LIFE PLAN

ETERNAL LIFE A

The 1st and ONLY micro life plan in the country.

Simple, Affordable and Reliable! A Renewable life plan for Every Juan.

1. Memorial service benefit equal to the Plan Value

2. Memorial service benefit is for the sole benefit of covered planholder (not assignable).

3. Memorial service benefit is not contestable. The memorial service benefit may be availed of within the 1st year or after the application is approved.

4. Un-rendered Service – if the memorial service is not used, seventy percent (70%) of the Life Plan Value is given to the beneficiary.

5. The plan is transferable limited to the unconsumed period of coverage.

6. Cash Assistance (subject to 1 year contest ability period) equivalent to 10% of the Life Plan Value is given for death within the coverage period

Planholder's Personal Information

Beneficiary / ies:

Full Name

Age

Relation to Plan Holder

Plan Data

Declaration and Representations

ARE YOU THE BEST OF YOUR KNOWLEDGE IN GOOD HEALTH AND FREE FROM ANY DEFORMITY ?
DID YOU HAVE THE FOLLOWING FOR THE PAST 5 YEARS? (CHECK APPROPRIATE BOX)

CASE

DATE

DURATION

REASON / DIAGNOSIS

TREATMENT / RESULT

PHYSICIAN / ADDRESS

I hereby enroll for Group Insurance and certify that the above answers are full, complete and true to my own knowledge.

I agree that the insurance coverage of this application is based on the truth of the foregoing representations and is subject to the provisions of the life insurance issued by a reputable insurance company.

I agree that this application, including the declarations and answers given above, shall be the basis of my application for insurance and issuance of the contract between ETERNAL PLANS, INC. and myself, and shall be deemed part thereof.

I further agree that the effectivity date of this plan shall be the date of approval issued by ETERNAL PLANS, INC. and should I fail to qualify for insurance coverage, I agree to be bound with No Insurance Benefit. 

I agree that this agreement shall become valid and binding from the date this is signed and upon tender of the first payment unless disapproved for cause within ninety (90) days from said date. 

In witness whereof, I have signed this application this

at,

Philippines

DATA PRIVACY CONSENT

In Compliance with the Data Privacy ACT (DPA of 2012, and its implementing Rules and Regulations (IRR), I allow Eternal Plans, Inc. and its agents, third parties, government agencies and instrumentalities to collect, use, share and retain my personal data:

                      A) to process my pre-need plan application and other requests;

                      B) to administer my pre-need plan;

                      C) to provide servicing and support;

                      D) to conduct research and analyse data to improve services; and

                      E) to market, promote and share information about the company and products

This authorization will continue to be in effect throughout the duration of the pre-need plan, and/or until expiration of the retention limit prescribed by the law. 

* BEFORE YOU CLICK SAVE AND SUBMIT PLEASE REVIEW YOUR INFORMATION ABOVE.

I hereby apply to purchase from ETERNAL PLANS, INC. a Pre-Need Plan in accordance with the data set forth in this application and hereby certify that the data and other information stated herein are true and correct and written by me or under my direction.

Eternal Plans, Inc.

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