date of receipt of such Regular Top-Up Premium , in accordance with the Fund
Allocation Rate specified in the Policy Data Page or in any subsequent endorsement recor ded with FWD.
The Minimum Death Benefit shall be automatically increased by 125% of each Regular Top-Up Premium paid. Regular Top-Up
Premiums do not increase the Benefit Amount of the Supplementary Benefit/s if any payable under this Policy.
Payment of Lump Sum Top-Up Premium

While this Policy is in force, the Owner may request for and upon approval by FWD pay a Lump Sum Top -Up Premium at any
time. Such Lump Sum Top -Up Premium, less any applicable Premium Charges and any Contract Debt, shall be allocated a nd
applied in accordance with the Owner's request on FWD's appropriate form to purchase Units at Unit Price/s of relevant Fund/s
at the Next Valuation Date subject to FWD's written approval and prevailing administrative rules and procedures at the time
of application.
Lump Sum Top-Up Premium shall be subject to FWD’s prevailing administrative rules on the minimum and maximum
requirements for Lump Sum Top -Up Premium. Each Lump Sum Top -Up Premium shall automatically increase the Minimum
Death Benefit by 125% of such Lump Sum Top -Up Premium amount paid. Lump Sum Top -Up Premiums do not increase the
Benefit Amount of any attached Supplementary Benefit/s . FWD reserves the right to require evidence of insurability or to
decline such payment of Lump Sum Top-Up Premium.
Premium Holiday
Premium Holiday is allowed as long as the Total Account Value is sufficient to cover the Premium Charges and Insurance
Charges when they fall due. This Policy can go into Premium Holiday:
i. automatically when Regular Premium /s and any Regular Top-Up Premium/s remains unpaid at the end of the Grace
Period; or
ii. upon the Owner's request.
After the Premium Holiday period, the Owner may resume payment of the Regular Premium/s and any Regular Top-Up
Premium/s due.
Subject to Grace Period and Contract Debt provisions, the Total Account Value may become insufficient to cover the Premium
Charges and Insurance Charges during the Premium Holiday period and may result to the termination of this Policy.
13. REINSTATEMENT
If this Policy terminates due to insufficient Total Account Value, this Policy may be reinstated within three (3) years from the
date of such termination provided that (i) the Insured is alive at the time of application and (ii) this Policy has not been
surrendered for its Total Account Value.
To apply for reinstatement, FWD requires the following:
i. a written application for reinstatement using the appropriate form; and

ii. satisfactory evidence of insurability; and
iii. receipt of payment of all amounts necessary to put this Policy in force.
This Policy shall be reinstated on the date on which FWD determines that the requirements have been met .
Subject to Section 9 Incontestability, any reinstated Policy shall only cover loss or insured events that occurred after the date
of approval of the reinstatement.
14. CHARGES
Unless otherwise stated and with at least one (1) month prior notice to the Owner, all charges and/or payments in this section
are subject to revision. A general change to charges and/or payments requires prior approval of the Insurance Commission.
Premium Charges
The Premium Charges consist of the following:
i. Regular Premium Charge. This is determined by multiplying the Regular Premium by the Premium Charge rate. The
Regular Premium Charge shall be deducted as follows:
a. If the Regular Premium is paid in accordance with the Schedule of Premiums, the Regular Premium Charge shall
be deducted from the Regular Premium amount received by FWD before purchasing Units at Unit Price /s of the
relevant Fund/s.
b. If the Regular Premium is not paid in accordance with the Schedule of Premiums and this Policy has sufficient
Total Account Value, the Regular Premium Charge shall be charged proportionately to the Fund Account Value
of each Fund in which the Owner has invested in, subject to the Grace Period provision in Section 12 Premiums.
Any premiums received after the Regular Premium Charge has been deducted from the Total Account Value and
before purchasing Units at Unit Price/s of relevant Fund/s shall be allocated to pay for (i) any Regular Premium/s
that fell due and remains unpaid, (ii) Regular Premium for the next Premium Due Date, less any applicable
Premium Charge and less any Contract Debt, if such premiums were received before the end of the Grace Period
of such Premium Due Date, and (iii) Top-Up Premium less any applicable Premium Charge.
c. If the Regular Premium is not paid in accordance with the Schedule of Premiums and this Policy has insufficient
Total Account Value to cover the Regular Premium Charge, this Policy shall terminate subject to the Grace Period
provision in Section 12 Premiums.
ii. Regular Top-Up Premium Charge. This is determined by multiplying the Regular Top-Up Premium by the Premium
Charge rate. The Regular Top-Up Premium Charge shall be deducted from the Regular Top -Up Premi um amount
received by FWD before purchasing Units at Unit Price/s of the relevant Fund/s.
iii. Lump Sum Top-Up Premium Charge. This is determined by multiplying the Lump Sum Top-Up Premium by the
Premium Charge rate. The Lump Sum Top-Up Premium Charge shall be deducted from the Lump Sum Top-Up
Premium amount received by FWD before purchasing Units at Unit Price/s of the relevant Fund/s.
Insurance Charges
Subject to the Contract Debt provision in this section, the Insurance Charge s shall be deducted each month from the Total
Account Value at the Unit Price on the Next Valuation Date after the Monthly Anniversary. Insurance Charges shall be charged
to each Fund in proportion to the Fund Account Value of each Fund in which the Owner has invested in. The Insurance Charges
consist of the following:

i. Cost of Insurance of the Basic Plan. This is determined by multiplying the difference between the Death Benefit and
the Total Account Value by the Cost of Insurance rate of the Basic Plan as determined by FWD from time to time. The
Cost of Insurance rate of the Basic Plan is determined by the attained age and risk class of the Insured at the start of
the Policy Year.
ii. Cost of Insurance of the Supplementary Benefit/s if any. This is determined by multiplying the Benefit Amount of the
Supplementary Benefit/s if any by the Cost of Insurance rate of the corresponding Supplementary Benefit/s if any as
determined by FWD from time to time. The Cost of Insurance rate of the Supplementary Benefit/s if any is determined
by the attained age and risk class of the Insured at the start of the Policy Year.
Surrender Charges
No surrender charges shall be applied on any partial or full withdrawals from the Total Account Value.
Other Charges
Subject to the Insurance Commission's approval, FWD reserves the right to impose additional charges by giving the Owner at
least one (1) month prior written notice.
Contract Debt
This provision on Contract Debt applies provided that during the first three (3) years of this Policy:
i. Regular Premiums and Regular Top-Up Premiums are paid before the end of the Grace Period; and
ii. No withdrawals are made against the Total Account Value.
If the Total Account Value is insufficient to cover the Insurance Charges, FWD shall create a Contract Debt without interest in
FWD’s favor equal to the cumulative Insurance Charges not paid from the Total Account Value. The Contract Debt shall be paid
by deducting its amount from any Regular Premium paid after deduction of any applicable Regular Premium Charge and/or
from any Top-Up Premium paid after deduction of any applicable Top-Up Premium Charge.
15. DEATH BENEFIT
While this Policy is in force and subject to its terms and conditions, FWD shall pay the Death Benefit less any Contract Debt.
The Death Benefit payable is equal to the higher of:
i. The current Sum Assured; or

ii. Minimum Death Benefit; or
iii. Total Account Value.
The Minimum Death Benefit shall be:
i. 500% of the Regular Premium; plus

ii. 125% of all Top-Up Premiums paid; less
iii. 125% of all partial withdrawals made.
The Total Account Value is calculated based on the Unit Price/s of each of the relevant Fund /s as of the Next Valuation Date
following FWD’s receipt of written notice of the Insured's death.
16. CLAIM SETTLEMENT
For settlement of claims under this Policy, this Policy must be presented at any of FWD's duly designated offices together with
due proof for the claim and all other requirements satisfactory to FWD.

