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Large Amount Questionnaires 2018

The document is a Large Amount Questionnaire for insurance purposes, gathering detailed financial information from the proposed insured, including income, expenses, assets, and personal lifestyle details. It includes sections for income details, assets, and personal information, requiring specifics about real estate, vehicles, liquid assets, education, and family. The form also requires signatures from the policy owner and proposed insured, along with a financial advisor's information.

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37 views2 pages

Large Amount Questionnaires 2018

The document is a Large Amount Questionnaire for insurance purposes, gathering detailed financial information from the proposed insured, including income, expenses, assets, and personal lifestyle details. It includes sections for income details, assets, and personal information, requiring specifics about real estate, vehicles, liquid assets, education, and family. The form also requires signatures from the policy owner and proposed insured, along with a financial advisor's information.

Uploaded by

reefgreenpet
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

LARGE AMOUNT QUESTIONNAIRE

NAME OF PROPOSED INSURED

FIRST NAME POLICY NUMBER

MIDDLE NAME

LAST NAME

PART I – INCOME DETAILS (If Proposed Insured is a minor, questions shall refer to Owner)

1a. What is your current average income from all sources? (Including salary, bonus, commission, other
allowances/compensations, property rental income, interest from bank deposit, interest from fixed income PHP/MO
securities and dividends from shares, etc.)

1b. What are your current average monthly expenses?


(Including mortgage instalment, rent, clothing, transportation, loans, premium, etc)
PHP/MO

Income in the last 3 years (including all commissions and bonuses)

Interest from
Salaries, Bonuses, Property Rental Bank Deposits / Dividends from Total
YEAR Other Income
Commissions Income Fixed Income Shares
Securities

For businessmen or business owners:

Percentage of Duration of
Number of
Ownership in the Business
Employees
Company Operation

Business Turnover / Gross Profit / Net Profit for the last 3 years

Year Turnover Gross Profit Net Profit

PART II – ASSETS (If Proposed Insured is a minor, questions shall refer to Owner)

1. Real Estate – properties owner other than current residence (If more than five properties, please use a separate sheet.)
Address Value

2. Privately Owned Vehicles – indicate body style, model of vehicle

QR-UND-LAQ / REV 8 / NOVEMBER 2018 PHILAM LIFE CUSTOMER CONFIDENTIAL


LARGE AMOUNT QUESTIONNAIRE

x Amount

3. What is your approximate Cash


current accumulative Money in Bank Accounts
amount of liquid assets?
Please indicate specific Actively Traded Stocks
types and total amounts. Money Market Accounts
Bonds and Mutual Funds
Others
Total

PERSONAL AND LIFESTYLE INFORMATION

1. Proposed Insured (if the Proposed Insured is a minor, the questions shall refer to Owner)

Highest Educational
School Course Years Attended
Attainment

Memberships to Social Clubs, Professional and Social-Civic


Physical Activity / Sports / Hobbies
Organizations:

2. Family

A. Children (If the Proposed Insured has Children)

Schools attended by
Proposed Insured’s
Children

B. Vacations

On average, how many times a year?

Places/Countries Visited in the last 12 Months?

3. Other information about the circumstances and lifestyle of the Proposed which reflects the financial capability and stature in
the community (include any threats on life, lawsuits/legislations, undesirable habits/vices, political activities)

I certify the above information is based on my personal knowledge and information I personally obtained from the Proposed Insured
whose signature of authorization appears below.

Name and Signature of Policy Owner Name and Signature of Proposed Date
Insured
(If the Owner is not the same person as the
Proposed Insured)

Financial Advisor Code Financial Advisor Name and Signature

QR-UND-LAQ / REV 8 / NOVEMBER 2018 PHILAM LIFE CUSTOMER CONFIDENTIAL

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