Policy Details Change Form: General Information

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

Head Office: 10th Floor NEX Tower, 6786 Ayala Avenue, Makati City, 1229, Philippines
Customer Care: +632 8884 7000
Domestic Toll-Free: 1 800 1 8888 6268
Website: www.manulife.com.ph
Email:[email protected]
Change Form
General Information
Policy Number Name of Life Insured (Last, First, Middle)
Email Address Mobile Number (Country Code, Area Code, Telephone Number)
Policy Details to be Changed

Face Amount From
Basic Premium
(for MAB Only) To
Rider
Supplemental Benefit Benefit
Add
Coverage
Delete
Supplemental Benefit Benefit

Coverage:
Increase Coverage
Decrease
Premium Adjustment Occupation Avocation Health/Medical Condition
Due to Change in:
Plan Change* From To
Premium Default Option**

Premium Loan Option Surrender for Cash Value Reduced Paid-up Insurance
*Applicable within the first 6 months of plan effectivity.
**Applicable for traditional policies only.
Payment Mode
Annual Quarterly Change in Draw Date: _____________________
Semi-Annual Monthly *Applicable to Auto-Debit Arrangement
Regular Payment Scheme

Credit Card Auto-Debit Arrangement Post-Dated Checks
*Manulife account must be enrolled in the accredited bank, additional forms and requirements must be submitted.
Change in Dividend Option

Accumulative with Interest Reduced Paid-up Paid in Cash
Pay Future Premiums Extend Term Insurance__________________
Form No. MP CPA PDC (v.11/2019) Page 1 of 2

Policy Details
The Manufacturers Life Insurance Co. (Phils.), Inc.
Head Office: 10th Floor NEX Tower, 6786 Ayala Avenue, Makati City, 1229, Philippines
Customer Care: +632 8884 7000
Domestic Toll-Free: 1 800 1 8888 6268
Website: www.manulife.com.ph
Email:[email protected]
Change Form
Is the policy for reinstatement?
Yes No
If yes, submit accomplished Non-Medical form together with this Policy Details Change form
If yes, will anyone other than the Insured/Owner be paying for this policy?
Yes No
If yes, has the Insured/Owner or any direct relative of either person ever held a senior position in the government, political party, the
military, any tribunal or government - owned corporation?
Yes No Source of Income: _______________ Estimated Net Worth:________________
Do you want to change your servicing Financial Advisor?

Yes No
If yes, provide the Name of preferred Financial Advisor (Last, First, Middle)
following details
Agent Code
Declaration and Agreement

By signing this form, I confirm that the information I provided is complete and true. I also allow Manulife to update my records based on
the information in this form. Once these changes are affected, I agree to receive a copy of my updated Policy Specifications to reflect the
changes I requested in this form. If the change I requested requires evidence of insurability, I agree that Manulife will not be able to
challenge this policy change after two years from the time it started. However, we can still challenge it after this period has ended for
the following reasons:
1. If we have not received payment for your policy’s premium
2. If your account value is not enough to pay the monthly deductions (applicable to Variable Life only)
3. For any other reason allowed by law.
If the insured commits suicide within one year from the change or last reinstatement, the relevant Insurance Code provision will apply. If
suicide is not covered, Manulife will only pay the refund value.
_____________________________________________ _______________________________________________________________
Policyowner Signature Over Printed Name Irrevocable Beneficiary/ies (if any) Signature over Printed Name
Date: ______________ Place: __________________ Date: ______________ Place: __________________
_____________________________________________ _______________________________________________________________
Assignee Signature Over Printed Name Financial Advisor as Witness Signature over Printed Name
Date: ______________ Place: __________________ Date: ______________ Place: __________________ FA Code: _____________
For Manulife use only

Valid IDs: Type: _____________________________ ID#___________________________________ Documents Presented: _______________________________________________________
Documents received and validated by: _______________________________________________________ _____________________________________________ ___________________________
Name of CSO Branch Date (mm/dd/yyyy)
Form No. MP CPA PDC (v.11/2019) Page 2 of 2

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Policy Details

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

Policy Details to be Changed

Supplemental Benefit Benefit

Plan Change* From To

Premium Default Option**

Regular Payment Scheme

Change in Dividend Option

Form No. MP CPA PDC (v.11/2019) Page 1 of 2

Do you want to change your servicing Financial Advisor?

Declaration and Agreement

Date: Place: Date: Place: ________

For Manulife use only

Form No. MP CPA PDC (v.11/2019) Page 2 of 2

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