FWD must receive the requirements within ninety (90) days from the date of claim. Failure to submit the requirements shall
not invalidate or reduce the claim if it is shown not to have been reasonably possible to give such notice or proof and that such
was given as soon as was reasonably possible.
17. TERMINATION OF THE POLICY
This Policy shall terminate on the earliest of the following:
i. at the end of the Grace Period if the Total Account Value of this Policy becomes insufficient to pay for the Premium
Charges and Insurance Charges in accordance with the Grace Period in Section 12 Premiums, except when Contract
Debt is in effect;
ii. the date of approval by FWD of the Policy’s full surrender as provided under Section 20 Surrender and Withdrawals;
iii. on the date of death of the Insured subject to Section 15 Death Benefit; or
iv. the Expiry Date of this Policy.
If this Policy terminates under (i), (ii) and (iv) above, the Total Account Value if any, less Contract Debt if any, shall be returned
to the Owner based on the Unit Price/s of the relevant Fund/s, as of the Next Valuation Date following the termination of this
Policy.
18. FUNDS
Investment Funds
FWD created and maintains Variable Unit Linked Investment Funds, where the investment portion of the premium under this
Policy shall be allocated. The investment management of each Fund shall be at FWD’s full discretion. The investment policy of
each Fund may be changed subject to the approval of the Insurance Commission. The Fund/s and all its assets shall be and
remain in the absolute beneficial ownership of FWD on behalf of or for the account of the Owner.
Each Fund is den ominated in Units of equal value, and the value of each Unit of a given Fund may change from time to time
depending on market conditions.
FWD may do the following subject to the approval of the Insurance Commission:
i. create new Fund/s and all the provisions of this Policy shall apply to the new Fund/s;
ii. delegate all or any of FWD's discretion and investment powers to any person and/or entity on such terms as FWD
determines;
iii. withdraw or change the Fund/s being offered by FWD. In such event, FWD shall give the Owner a written notice at
least three (3) months in advance of FWD's intent to withdraw or change the Fund/s and invite the Owner to direct
FWD to transfer the balance of the Investment Fund/s into another Investment Fund/s then offered by FWD. If FWD
does not receive any instruction from the Owner within the time period specified in FWD's notice, FWD shall surrender
all the outstanding Units of the Fund/s being withdrawn. Proceeds from the withdrawn Fund/s shall be distributed in
the following order:
a. allocate it to other available Fund/s deemed to have an equivalent fund asset mix as with the original source
Fund, if any; or
b. allocate it to the remaining Fund/s in which the Owner has Fund Account Value balances, in proportion to
this Policy's Fund Account Values in such Fund/s; or
c. return it to the Owner if there are no remaining balances in the Fund/s in which the Owner has Fund Account
Value balances.

Valuation of Fund and Units
The valuation of the Fund/s shall be done by FWD on a daily basis. Net asset value shall be determined by using market prices
of the underlying funds or the quoted prices of direct investments, allowing for fund management fee, any fund administration
charge, purchase and sell expense, tax or other statutory levy, deposit and withdrawal made since the last Valuation Date. The
Unit Price of each Fund shall be determined by dividing the Fund’s net asset value by the corresponding number of outstanding
Units of such Fund.
Deductions from the Funds
FWD shall deduct from each Investment Fund the following:
i. all expenses incurred by FWD directly or indirectly upon purchase and sale of investments;
ii. all expenses incurred by FWD directly or indirectly in managing, maintaining and valuing assets in such Fund;
iii. any tax or other statutory levy attributable to the investment income and capital gain on assets of the Fund;
iv. Fund Management Charge, subject to FWD's sole discretion to change the Fund Management Charge rate by giving
the Owner at least three (3) months written notice; and
v. all other additional Charges as determined by FWD subject to approval of the Insurance Commission.
Fund Account Value
For this Policy, the Fund Account Value corresponding to a Fund is the net value of that Fund’s Units allocated to this Policy at
the Unit Price on the Next Valuation Date, after adjusting for the following transactions net of fees:
i. increased by the amount of premiums allocated and applied to such Fund Account Value;
ii. increased by any amount transferred from another Fund Account Value to such Fund Account Value;
iii. decreased by any amount transferred to another Fund Account Value from such Fund Account Value;
iv. decreased by any amounts withdrawn from such Fund Account Value; and
v. decreased by the amount of any monthly deductions and any other Charges made by FWD from such Fund Account
Value.
This Policy shall have a Fund Account Value corresponding to each Fund the Owner has opted to invest in.
Exceptional Circumstances
Where for any reasons other than payment of the Death Benefit under this Policy, the creation and/or cancellation of Units in
any Fund Account Value becomes necessary and FWD in its absolute discretion deems the circumstances to be prejudicial to
the interests of its policyholders, the creation and/or cancellation of Units in any Fund Account Value shall be deferred for a
period not exceeding six (6) months from the date the creation and/or cancellation would in normal circumstances have taken
place.
Exceptional circumstances include, but are not limited to:
i. the closure or suspension of dealings on recognized stock exchanges;

ii. suspension of valuation or dealings of the underlying Investment Funds ; or
iii. periods when the assets in an Investment Fund cannot be valued or invested according to its investment objective.
19. DEFERMENT AND LIMITATION
For valid reasons solely determined by FWD, the valuation, creation or cancellation of Units of the Investment Fund/s may be
temporarily suspended or deferred.

FWD may also limit the number of Units of an Investment Fund that can be ca ncelled on any Valuation Date (whether for this
Policy or otherwise) as FWD may determine from time to time. In such case, Units of the Investment Fund allocated to this
Policy shall be cancelled on a pro rata basis. Units not cancelled shall be carried forward for cancellation, subject to the same
limitation, on the Next Valuation Date of the Investment Fund.
20. SURRENDER AND WITHDRAWALS
The Owner may surrender th is Policy for its Total Account Value while this Policy is in force . This Policy shall terminate at the
effective date of such surrender.
The Owner may withdraw part of the Total Account Value of this Policy while this Policy is in force. Such transaction is referred
to as withdrawal.
The following conditions shall apply:
i. Owner must request for surrender or partial withdrawal using the appropriate form prescribed by FWD.
ii. The Owner’s request shall be subject to FWD’s prevailing administrative rules and procedures at the time of
application for surrender or withdrawal.
iii. The amount of withdrawal must not be less than the minimum amount determined by FWD from time to time.
iv. If there is more than one Investment Fund and the Owner does not specify the Investment Fund/s from which the
amount requested is to be withdrawn, then the withdrawal amount shall be taken proportionately from each
Investment Fund.
v. The Total Account Value immediately after the request for partial withdrawal must not be less than the minimum
amount specified by FWD from time to time; otherwise, the Owner must fully surrender this Policy. The withdrawal
amount with respect to a Fund must not exceed this Policy’s Fund Account Value for such Fund.
vi. Any amount surrendered or partially withdrawn from a Fund shall be deducted from the Fund Account Value of such
Fund at its Unit Price determined at the Next Valuation Date following the date that FWD approves the Owner's
request.
vii. FWD shall automatically reduce the Minimum Death Benefit by 125% of the amount of the partial withdrawal, subject
to the Minimum Death Benefit requirement of the Insurance Commission.
21. FUND SWITCH
While this Policy is in force, the Owner may at any time request FWD to switch all or part of the Fund Account Value with
respect to any of the Fund/s under this Policy, to one or more of the other Fund/s. Such transaction is referred to as Fund
Switching.
i. Owner must request for Fund Switching using the appropriate form prescribed by FWD.
ii. The Owner’s request for Fund Switching shall be subject to prevailing administrative ru les and procedures of FWD at
the time of application for Fund Switching.
iii. The amount to be switched must not be less than the minimum amount as determined by FWD from time to time.
iv. Fund Switching may be allowed without a Fund Switching Charge for up to six (6) times per Policy Year, provided that
the Fund Switch was requested through FWD’s online facility. If the Owner exceeds the maximum number of allowed
Fund Switching through FWD’s online facility or requests such Fund Switching other than through FWD’s online
facility, a Fund Switching Charge shall be deducted from the Total Account Value upon approval by FWD of such Fund
Switch. The Fund Switching Charge may change from time to time and shall be subject to FWD’s prevailing
administrative rules and procedures at the time of the Fund Switch.

v. Immediately after the Fund Switch, the Total Account Value must not be less than the minimum amount as specified
by FWD from time to time; otherwise, the Owner must withdraw theTotal Account Value. The amount switched from
a particular Fund plus any Fund Switching Charge with respect to such Fund must not exceed the Fund Account Value
corresponding to such Fund.
vi. The amount switched from a Fund shall be deducted from the Fund Account Value of such Fund at the Fund’s Unit
Price on the Next Valuation Date following the date the Owner's written request for such Fund Switching is approved
by FWD. The amount switched less any Fund Switching Charge shall be applied to purchase Units at Unit Price/s of
the respective Fund/s determined at the Next Valuation Date following such cancellation.
22. CHANGE OF FUND ALLOCATION RATE

While this Policy is in force, the Owner may, at any time, request FWD to change the Fund Allocation Rate under this Policy.

