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Personal Information

Rank:
Last Name:*
First Name:*
MI:
Branch of Service:
(if applicable)
Age:
Tel No:*
Address:
Provincial Address:
Annual Income:
Email Address:*

Occupational Classification

Class 1: Non hazardous office and executive personnel whose duties are office and travelling only such as Accountant, Advertising Manager, Lawyer (office only), Salesman, Teacher and similar professions and occupations. Class 2: Occupation involving limited manual labor (not using machinery) but include travelling such as Dentist, Lawyer (including travel), Mechanic (performing bench work only), Press Photographer, Physician and similar professions and occupations.
Class 3: Skilled or semi-skilled industrial worker using light machinery such as Bakery Manager, Contractor, Foreman, Gas Station Attendants, Painting Contractor and similar professions and occupants. Class 4: Industrial workers using heavy machinery or unskilled workers such as Baker, Chauffeur (private), Engraver, Lineman, Radio Technicians, Warehouseman and similar professions or occupations.



Coverage

Death / Dismemberment Benefit Amount:
(maximum 10 times of annual income less existing insurances)
Additional Coverages
Weekly Indemnity:
(maximium 75% of weekly income not exceeding P75,000)
Medical Reimbursement:
(maximium 10% of principal sum not exceeding P75,000)