Paramount Direct

Sure Savings Plan

I understand that this does not obligate me in any way and that I will have the opportunity to inspect my policy for up to 15 days before I accept it. I understand that the insurance will take effect when my policy is issued and I have paid my first premium during my lifetime and good health.

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Where did you hear about us?

My insurance needs match:

I want to pay:

Premium:

Policy Owner Information

Title

Name

Gender

Birthdate

Place Of Birth
(Optional)

Nationality

In order to continue with the processing your application, may we request you to send us the following requirements:

1. Copy of Permanent Resident Visa (Philippines)
2. Copy of valid I.D
3. Number of years stayed (Philippines)

Please send it to direct@paramount.com.ph, so we may process your application immediately.

Weight

Height

Contact Information

Address

Mail to this address
Mail to a different address

Mailing Address

Mobile Number

Telephone Number

Area Code

Phone number

Email Address

Make sure your email address is updated to guarantee that you receive your policy and other important messages from us.

Employment Information

Occupation

Specific duties

Office Address

Zipcode

Office Tel. No.

Area Code

Phone number

Source of Funds

TIN

GSIS / SSS

Other Information

Beneficiaries

Full Name

Relationship to you

Birthdate

Revocable ^?

Revocable & Irrevocable

A REVOCABLE beneficiary on a policy is usually the best course of action, as it allows you to change the beneficiary on the policy should certain circumstances change. It is harder to change the beneficiary on an irrevocable policy because it requires the consent of the current beneficiary.

If a parent wanted to leave money to a child, the parent could designate that child as an IRREVOCABLE beneficiary, thus ensuring the child will receive the compensation of the life insurance policy or the segregated fund contract.

Non-forfeiture Options ^?

If premium is unpaid on expiry of grace period, apply cash value, if any, to effect:

Non-Forfeiture Options

The AUTOMATIC PREMIUM LOAN option automatically borrows from the available Cash Value to pay for your premium due.

The PAID-UP INSURANCE option allows you to stop paying premiums and still keep insurance coverage at reduced benefit value.

The SURRENDER OPTION lets you cash-in your policy. However, please note that once you choose to surrender your policy, your coverage is terminated.

With the EXTENDED TERM INSURANCE, the face amount of the policy stays the same, but it is flipped to an extended term insurance policy. The equity you built is used to purchase a term policy that equals the number of years you paid premiums.

Declaration on Existing Policy(ies)

Do you have other life insurance policies inforce with other insurance companies?

If yes, please provide details.

a. Total Life Insurance inforce on:

Insurance Company

Basic / Cover

Accident Rider / Year Issued

b. Is the policy applied for intended to change or replace any existing inforce policies? If yes, please complete Repleacement Notification Form that we will send you.

Reminder: It is usually disadvantageous to REPLACE existing life insurance policy(ies) with a new one. Some disadvantages are: You may not be insurable on standard terms; You may have to pay a higher premium in view of higher age; You may lose financial benefits accumulated over the years. Please note that in your own interest, we would advise that you consult your present insurer before making a final decision. Hear from both sides and make careful comparison. You can then be sure that you are making a decision in your best interest.

Here are the benefits included:

Learn more about the Benefits.

Life Benefit	100,000.00
Hospital Income Benefit	500.00
Accidental Death Benefit	100,000.00
Waiver of Premium	Yes

Benefits

The Life Benefit

The Life Benefit shall be payable to the Owner if the Policy is in force and the Insured is alive on the Maturity Date. In case of the insured's sudden death due to natural causes, the beneficiaries will receive the lump sum cash benefits.

Hospital Income Benefit Rider

This is an additional benefit that provides daily hospital cash assistance in casethe Insured is hospitalized due to sickness, injury or dread disease.

This benefit is directly paid to you and provides you the privilege to choose how and where to spend it - whether to pay for medical expenses or any additional expenses incurred during hospital confinement.

Accidental Death Benefit Rider

This is an additional benefit that is payable to the beneficiary/ies when the Insured dies due to an accident.

Accidental Death Benefit rider saves your family from financial losses caused by your sudden demise.

Waiver of Premium due to Disability Rider

This is an additional benefit that waives premium in the event the Insured becomes seriously injured or disabled.

Waiver of Premium on Disability rider gives you and your family peace of mind knowing that you are still protected during this trying times.

Payor Information

Is Payor is the same with the Insured?

Name

Contact Number

Email Address

Relationship

Other

Please confirm that the details provided below are true and complete.

Sure Savings Plan

Personal Information Edit

Name:

Gender:

Birthdate:

Place of Birth:

Nationality:

Height:

Weight:

Contact InformationEdit

Address:

Mailing Address:

Mobile Number:

Telephone Number:

Email Address:

We will send a confirmation email on this email address. Please make sure this email address is correct.

Employment InformationEdit

Company:

Occupation:

Specific duties:

Office Address:

Zipcode:

Office Telephone Number:

Philhealth:

Insured PersonEdit

BeneficiaryEdit

Full Name

Relationship to you

Birthdate

Is Revocable

Non-forfeiture OptionsEdit

Payor Information Edit

Is Payor is the same with the Insured?

Name:

Contact Number:

Email Address:

Relationship:

Data Privacy Consent Form

Paramount Life & General Insurance Corporation (PLGIC) (“the Company”) upholds the data privacy rights of its data subjects and ensures that all personal data collected or to be collected, are processed in compliance with the Data Privacy Act of 2012 and its Implementing Rules and Regulations (IRR).