i. Owner must request for change in Fund Allocation Rate using the appropriate form prescribed by FWD.
ii. The Owner’s request to change the Fund Allocation Rate shall be subject to prevailing administrative rules and
procedures at the time of application of the change in the Fund Allocation Rate.
iii. The Fund Allocation Rates to the selected Fund/s, when changed, must not be less than the minimum as determined
by FWD from time to time.
iv. The change shall be effective at the Next Valuation Date following the date the Owner's request for such change in
allocation has been approved by FWD. Such change in the Fund Allocation Rate shall apply only to subsequent
allocations of the premiums to the Fund/s.
v. A fee for change in allocation may be charged, subject to FWD’s prevailing administrative rules and procedures at the
time of the change in allocation.
23. LOYALTY BONUS

While this Policy is in force, FWD may award a Loyalty Bonus payable at the end of the tenth (10th) Policy Year and on every
fifth (5 th) Policy anniversary thereafter. The Loyalty Bonus shall be a percentage of the average Total Account Value over the
past sixty (60) Monthly Anniversaries of this Policy, and such percentage shall be determined by FWD from time to time. Any
Loyalty Bonus payable shall be made by crediting additional Units proportionately to each Fund Account Value.
The Loyalty Bonus is non -guaranteed. If this Policy has been reinstated at any time during its lifetime, this Policy shall not be
eligible to receive the Loyalty Bonus after the approval date of last reinstatement.
24. DISCLOSURES OF CONFLICT OF INTEREST

The fund manager makes investment decisions for the Investment Fund/s based on the circumstances of each Investment
Fund and independently of decision made for other Investment Fund /s. The fund manager may make the same investments
for an Investment Fund and one or more other Investment Fund/s. This may create a conflict of interest if there is only a limited
amount of the investment available, or if the investment is purchased at different times or at different prices for different
Investment Fund/s. If this happens, the fund manager shall attempt to allocate the investment fairly between the Investment
Fund and other Investment Fund /s. Factors the fund manager considers in allocations include the size and timing of previous
allocations, whether the security meets the objectives of the respective portfolios, the relative portfolio size and the rate of
growth of the portfolios.
25. LIMITATION OF ACTION

No legal action on this Policy may be filed after five (5) years from the time the cause of action accrues.

IMPORTANT NOTICE
The Insurance Commission, with offices in Manila, Cebu and Davao, is the government office in charge of the enforcement of
all laws related to insurance and has supervision over insurance companies and intermediaries. It is ready at all times to assist
the general public in matters pertaining to insurance. For any inquiries or complaints, please contact the Public Assistance and
Mediation Division (PAMD) of the Insurance Commission at 1071 United Nations Avenue, Manila with telephone numbers
+632-5238461 to 70 and email address [email protected]. The official website of the Insurance Com mission
is www.insurance.gov.ph.

This Critical Illness Supplementary Benefit is attached to Policy Number 51271448 and
with Effective Date on August 13, 2019.
Supplementary Benefit:
Critical Illness
This Supplementary Benefit applies only if the Form Number is shown on the Policy Data Page of the Policy. The Benefit
Amount of this Supplementary Benefit is also shown on the Policy Data Page.
DEFINITIONS
“Critical Illness” refers to a Critical Illness defined under Section 13 Definition of Covered Critical Illnesses.
“Insured” refers to the person covered by this Supplementary Benefit and whose name is shown on the Policy Data
Page.
“Medical Practitioner” means a person licensed or registered in the Philippines with a medical degree and accredited by
a medical board or an equivalent organization, to render medical services and is neither the Owner or Insured, a
member of the Owner or Insured’s immediate family (parents, spouse, children, brothers, sisters) nor business partner
of the Owner or Insured.
1. EFFECTIVE DATE
Unless otherwise shown on this Supplementary Benefit, the Effective Date of this Supplementary Benefit shall be the
same as the Effective Date of the Policy.
2. BENEFIT
FWD shall pay to the Owner the Benefit Amount for this Supplementary Benefit if:
i. The Insured first experiences signs and/or symptoms that is related to a Critical Illness ninety (90) days after
the Effective Date or date of last reinstatement or Effective Date of an increase in the Benefit Amount (with
respect to that increase); and
ii. The Insured is subsequently diagnosed as suffering from that Critical Illness by a Medical Practitioner approved
by FWD; and
iii. The Insured is alive and this Supplementary Benefit is inforce fourteen (14) days after the diagnosis of that
Critical Illness.
The above means that no Benefit Amount will be paid if the Insured first experiences signs and/or symptoms that is
related to a Critical Illness before the end of the ninety (90) day period mentioned above, even if the diagnosis of that
Critical Illness is made after the ninety (90) day period. If the Owner is deceased or incompetent as determined in good
faith by FWD, the Benefit Amount shall be payable to the Insured.
Any outstanding Contract Debt on the Policy may be deducted from Benefits payable from this Supplementary Benefit.
3. MAXIMUM COVERAGE
The aggregate Benefit Amount of this Supplementary Benefit and all similar Benefits of the Insured under all FWD
policies shall not exceed the maximum amount offered by FWD, as may be determined by FWD at the time of
application. Any excess coverage shall be void and any proportionate Cost of Insurance of this Supplementary Benefit
corresponding to such excess deducted from the Total Account Value shall be refunded without interest.
4. COST OF INSURANCE
To provide this Supplementary Benefit, FWD shall deduct the Cost of Insurance from the Total Account Value on the
Effective Date and every subsequent monthly anniversary of the Policy until this Supplementary Benefit terminates.
Form Number: CIBVUL.01.2017 Page | 1

The Cost of Insurance is determined by multiplying the Benefit Amount by the Cost of Insurance rate of this
Supplementary Benefit. The Cost of Insurance rate is determined by the Insured's age at issue, policy year and risk class.
Please note, FWD may adjust the Cost of Insurance rate but not more than once a year after the first Policy Year by
giving at least ninety (90) days prior notice and with prior approval of the Insurance Commission.
5. BASIS FOR OFFERING THIS SUPPLEMENTARY BENEFIT

FWD has used the information that the Owner and the Insured provided in the Application Form and other documents
that the Owner has submitted to determine whether to offer this Supplementary Benefit.
If the Insured’s age, gender or occupation provided is incorrect, FWD may adjust the Cost of Insurance payable. If FWD
would not have offered this Supplementary Benefit based on the correct age, gender and occupation information, FWD
may terminate this Supplementary Benefit and refund all Cost of Insurance of this Supplementary Benefit deducted
from the Total Account Value.
FWD may also terminate this Supplementary Benefit within two (2) years from the Effective Date or approval date of its
last reinstatement if any other information provided is incorrect and if, based on the correct information, FWD would
not have offered this Supplementary Benefit. In this situation, FWD shall refund all Cost of Insurance of this
Supplementary Benefit deducted from the Total Account Value. After this two (2) year period, FWD shall not contest
any claim filed on the Supplementary Benefit.
6. RENEWAL
This Supplementary Benefit may be renewed until its Expiry Date as shown in the Policy Data Page without evidence of
insurability. The Cost of Insurance of this Supplementary Benefit shall be deducted from the Total Account Value at
FWD’s Cost of Insurance rate at the time of renewal, subject to FWD’s right to decline renewal on any renewal date. A
notice of any change in the basis for the Cost of Insurance of this Supplementary Benefit will be sent to the Owner at
least forty-five (45) days before the next Policy anniversary date.
7. NON-PARTICIPATION
This Supplementary Benefit is non-participating and does not provide policy dividends.
8. REINSTATEMENT
If this Supplementary Benefit terminates due to insufficient Total Account Value in the Policy, this Supplementary
Benefit may be reinstated within three (3) years from the date of termination if the following requirements are met:
i. A completed FWD reinstatement application form is submitted;

ii. Satisfactory evidence of insurability is provided; and
iii. Receipt of payment of all amounts necessary to put this Supplementary Benefit in force.
Reinstatement will be on the date on that FWD determines the above requirements have been met.
9. EXCLUSIONS
No Benefit Amount shall be payable if the Critical Illness results wholly or partly from any of the following:
i. Attempted suicide or an intentional self-inflicted act by the Insured within two (2) years of the Effective Date,
date of last reinstatement or Effective Date of an increase in the Benefit Amount (with respect to that
increase);
ii. The wilful participation of the Insured in illegal and/or unlawful acts and/or omissions;
iii. Diagnosis of Late Stage Cancer in the presence of HIV infection;

iv. The Insured first experiences signs and/or symptoms or is diagnosed with Alzheimer’s Disease, Late Stage
Cancer, Chronic Liver Disease, Chronic Recurrent Pancreatitis, Coma or Parkinson’s Disease within two (2)
years of the Effective Date, date of last reinstatement or Effective Date of an increase in the Benefit Amount
(with respect to that increase) and the signs and/or symptoms or diagnosed condition is due to habitual
alcohol consumption, or the result of alcohol or drug abuse; or
v. War or any act of war (whether declared or not) and any civil or military insurrection.
If the Insured’s Critical Illness is caused by the willful participation of the Owner in illegal and/or unlawful acts and/or
omissions, said Owner shall no longer be a qualified claimant.
10. APPLYING TO RECEIVE YOUR BENEFITS

