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Irrevocable Beneficiary Consent Form Bpi Aia

This document is an irrevocable beneficiary consent form for a BPI AIA life insurance policy. It provides contact information for BPI AIA and requests the irrevocable beneficiary's consent to make changes to the policy by checking the appropriate box for transactions like cancellation, conversion, cash surrender, or changing beneficiaries. The beneficiary acknowledges their future benefits may be affected by signing and dating the form.

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PSC.CLAIMS1
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1K views1 page

Irrevocable Beneficiary Consent Form Bpi Aia

This document is an irrevocable beneficiary consent form for a BPI AIA life insurance policy. It provides contact information for BPI AIA and requests the irrevocable beneficiary's consent to make changes to the policy by checking the appropriate box for transactions like cancellation, conversion, cash surrender, or changing beneficiaries. The beneficiary acknowledges their future benefits may be affected by signing and dating the form.

Uploaded by

PSC.CLAIMS1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

BPI AIA Life Assurance Corporation

12F & 15F BPI-Philam Makati, 6811 Ayala Ave.


Makati City 1226, Philippines
Telephone: (632) 8528 5501
W: www.bpi-aia.com.ph

IRREVOCABLE BENEFICIARY CONSENT FORM

As the designated irrevocable beneficiary of the BPI AIA for:

Policy Number

Policy Owner’s Details


Last name First Name Middle Name Suffix

I provide my consent to make the following change/s to this policy. Kindly check (✓) the appropriate
box to indicate the transaction you are providing your consent to:

 Cancellation during Cooling off Period  Conversion to Reduced Paid Up


 Cash Surrender  Decrease Coverage
 Change in Beneficiary  Dividend Withdrawal
 Change in Fund Allocation  File a Loan
 Change in Ownership  Full Withdrawal
 Change Plan  Fund Switch
 Conversion to Extended Term  Partial Withdrawal
Insurance
 Policy Assignment

By affixing my signature below, I understand that any change made to this policy may affect my
future benefits as the designated beneficiary.

Irrevocable Beneficiary

________________________________________ ________________________________________
Signature over Printed Name Date Signed
(First Name, Middle Name, Last Name) (Month Day, Year)

QR-BPOS-IBCF / REVISION 0 / DECEMBER 2021 BPI AIA CUSTOMER CONFIDENTIAL

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