By availing of PLGIC’s insurance products and services or by transacting with the Company, the latter may collect personal information or sensitive personal information (collectively “personal data”). Accordingly, I, the undersigned, hereby give my consent to the following:

	processing of my personal data whether manually or via electronic channels, including but not limited to the collection, usage, storage, customer/client profiling, and disclosure to third parties by “PLGIC”, its subsidiaries, affiliates, directors, officers, employees, and agents: (a) to verify and/or confirm any or all the information provided or representation made, (b) to provide, facilitate, monitor, improve the quality of, or otherwise service my account and such products, services, and facilities and/or channels availed by me or may be offered by PLGIC, and (c) to comply with legal, regulatory or other obligations of PLGIC under applicable local or foreign laws, rules and regulations;
	retention by PLGIC of the personal data that I submitted for a period of five (5) years, or for a longer period, if the personal data is related to or required to be preserved for litigation or to comply with legal or regulatory requirement. I likewise consent to the correction, amendment, deletion and/or disposal by PLGIC, its subsidiaries, affiliates, directors, officers, employees, agents, and authorized third parties of my personal data which may be inaccurate or incorrect.
	use my contact details and demographic information for direct marketing or dissemination of promotional information regarding the company’s products and services by means of phone calls, mail, email, SMS or any type of electronic facility.
	authorize PLGIC to use my Personal Data for purposes of providing services or for other reasonable purposes which are related to the services it provides or improvements/upgrades in its systems and business processes, including but not limited to data analytics and automated processing.
	authorize PLGIC to share my Personal Data to its subsidiaries, affiliates and authorized third parties for legitimate commercial or business purposes.

Your rights

You have the right to ascertain the Company's policies and practices in relation to personal data, and to obtain access to and to request correction of your personal data held by the Company. If we propose to expand the amount of personal information collected, the purposes for collection or the types of parties to whom we may share the information, you have the right to the further processing of your personal information. You also have the right to withdraw your consent to the processing of your personal information. Exercising your right to object or withdrawing your consent may prevent the Company from rendering insurance services to you. You have the right to complain to the National Privacy Commission (NPC) as the mandated government agency to administer and implement the provisions of the Data Privacy Act of 2012.

Your right to access your personal information may be subject to payment of an administrative fee. Request/s for such access or correction, to withdraw consent for direct marketing, or for further information about our data privacy policies and practices can be made in writing to the Data Protection Officer (DPO), Paramount Life & General Insurance Corporation, 14th and 15th Floor, Sage House, 110 V. A. Rufino St., Legaspi Village, Makati City, Philippines or email us at dataprotectionofficer@paramount.com.ph or call us at telephone number 632-87729200.

This authorization and consent are as valid as a signed document and will continue to have effect throughout the duration of your coverage under your policy and/or until expiration of the retention limit set by laws and regulations from account disclosure, and the period set until destruction or disposal of records, unless withdrawn in writing or withheld due to changes in the information supplied by the Company.

Attestation

I declare that I have read this form, understood its contents, and attest that I have been made aware of and understood my rights as data subject and how these can be exercised, and that I was informed of the nature, extent and processing of the personal data I provided. I understand and agree that the consent hereby given may be revoked or withdrawn through formal written notice to PLGIC.

Data Privacy Consent Statement

I hereby consent to the processing of the personal data stated above whether manually or via electronic channels, including but not limited to the collection, usage, storage, customer/client profiling, and disclosure to third parties, by Paramount Life & General Insurance Corporation (hereafter, “PLGIC”), its subsidiaries, affiliates, directors, officers, employees, and agents (a) to verify and/or confirm any or all the information provided or representation made, (b) to provide, facilitate, monitor, improve the quality of, or otherwise service my account and such products, services, and facilities and/or channels availed by me or may be offered by PLGIC, (c) for marketing purposes, and (d) to comply with legal, regulatory or other obligations of PLGIC under applicable local or foreign laws, rules and regulations.

I likewise consent to the processing of the personal data stated above whether manually or via electronic channels, including but not limited to the collection, usage, storage, and customer/client profiling, by authorized third parties for the foregoing purposes.

Such processing may be conducted for the duration of my availment of PLGIC’s products, services, facilities and/or channels. I further consent that the personal data stated above shall be retained by PLGIC for an additional period of at least five (5) years, or for a longer period if the personal data is related to or required to be preserved for litigation or to comply with legal or regulatory requirement. I likewise consent to the correction, amendment, deletion and/or disposal by PLGIC, its subsidiaries, affiliates, directors, officers, employees, agents, and authorized third parties, of my personal data which may be inaccurate or incorrect.

I attest that I have been made aware of and understood my rights as data subject and how these can be exercised, and that I was informed of the nature, extent and processing of the personal data I provided. I understand and agree that the consent hereby given may be revoked or withdrawn though formal written notice to PLGIC.

Finally, I authorize PLGIC, its subsidiaries, affiliates, directors, officers, employees, agents, and authorized third parties to obtain such other information they may deem necessary to verify or confirm the personal data declared or the documents furnished in relation to this application, and that I agree that such documents may remain in the possession of PLGIC whether or not this application is granted, for the purposes above mentioned.

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Payor Information

Non-forfeiture Options ^?