To apply for the Benefits, the following information should be submitted to FWD at the Owner’s expense:
i. Claimant’s Statement;
ii. Attending Physician’s Statement (APS);
iii. Medical Certificate;
iv. Medical Records;
v. Evidence of Accident, where appropriate; and
vi. Any medical requirements as specified in Section 13 Definition of Covered Critical Illnesses.
FWD must receive the above requirements within ninety (90) days from the date of knowledge of the occurrence of the
Critical Illness. Failure to submit within ninety (90) days shall not invalidate or reduce any claim if it can be shown that it
was not practicable to submit the requirements and its submission was made as soon as it was reasonably possible.
FWD reserves the right to require additional documents or evidences to help assess the validity of the claim at the
Owner’s expense. FWD shall have the right to make an autopsy, unless forbidden by law.
11. TERMINATION OF THIS SUPPLEMENTARY BENEFIT

This Supplementary Benefit shall automatically terminate on the earliest of the following:
i. Upon payment of the Benefit Amount in accordance with Section 2 ‘Benefit’;

ii. The Total Account Value becomes insufficient to cover the Cost of Insurance of this Supplementary Benefit,
except when Contract Debt is in effect;
iii. On the date following FWD’s approval of the Owner’s written request for termination of this Supplementary
Benefit;
iv. The Expiry Date of this Supplementary Benefit; or
v. Termination of the Policy.
Termination of this Supplementary Benefit shall not prejudice any claim arising prior to such termination.
12. LIMITATION OF ACTION

No legal action on this Supplementary Benefit may be filed after one (1) year from the time the cause of action accrues.

13. DEFINITION OF COVERED CRITICAL ILLNESSES
1. Accidental Major Head Trauma
A head injury due solely to an Accident that results in there being at least three (3) of the following six (6) Activities of
Daily Living which the Insured (with or without the use of mechanical equipment, special devices or other aids and
adaptations in use for disabled persons) is unable to perform without the continuous assistance of another person:
i. Washing : the ability to wash in the bath or shower (including getting into and out of the bath or shower) or
wash satisfactorily by other means,
ii. Dressing : the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces,
artificial limbs or other surgical appliances,
iii. Transferring : the ability to move from a bed to an upright chair or wheelchair and vice versa,
iv. Mobility : the ability to move indoors from room to room on level surfaces,
v. Continence: the ability to control bowel and bladder function so as to maintain a satisfactory level of personal
hygiene,
vi. Feeding: the ability to feed oneself once food has been prepared and made available.
The neurological deficit must have persisted continuously for at least six (6) weeks and must (at the end of that period)
be deemed permanent by a neurologist acceptable to FWD, supported by unequivocal findings on Magnetic Resonance
Imaging, Computerised Tomography scan, or other reliable imaging techniques.
“Accident” refers to the abrupt, unanticipated and unwanted contact between the Insured and an external object or
substance (inclusive of liquid, gas, fire) that is the sole and direct cause of bodily injury. Contact that directly or
indirectly exacerbates a previously existing physical bodily injury is not considered an Accident.
For clarity, major head injuries due to non-Accidental causes and spinal cord injuries do not meet the above definition
of Accidental Major Head Trauma.
2. Alzheimer’s Disease
Deterioration or loss of intellectual capacity as confirmed by clinical evaluation and imaging tests, arising from
Alzheimer's disease or irreversible organic disorders, resulting in there being at least three (3) of the following six (6)
Activities of Daily Living which the Insured (with or without the use of mechanical equipment, special devices or other
aids and adaptations in use for disabled persons) is unable to perform without the continuous assistance of another
person:
v. Continence: the ability to control bowel and bladder function so as to maintain a satisfactory level of personal
hygiene,
vi. Feeding: the ability to feed oneself once food has been prepared and made available.
The diagnosis must be clinically confirmed by an appropriate neurologist acceptable to FWD.
For clarity, neurosis and psychiatric illnesses do not meet the above definition of Alzheimer’s Disease as they are non-
organic diseases.
3. Apallic Syndrome
Universal necrosis of the brain cortex with the brainstem intact. The definite diagnosis must be confirmed by a
neurologist acceptable to FWD and evidenced by specific findings in neuro-radiological tests. This Condition has to be
medically documented for continuous period of at least one (1) month.

4. Aplastic Anaemia
Chronic persistent bone marrow failure which results in anaemia, neutropenia and thrombocytopenia requiring
treatment with at least one of the following:
i. blood product transfusion,

ii. marrow stimulating agents,
iii. immunosuppressive agents, or
iv. bone marrow transplantation.
The diagnosis must be confirmed by a haematologist acceptable to FWD.
5. Bacterial Meningitis
Bacterial infection resulting in severe inflammation of the membranes of the brain or spinal cord resulting in significant,
irreversible and permanent neurological deficit confirmed by a neurologist acceptable to FWD. Confirmation of
bacterial infection in cerebrospinal fluid by lumbar puncture is required and the neurological deficit must persist
continuously for at least six (6) weeks.
6. Benign Brain Tumour
A benign tumour in the brain as evidenced by all of the following:
i. the tumour is life threatening,

ii. it has caused damage to the brain and
iii. it has undergone surgical removal or, if inoperable, has caused a permanent neurological deficit.
The presence of the underlying tumour must be confirmed by a neurologist or neurosurgeon acceptable to FWD,
supported by findings on Magnetic Resonance Imaging, Computerised Tomography scan, or other reliable imaging
techniques.
For clarity, the following conditions do not meet the above definition of Benign Brain Tumour:
i. cysts,
ii. granulomas,
iii. vascular malformations,
iv. haematomas, and
v. tumours of the pituitary gland or spine.
7. Cerebral Aneurism Requiring Invasive Brain Surgery
Invasive brain surgery to correct an abnormal dilation of cerebral arteries, involving all three (3) layers of the walls of
the cerebral arteries. The aneurism must be at least 10 mm in size or increasing by at least 0.95 mm per year and the
need for surgery must be confirmed by a neurosurgeon acceptable to FWD, as evidenced by the results of cerebral
angiography.
For clarity, limited craniotomy and burr-hole procedures do not meet the above definition of Cerebral Aneurism
Requiring Invasive Brain Surgery as neither are typically invasive and both usually have shorter recovery times.
Similarly, infection and mycotic aneurisms do not meet the above definition of Cerebral Aneurism Requiring Invasive
Brain Surgery.
8. Chronic Liver Disease
End-stage liver failure as evidenced by all of the following:
i. permanent jaundice,
ii. ascites, and
iii. hepatic encephalopathy.

9. Chronic Lung Disease
End-stage lung disease, causing chronic respiratory failure, as evidenced by all of the following:
i. FEV1 test results consistently less than one (1) litre,

ii. the requirement for permanent supplementary oxygen therapy for hypoxemia,
iii. arterial blood gas analyses with partial oxygen pressures of 55mmHg or less (PaO2 < 55mmHg), and
iv. dyspnoea at rest.
The diagnosis must be confirmed by a pulmonologist acceptable to FWD.
10. Chronic Recurrent Pancreatitis
Continuing chronic inflammatory process of the pancreas, characterised by irreversible morphological changes and
progression of the disease and evidenced by all of the following:
i. uniform accumulation of calcium in the pancreas as evidenced from the results of imaging tests, and
ii. chronic failure of pancreatic function, causing continuous disruption of intestinal absorption (excess fat in the
faeces) or diabetes.
The diagnosis must be confirmed by a specialist in internal medicine acceptable to FWD.
11. Coma
A coma that persists for a continuous period of at least ninety-six (96) hours and evidenced by all of the following:
i. there is no response to external stimuli for at least ninety-six (96) hours,

ii. life support measures are necessary to sustain life, and
iii. there is brain damage that results in a permanent neurological deficit.
The permanence of the neurological deficit must be assessed by a neurologist acceptable to FWD at least thirty (30)
days after the onset of the coma.
12. Coronary Artery Bypass Grafting
The actual undergoing of open-heart surgery to correct the narrowing or blockage of one or more of the coronary
arteries with bypass grafts.
Angiographic evidence of significant coronary artery obstruction must be provided and the procedure must be
considered medically necessary by a cardiologist acceptable to FWD.
For clarity, as the following procedures do not involve open-heart surgery, they do not meet the above definition of
Coronary Artery Bypass Grafting: angioplasty and all other intra-arterial, catheter-based techniques, keyhole or laser
procedures.
13. Fulminant Viral Hepatitis
A submassive to massive necrosis of the liver by the hepatitis virus, leading precipitously to liver failure. The diagnosis
in respect of this illness must be evidenced by all of the following:
i. a rapidly decreasing liver size,

ii. necrosis involving entire lobules, leaving only a collapsed reticular framework,
iii. rapid deterioration of liver function tests,
iv. deepening jaundice, and
v. hepatic encephalopathy.
14. Heart Valve Surgery
The actual undergoing of open-heart surgery to replace or repair heart valve abnormalities. The diagnosis of heart
valve abnormality must be supported by cardiac catheterization or echocardiogram and the procedure must be
considered medically necessary by a cardiologist acceptable to FWD.

15. HIV/AIDS due to Blood Transfusion
Infection with the Human Immunodeficiency Virus (HIV) through a blood transfusion, as evidenced by all of the
following:
i. the infection was due to a blood transfusion that was medically necessary or given as part of a medical
treatment,
ii. the blood transfusion was received in Philippines after the Effective Date, or date of reinstatement of this
Supplementary Benefit (whichever is the latest),
iii. the source of the infection is established to be from the institution that provided the transfusion and the
institution is able to trace the origin of the HIV tainted blood; and
iv. the insured does not suffer from thalassaemia major or haemophilia.
No payment will be made under this condition where a cure has become available prior to the infection. “Cure” means
any treatment that renders the HIV inactive or non-infectious.
16. Late Stage Cancer
A malignant tumour characterised by the uncontrolled growth and spread of malignant cells with invasion and
destruction of normal tissue. The cancer must be confirmed by histological evidence of malignancy by a pathologist
acceptable to FWD.
For clarity, the below pre-cancerous tumours and early stage cancers do not meet the definition of Late Stage Cancer:
i. tumours showing the malignant changes of carcinoma-in-situ and tumours which are histologically described
as pre-malignant or non-invasive, including, but not limited to:
a. carcinoma-in-situ of the breasts and
b. cervical dysplasia CIN-1, CIN-2 and CIN-3,
ii. all of the following types of skin cancer, unless there is evidence of metastases:
a. hyperkeratosis,
b. basal cell and squamous skin cancers and
c. melanomas of less than 1.5mm Breslow thickness, or less than Clark Level 3,
iii. prostate cancers which are histologically described as TNM Classification T1a or T1b or prostate cancers of
another equivalent or lesser classification,
iv. T1N0M0 papillary micro-carcinoma of the thyroid less than 1 cm in diameter,
v. papillary micro-carcinoma of the bladder,
vi. chronic lymphocytic leukaemia less than RAI Stage 3, and
vii. tumours of the ovary classified as T1aN0M0, T1bN0M0 or FIGO 1A, FIGO 1B.
17. Loss of Hearing (Deafness)
Total and irreversible loss of hearing in both ears as a result of illness or accident. The inability to hear must be
established for a continuous period of six (6) months and must (at the end of that period) be deemed permanent on the
basis of audiometric and sound-threshold test results furnished by an Ear, Nose and Throat (ENT) specialist acceptable
to FWD.
Total means “the loss of at least 80 decibels in all frequencies of hearing”.
18. Loss of Sight (Blindness)
Total and irreversible loss of sight in both eyes as a result of illness or accident. The blindness must be confirmed by an
ophthalmologist acceptable to FWD.
19. Loss of Speech
Total and irrecoverable loss of the ability to speak due solely to the Insured’s vocal cords being permanently damaged
from an injury or disease. The inability to speak must be established for a continuous period of twelve (12) months and
must (at the end of that period) be deemed permanent on the basis of medical evidence furnished by an Ear, Nose and
Throat (ENT) specialist acceptable to FWD.

20. Major Burns
Third degree (full thickness of the skin) burns covering at least twenty percent (20%) of the surface of the Insured’s
body.
Diagnosis must be confirmed by a specialist acceptable to FWD and must be evidenced by specific results using the
Lund Browder Chart or equivalent burn area calculators.
21. Major Organ Transplant
The actual undergoing (as a recipient) of a transplant of:
i. one of the following human organs:

a. heart,
b. lung,
c. liver,
d. kidney,
e. pancreas, or
ii. human bone marrow using haematopoietic stem cells preceded by total bone marrow ablation,
as a result of irreversible end-stage failure of the relevant organ.
For clarity, transplants of other human organs and other stem cell transplants do not meet the above definition of
Major Organ Transplant.
22. Major Stroke
A cerebro-vascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, cerebral
embolism and cerebral thrombosis, as evidenced by all of the following:
i. there is evidence of permanent neurological damage confirmed by a neurologist acceptable to FWD for a
continuous period of at least six (6) weeks after the event,
ii. there are findings on Magnetic Resonance Imaging, Computerised Tomography scan, or other reliable imaging
techniques consistent with the diagnosis of a new stroke.
The following are excluded:
i. transient ischaemic attacks,

ii. brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease,
iii. vascular disease affecting the eye or optic nerve, and
iv. ischaemic disorders of the vestibular system.
23. Major Surgery to Aorta
The actual undergoing of major surgery to repair or correct an aneurysm, narrowing, obstruction or dissection of the
aorta through surgical opening of the chest or abdomen.
For the purpose of this definition aorta shall mean the thoracic and abdominal aorta but not its branches.
For clarity, surgery performed using only minimally invasive or intra-arterial techniques do not meet the above
definition of Major Surgery to Aorta.
24. Medullary Cystic Disease
A progressive hereditary disease of the kidneys characterised by the presence of cysts in the medulla in both kidneys,
tubular atrophy and intestitial fibrosis with the clinical manifestations of anaemia, polyuria and renal loss of sodium.
The condition must present as the chronic irreversible failure of both kidneys to function, requiring regular renal
dialysis.
Diagnosis must be supported by renal biopsy.

25. Motor Neurone Disease
Motor neurone disease of unknown aetiology, as characterised by progressive degeneration of corticospinal tracts and
anterior horn cells or bulbar efferent neurones. These include spinal muscular atrophy, progressive bulbar palsy,
amyotrophic lateral sclerosis and primary lateral sclerosis.
The condition must result in there being at least three (3) of the following six (6) Activities of Daily Living which the
Insured (with or without the use of mechanical equipment, special devices or other aids and adaptations in use for
disabled persons) is unable to perform without the continuous assistance of another person:
v. Continence : the ability to control bowel and bladder function so as to maintain a satisfactory level of personal
hygiene,
vi. Feeding : the ability to feed oneself once food has been prepared and made available.
For a benefit to be payable, such disability must have persisted for a continuous period of at least three (3) months and
must (at the end of that period) be confirmed by a neurologist acceptable to FWD as progressive and resulting in
permanent disability and neurological deficit.
26. Multiple Sclerosis
The definite occurrence of multiple sclerosis, as diagnosed by a neurologist acceptable to FWD, and as evidenced by all
of the following:
i. investigations unequivocally confirm the diagnosis to be multiple sclerosis,

ii. multiple neurological deficits have occurred over a continuous period of at least six (6) months, and
iii. there is a well documented history of exacerbations and remissions of said symptoms or neurological deficits.
For clarity, other causes of neurological damage such as SLE do not meet the above definition of Multiple Sclerosis.
27. Muscular Dystrophy
A group of hereditary degenerative diseases of muscle, characterised by weakness and atrophy of muscle. The
diagnosis of muscular dystrophy must be unequivocal and made by a neurologist acceptable to FWD. The condition
must result in there being at least three (3) of the following six (6) Activities of Daily Living which the Insured (with or
without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons) is
unable to perform without the continuous assistance of another person:
hygiene,
For a benefit to be payable, such disability must have persisted for a continuous period of at least six (6) months and
must (at the end of that period) be deemed permanent by a physician acceptable to FWD.

28. Myocardial Infarction (Heart Attack)
Death of a portion of the heart muscle arising from inadequate blood supply to the relevant area. The diagnosis must
be met by three or more of the following five (5) criterias, which are consistent with a new heart attack:
i. a history of typical chest pain,

ii. new electrocardiogram (ECG) changes proving infarction,
iii. diagnostic elevation of cardiac enzyme CK-MB,
iv. cardiac troponin T or I at 0.5ng/ml and above, or
v. left ventricular ejection fraction less than fifty percent (50%), measured three (3) months or more after the
event.
29. Occupationally Acquired HIV/AIDS
Infection with the Human Immunodeficiency Virus (HIV) which resulted from an accident occurring after the Effective
Date or date of reinstatement of this Supplementary Benefit (whichever is the latest) and whilst the Insured was
carrying out the normal professional duties of his or her occupation in Philippines. No payment will be made unless all
of the following are proved to FWD’s satisfaction:
i. proof of the accident giving rise to the infection must be reported to FWD within thirty (30) days of the
accident taking place,
ii. proof that the accident involved a definite source of the HIV infected fluids and
iii. proof of sero-conversion from HIV negative to HIV positive occurring during the one hundred eighty (180) days
following the documented accident. This proof must include a negative HIV antibody test conducted within
five (5) days of the accident.
For clarity, HIV infection resulting from any other means (including sexual activity and the use of intravenous drugs)
does not meet the above definition of Occupationally Acquired HIV/AIDS.
This benefit is only payable when the occupation of the Insured is a medical practitioner, medical student, state
registered nurse, medical laboratory technician, dentist (surgeon or nurse) or paramedical worker, registered with the
appropriate body and working in a medical center or clinic (in Philippines).
No payment will be made under this condition where a cure has become available prior to the infection. “Cure” means
any treatment that renders the HIV inactive or non-infectious.
30. Paralysis
Total and irreversible loss of use of at least two (2) entire limbs due to injury or disease. This condition must have
persisted for a continuous period of at least six (6) months and must (at the end of that period) be deemed permanent
by a neurologist acceptable to FWD.
31. Parkinson’s Disease
The unequivocal diagnosis of Parkinson’s Disease by a neurologist acceptable to FWD, as evidenced by all of the
following:
i. it cannot be controlled with medication,

ii. it show signs of progressive impairment and
iii. it results in there being at least three (3) of the following six (6) Activities of Daily Living which the Insured
(with or without the use of mechanical equipment, special devices or other aids and adaptations in use for
a. Washing : the ability to wash in the bath or shower (including getting into and out of the bath or
shower) or wash satisfactorily by other means,
b. Dressing : the ability to put on, take off, secure and unfasten all garments and, as appropriate, any
braces, artificial limbs or other surgical appliances,
c. Transferring : the ability to move from a bed to an upright chair or wheelchair and vice versa,

d. Mobility : the ability to move indoors from room to room on level surfaces,
e. Continence : the ability to control bowel and bladder function so as to maintain a satisfactory level of
personal hygiene,
f. Feeding : the ability to feed oneself once food has been prepared and made available.
must (at the end of that period) be deemed permanent by a neurologist acceptable to FWD.
32. Poliomyelitis
The occurrence of poliomyelitis as evidenced by all of the following:
i. the polio virus is identified as the cause, and

ii. paralysis of the limb muscles or respiratory muscles must be present and must have persisted continuously for
at least three (3) months.
For clarity, other causes of paralysis do not meet the above definition of Poliomyelitis.
33. Primary Pulmonary Arterial Hypertension
Primary pulmonary hypertension with substantial right ventricular enlargement, established by investigations including
cardiac catheterisation and resulting in permanent physical impairment to the degree of at least Class IV of the New
York Heart Association (NYHA) Functional Classification of cardiac impairment.
Class IV is defined as the inability to carry out any activity without discomfort. Symptoms of Congestive Cardiac Failure
are present even at rest. With any increase in physical activity, discomfort will be experienced.
34. Progressive Scleroderma
A systemic collagen-vascular disease causing progressive diffuse fibrosis in the skin, blood vessels and visceral organs.
An unequivocal diagnosis of this disease must be supported by biopsy and serological evidence and the disorder must
have reached systemic proportions to involve the heart, lungs or kidneys such that two (2) of the following criteria are
met:
i. pulmonary involvement showing carbon monoxide diffusing capacity (DLCO) < seventy percent (70%) of the
predicted value, or forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC) or total lung capacity
(TLC) < seventy five percent (75%) of the predicted value;
ii. renal involvement showing glomerular filtration rate (GFR) < 60 ml/min;
iii. cardiac involvement showing evidence of either congestive heart failure, cardiac arrhythmia requiring
medication, or pericarditis with moderate to large pericardial effusion.
For clarity, whilst Localised scleroderma (linear scleroderma or morphea), eosinophilic fasciitis and CREST may exhibit
some or all of the above signs and/or symptoms, they are medically different conditions and therefore do not meet the
above definition of Progressive Scleroderma.
35. Renal Failure
Chronic irreversible failure of both kidneys, requiring either permanent renal dialysis or kidney transplantation.
36. Severe Rheumatoid Arthritis
Severe rheumatoid arthritis, with the diagnosis confirmed by a rheumatologist acceptable to FWD and as evidenced by
all of the following:
i. x-ray reveals typical rheumatoid change,

ii. the joint deformity change persists continuously for at least six (6) months, and
iii. at least three of the following groups of joints are involved and deformed:
- finger joints,
- wrist joints,
- elbow joints,
- knee joints,
- hip joints,
- ankle joints,
- spine.
The condition must result in there being at least three (3) of the following six (6) Activities of Daily Living which the
Insured (with or without the use of mechanical equipment, special devices or other aids and adaptations in use for
hygiene,
must (at the end of that period) be deemed permanent by a physician acceptable to FWD.
37. Systemic Lupus Erythematosus
A multi-system, multi-factorial, autoimmune disorder characterized by the development of auto-antibodies directed

against various self-antigens. In respect of this Supplementary Benefit, systemic lupus erythematosus will be restricted
to those forms of systemic lupus erythematosus which involve the kidneys (Grade III to Grade VI lupus nephritis,
established by renal biopsy, and in accordance with the WHO classification as defined below). The diagnosis must be
evidenced by a histological report and confirmed by a specialist in rheumatology and immunology acceptable to FWD.
Other forms of lupus, such as discoid lupus erythematosus or those that affect only the blood and joints are specifically
excluded.
The WHO classifications of lupus nephritis are:
i. Grade I: minimal change glomerulonephritis

ii. Grade II: Pure messangial alterations
iii. Grade III: focal segmental or focal proliferative glomerulonephritis
iv. Grade IV: diffuse proliferative glomerulonephritis
v. Grade V: diffuse membranous glomerulonephritis
vi. Grade VI: advanced sclerosing glomerulonephritis
38. Terminal Illness
Means the conclusive diagnosis by a specialist of an illness that is expected to result in death of the Insured within
twelve (12) months.
The insured must no longer be receiving active treatment other than that for pain relief and the diagnosis must be
confirmed by a specialist acceptable to FWD.
In recognition of medical advances, FWD does not consider HIV/AIDS to be a Terminal Illnesses.

Set for Life Regular Application Form
Policy Number: 51271448
Importance of Truthful Disclosure: It's important that you provide truthful answers in the Application Form.
Concealment of any facts may cause FWD to deny a claim on this policy.
INDIVIDUAL PROPOSED OWNER AND INSURED INFORMATION

Full name Ms. Amylynn Balubar Alberto
Gender Female
Date of Birth 11/06/1982
Marital Status Single
Country of Birth Philippines
Nationality Filipino
TIN Number 300738172
Valid ID TIN
ID Number 300738172
Blk 1 Lot 15 Dasmarinas, Townsville, Sabang, Dasmarinas, Dasmariñas,
Current Address
Cavite, Philippines, 4114
Permanent Address
Email Address [email protected]
Primary Contact Number 63-9369054974
FWD will use your policy delivery mode and contact details to update and notify you in relation to your policy such as
payments, billings, annual statement. It’s also important to let us know when your contact details change in order for
us to manage your account better.
Occupation Accountant
Annual Income Php 300,000.00
Source of Funds Salary
Purpose of Insurance Protection
Employer's Name Jeppaman Builders Corporation
Industry Office work
Blk 14 Lot 1 Mangga St , Greenfield Heights Subd, Dasmariñas, Cavite,
Business Address
Philippines, 4114
Policy Delivery Mode Post + Customer Portal
Delivery Address by Post
Ver No. 001-REGAPP (08/08/2017) Page 1 of 7

PLAN DETAILS
PLAN PAYMENT TERM SUM ASSURED PREMIUM
Set for Life 10 700,000.00 42,000.00
FWD Critical Illness Benefit Rider for UL 34 350,000.00 -
FUND ALLOCATION (Each fund should have minimum of 10%. Total Fund Allocation should equal to 100%)
FUND NAMES ALLOCATION (%)
FWD PESO High Dividend Equity Fund 100.0
PAYMENT INFORMATION
Payment Mode Monthly
Initial Payment Mode
Cash (Partner Banks)
APP No. 0102472400090
Renewal Premium Payment Mode Auto Credit Arrangement
BENEFICIARY DETAILS
Full Name Date of Gender Relationship Allocation Type of Designation Trustee Name
Birth to the of Beneficiary
Proposed Benefits
Insured (%)
Mr. Connor James

12/14/2011 Male Mother 50.00 Primary Revocable Jerecho Alberto
Alberto Seazar
Ms. Kaelyn Rae
09/17/2015 Female Mother 50.00 Primary Revocable Jerecho Alberto
Alberto Seazar
Please note:
If the "Allocation of Benefits" is left blank, benefits will be shared equally between Beneficiaries of the same
type.
If the "Type of Beneficiary" or "Designation" are left blank, the Beneficiary will be defined as "Primary" or
"Revocable" respectively.
FWD will require prior approval of all Beneficiaries designated as "Irrevocable" before processing any policy
transactions.
If there are no changes to the Beneficiary or his designation during the lifetime of the Proposed Insured, the
designation will automatically be deemed "Irrevocable".
If a designated Beneficiary is a minor, a legally recognized guardian or trustee may be required to enact a policy
transaction or file a claim.

EXISTING POLICIES/PENDING APPLICATIONS

Does the Proposed Insured have any existing inforce policy, pending application or
reinstatement for life, critical illness, disability, or accident policy with any other company No
outside of FWD?
OTHER DECLARATIONS
REPLACEMENT OF EXISTING POLICIES
Is the Policy applied for intended to change or replace any existing insurance inforce on the
No
Proposed Owner or Insured?
Will premiums for the insurance you are applying for be paid by a policy loan or surrender
No
value from any existing policies?
REMINDERS: REPLACING an existing life insurance policy with a new one is usually disadvantageous as you may lose
financial benefits you have accumulated over the years, or you may not even be insurable on standard terms, or you
may be required to pay a higher premium in view of higher age. Thus, for your own benefit and interest, please consult
your present insurer before making a final decision. Hear from both sides and make a careful comparison. You can then
be sure that you are making a decision that is your best interest.
US TAX DECLARATION
Are you a citizen, taxpayer, passport holder or green card holder of the U.S. or were you born
No
in the U.S ?

HEALTH AND LIFESTYLE DECLARATIONS

Proposed Insured
Do you currently participate in an extreme or dangerous sport such as scuba No
diving deeper than 30 metres, motor racing, mountain climbing over 4,000
metres, sky diving or private flying other than as a fare paying passenger?
Do you smoke? No
Have you ever taken addictive or illegal drugs, received medical advice, No
counselling or treatment for alcohol consumption or addiction or been advised
to stop or restrict your alcohol intake?
Have you ever been active or intend to be active in politics as a candidate or in No
any other capacity?
MEDICAL INFORMATION AND HISTORY

Proposed Insured
Height 4 ft and 11 in OR 150 cm
Weight 101 lbs OR 46 kg
Have you ever had symptoms or been told to have or received medical advice or treatment for any of the following:
Heart attack, heart murmur, chest pain, high blood pressure, high No
cholesterol or any other disease or disorder of the heart or blood
vessels?
Stroke, epilepsy, paralysis, depression, psychiatric illness or any other No
disease or disorder of the brain or nervous system?
Cancer, tumour, cyst, lump or growth of any kind, HIV infection or No
Acquired Immunodeficiency syndrome (AIDS)?
Diabetes, elevated blood sugar, thyroid disorder, kidney or bladder No
stones or any other disease or disorder of the endocrine system,
kidneys, urinary tract or reproductive system?
Asthma, bronchitis, tuberculosis, chronic obstructive pulmonary No
disease, sleep apnea or any other disease or disorder of the respiratory
system (excluding upper respiratory tract infection, common cold, flu or
cough)?
Hepatitis B or C, pancreatitis, fatty liver, cirrhosis, ulcer, ulcerative No
colitis, Crohn's disease or any other disease or disorder of the liver,
gallbladder, pancreas or gastrointestinal tract?
Deafness, blindness or any other disease or disorder of the ear or eyes No
(excluding prescription lenses for vision correction)
Arthritis, recurrent back pain or any other injury, disease or disorder of No
the spine, muscles, tendons, limbs, bones or joints
Aside from what you have already told us, in the last 5 years, have you had a No
surgical operation; medical investigation or tests i.e. ultrasound, imaging scan,
biopsy, with abnormal results; or been diagnosed with any other disease,
disorder or injury which has resulted in hospitalization or continuous medical
treatment for 7 days or longer?
Are you currently experiencing any symptoms for which you are planning to No
seek medical advice or treatment or are you awaiting a surgical operation or
the results of any medical tests?
For Females:
a. Are you currently pregnant? No

b. Do you currently have or have you had in a previous pregnancy, any No
complications such as high blood pressure, pre-eclampsia, gestational
diabetes or is there a risk of premature delivery?
FAMILY HISTORY
Proposed Insured
Has any of your natural parents, brothers or sisters been diagnosed before age No
60 with cancer of the breast, ovaries colon or rectum, heart disease, stroke,
diabetes, polycystic kidney disease, Alzheimer's Disease, Parkinson's disease,
Huntingtons' disease or any other hereditary disorder?
FWD'S HOME OFFICE ENDORSEMENTS AND SPECIAL INSTRUCTIONS

DECLARATIONS MADE BY PROPOSED OWNER

I UNDERSTAND AND CONFIRM THAT:
1. I read the Sales Illustration before applying for the policy and am fully informed about the product's benefits &
charges and my obligations.
2. The information I have provided above and in any supporting documents or information (collectively defined as
this 'Application Form') are true and complete. I understand that providing inaccurate or incomplete information
may result in future policy benefits being denied.
3. In case of apparent errors or omissions in this Application Form, or if the policy cannot be issued based on
FWD's underwriting guidelines, FWD may amend this Application Form in the FWD's Home Office Endorsement
and Special Instructions and may issue the policy on the basis of such amendments. I understand that my
acceptance of the policy ratifies these amendments.
4. If the policy will replace any existing policies, I have read the Replacement of Existing Policies.
5. I may be subjected to HIV testing and/or a personal investigation for the purpose of underwriting this
application.
6. FWD may collect, store and use information provided in this Application Form and from Third Parties (including,
but not limited to, affiliates, medical/financial/insurance institutions, government agencies and medical
information sharing facilities) to process this application and to service my policies. The information gathered
may be shared with those Third Parties for purposes consistent with which it was obtained.
7. In accordance with the Insurance Commission's Circular Letter No. 2016-54, your medical information will be
uploaded to a Medical Information Database accessible to life insurance companies for the purpose of
enhancing risk assessment and preventing fraud. Once uploaded, all life insurance companies will only have
limited access to your information in order to protect your right to privacy in accordance with law. A copy of
Circular Letter No. 201-54 may be accessed at the Insurance Commission's website at www.insurance.gov.ph.
8. FWD and its affiliates may contact me to request or clarify information to process this application and to service
my policies. I also authorize FWD and its affiliates to send me policy information and promotional information
about their products, services and offers.
9. I have fully disclosed all of my citizenships, tax status, residencies, relevant taxpayer identification numbers and
agree to notify FWD within thirty days of any changes to the above information. For the purposes of ensuring
continued compliance, FWD may request information and/or documents from me including completed,
executed and, if necessary, notarized tax declarations or forms.
10. I authorize FWD to disclose my personal and financial information to any government or tax authority (within or
outside the Philippines) for the purposes of ensuring FWD's continual compliance with applicable laws,
regulations, guidelines and good market practices. I also agree that FWD has the right to require any of my
beneficiaries, claimants, assignees and/or payees to:
1. provide FWD with their respective personal and financial information;
2. sign and submit such documents as FWD may reasonably require; and
3. authorize FWD to disclose such personal and financial information to relevant Filipino and/or foreign
government and/or tax authorities.
11. The amounts invested in the policies have been declared to the relevant government and tax authorities (within
or outside the Philippines) and none were derived, directly or indirectly, from illegal activities, illegal sources or
tax evasion. I authorize FWD to withhold payment of any amounts due to myself, my beneficiaries, claimants,
assignees and/or payees if required by any relevant government or tax authorities (within or outside the
Philippines).
12. The benefits payable under the policy are linked to the performance of the Investment Funds that I have elected
to invest in. I understand that the value of those Investment Funds and therefore the policy will rise and fall. I
confirm that my Fund Allocation Instruction above is based solely on my own judgment.
13. I may cancel the policy by giving FWD written notice within 15 days from receipt of the policy. In this situation, I
will receive a refund equal to the value of my units plus the Premium Charges and Insurance Charges.
14. FWD may require satisfactory evidence of insurability of the Proposed Insured prior to accepting any top-up
premiums.
Note: A separate Temporary Life Insurance Certificate form will be forwarded to you as soon as the Initial Modal Premium has been received.

Proposed Owner printed name and signature
Amylynn Balubar Alberto

Date of Signing : 07/17/2019
DECLARATIONS MADE BY FINANCIAL WEALTH PLANNER

In signing below, I certify that :
I have fully answered any questions the Proposed Owner and/or the Proposed Insured asked in a language
which they understand;
I have acted under the direction and authority of the Proposed Owner;
The Proposed Owner and/or Proposed Insured (where appropriate) have signed this Application Form in our
presence;
I affirm the identity of the Proposed Owner and/or Proposed Insured; and
I have seen and verified the original copy of the identification documents submitted in connection with this
application for insurance.
Name and signature of Financial Wealth Planner
Louise Eliesse Baldea Go

Code : 10005300
Date of Signing : 07/17/2019

RISK PROFILE QUESTIONNAIRE
1. Personal Information
Title First Name Middle Name Last Name Extension Name
Ms. Amylynn Balubar Alberto
m m d d y y y y
Date of Birth: 1 1 / 0 6 / 1 9 8 2 Industry : Occupation :
Residential No. Business / Office No.
Country Code Area Code Telephone Number Country Code Area Code Telephone Number
Mobile No. Email Address

63 9369054974 [email protected]
Country Code Area Code Mobile Number
2. Financial Profile
1. What is your family's average gross annual income?
 Less than PHP 500,000 Above PHP 2,000,000
PHP 500,000 to 1,000,000 No regular source of income
Above PHP 1,000,000 but less than PHP 2,000,000
2. Of the following financial needs, which do you consider the most important?
Protection for beneficiaries/dependents Estate Planning
Education Mortgage Redemption
Savings Retirement
Short-Term Invetsment Growth Accident Protection
Long-Term Investment Growth  Health Protection
3. Risk Profile Questionnaire (For Variable Life Insurance Policies)

1. What is your primary goal in investing
To earn regular income while preserving my capital. (1)
To have the potential for medium gains while accepting moderate risks. (2)
 To have the potential for large gains while accepting potential losses. (3)
2. How long do you intend to keep your investment?

Short-term(1 year or less). (1)
Medium (1-3 years). (2)
 Long (more than 3 years). (3)
3. How important is immediate access to your invested funds?

Very important. I may need to withdraw the income/principal anytime. (1)
Modestly important. I may need to withdraw the income/principal in the next 1-2 years. (2)
 Slightly important. I have no need to use the funds for the next 3 years. (3)
4. What is your knowledge in investment?

 Low. I know Bank Deposits, SDA, Money Market funds. (1)
Average. Aside from deposits and other money market funds, I also know Government Securities,
Corporate Bonds and Notes, Bond Funds, Euro bonds. (2)
High. I have knowledge of / experience in the stock market, Equity Funds, other complex products. (3)
5. As an investor, what is your attitude toward risk?

I cannot tolerate any losses on my investment. (1)
I am prepared to accept a small degree of risk in return for moderate returns. (2)
 I can tolerate a high degree of volatility in order to achieve higher financial gains even if this may
result in substantial losses during adverse market conditions. (3)
TOTAL SCORE (Question 1 to 10): 13
Total Score Risk Level Suitable Product Risk Investor Risk Profile and Investment Policy Statement
Refers to investors who are suitable for relatively low risk asset classes
and price fluctuation which achieve better yield than deposits and
inflation rate. Investors with this profile may invest in funds which targets
5-8 Conservative Low
long term growth through investments in a diverse mix of high quality,
medium to long term fixed securities such as government securities,
corporate bonds and notes.
Refers to investors who are suitable for medium risk asset classes and
price fluctuation which achieve long term capital gain. Investors with this
profile may invest in funds which targets long term growth through
9-11 Balanced Medium
investments in a balanced diversity of high quality equities listed in the
Philippine Stock Exchange and fixed income securities such as
government securities, corporate bonds and notes.
Refers to investors who are suitable for relatively high risk asset classes
and significant price fluctuation which achieve high growth of capital.
12-15 Aggressive High Investors with this profile may invest in funds which optimize growth over
the long term from a diversified portfolio of equities listed in the
Philippine Stock Exchange and money market securities.

4. Investment Policy Statement
I have read and understand the following before submitting this application:
l FWD Life Insurance Corporation’s assessment of my investment risk level and the resultant suitable
product risk recommendation above;
l The features of this plan and the investment strategy and goals of my nominated Investment Funds;
l The benefits payable under this plan are linked to the performance of my nominated Investment
Funds which will rise and fall. The investment risks under this plan are therefor borne solely by me.
I confirm that my decision to invest money in this plan and the nominated Investment Funds is based solely on my
own judgment. If I have nominated one or more Investment Funds that are inconsistent with FWD Life Insurance
Corporation’s assessment of my investment risk level and the resultant suitable product risk recommendation above, I
do so based solely on my own judgment. I therefore hold FWD Life Insurance Corporation, its principals, their
representatives, and successors-in-interest free and harmless from any and all liabilities, opportunity cost and/or
causes of any kind as a result of or due to this decision.
Ms. Amylynn Balubar Alberto Jul/16/2019
Owner's Full Name Date Accepted
Louise Eliesse Baldea Go 10005300
Primary Agent's Full Name & Code Primary Agent's Unit
Secondary Agent's Full Name & Code Secondary Agent's Unit
This Risk Profile Questionnaire is valid from

Jul <Date 1>
16, 2019 to Oct <Date 2>
13, 2019

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Policy Acknowledgement Receipt

OWNER : MS. AMYLYNN BALUBAR ALBERTO

PROPOSED INSURED : MS. AMYLYNN BALUBAR ALBERTO

POLICY NUMBER : 51271448

PLAN NAME : Set for Life

ADDRESS : BLK 1 LOT 15 DASMARINAS TOWNSVILLE, SABANG, DASMARIñAS CAVITE 4114

FULL NAME and SIGNATURE :

RECEIVED BY OWNER's AUTHORIZED REPRESENTATIVE: :

FULL NAME and SIGNATURE :

FULL NAME and SIGNATURE of SOLICITING AGENT :

THIS PORTION IS FOR COURIER SERVICES ONLY

Received at given address

Given address not found

Policy Owner moved out of given address

No person to receive at given address

Others (please specify) :

FULL NAME OF MESSENGER :

MS. AMYLYNN BALUBAR ALBERTO

TOWNSVILLE, SABANG, DASMARIñAS

Dear MS. ALBERTO,

SET FOR LIFE 51271448

Your cover is effective as from August 13, 2019.

Get ready to live!

Peter Karl Grimes

Cc: LOUISE ELIESSE BALDEA GO

SCHEDULE OF POLICY PREMIUMS (in PHP)

INVESTMENT FUND DETAILS

THE DOCUMENTARY STAMP TAX OF THIS POLICY HAS BEEN PAID.

Peter Karl Grimes

Form Number: RPVULAG.03.2017 Page | 2

“Beneficiary” or “Beneficiaries” has the meaning set out in Section 11 Beneficiary.

“Benefit” refers to the Basic Plan and Supplementary Benefit/s if any.

“Contract Debt” has the meaning set out in Section 14 Charges.

“Insurance Charges” has the meaning set out in Section 14 Charges.

“Premium Charge” has the meaning set out in Section 14 Charges.

Form Number: RPVULAG.03.2017 Page | 3

“Unit” refers to the unit of ownership in the Investment Fund.

Form Number: RPVULAG.03.2017 Page | 4

2. EFFECTIVITY OF THE POLICY

5. CURRENCY AND PLACE OF PAYMENT

6. COOLING OFF PERIOD

Form Number: RPVULAG.03.2017 Page | 5

i. Premium Charges and Insurance Charges; plus

8. MISSTATEMENT OF AGE OR SEX

i. Premium Charges and Insurance Charges; plus

i. Premium Charges and Insurance Charges; plus

Form Number: RPVULAG.03.2017 Page | 6

i. Legal spouse; then

Payment of Regular Premium

Form Number: RPVULAG.03.2017 Page | 7

Payment of Regular Top-Up Premium

Payment of Lump Sum Top-Up Premium

To apply for reinstatement, FWD requires the following:

i. a written application for reinstatement using the appropriate form; and

Form Number: RPVULAG.03.2017 Page | 9

15. DEATH BENEFIT

The Death Benefit payable is equal to the higher of:

i. The current Sum Assured; or