Вы находитесь на странице: 1из 10
September 24, 2018 CARYL SHENN CATBAGAN BOLIVER 191 BONIFACIO M LANG NORTH COTABATO 9600 Dear

September 24, 2018

CARYL SHENN CATBAGAN BOLIVER 191 BONIFACIO M LANG NORTH COTABATO

9600

Dear MS. BOLIVER:

Attached is your insurance contract no. S-72240764-3-1 from BDO Life Assurance Company, Inc. Please note the following components that form part of the policy:

a. Policy Schedule

b. Contract Provisions under the Basic Plan and Riders

c. Photocopy of Application Form

d. Endorsement and Liens, if any

e. Alteration of Application Form, if any

f. Other documents that may form part of the Policy Contract

Should you notice any discrepancy, error and/or omission in the information stated in your policy inconsistent with the insurance program you had applied for, please give us a call at our Hotline at (632) 885-4110, or email us at we-care@bdolife.com.ph so we can review your policy and perform the necessary rectifications as may be required.

Thank you for choosing BDO Life. We look forward to a long and fruitful relationship with you.

Sincerely yours, RENATO A. VERGEL DE DIOS President & Chief Executive Officer
Sincerely yours,
RENATO A. VERGEL DE DIOS
President & Chief Executive Officer

FA: JUSTIN ROI A. COCAL Gaisano Grand Mall - Cotabato Kidapawan

72240764-CARYL SHENN CATBAGAN BOLIVER

*72240764*

BDO LIFE ASSURANCE COMPANY, INC. Hereinafter called the Company, issues this Policy to the Policy Owner.

The Company hereby agrees to pay the Benefits specified in this Policy subject to the terms and conditions hereof.

The Policy Schedule and provisions on the succeeding pages form part of this Policy.

SIGNED at its Home Office in Makati City, Philippines as of the Issue Date indicated in the Policy Schedule.

RENATO A. VERGEL DE DIOS President & Chief Executive Officer
RENATO A. VERGEL DE DIOS
President & Chief Executive Officer

BDO Life Assurance Company, Inc. (Formerly Generali Pilipinas Life Assurance Company, Inc.) BDO Corporate Center, 7899 Makati Avenue, Makati City, Metro Manila, Philippines Customer Care Hotline: (632) 8854110 | Trunk lines: (632) 8854100, 8854200 | Fax (632) 3250792

72240764 - 180901813

*72240764*

Policy Schedule

Policy Schedule P o l i c y N u m b e r S-72240764-3-1 Effective

Policy Number

S-72240764-3-1

Effective Date

SEP-5-2018

Insured

CARYL SHENN CATBAGAN BOLIVER

Issue Date

SEP-22-2018

Plan

TRIP SECURE

Issue Age

23

Sum Assured

1,000,000.00

Policy Currency

Philippine Peso

 

Policy Owner

CARYL SHENN CATBAGAN BOLIVER

Type of Plan

NON-PARTICIPATING

Schedule of Benefits and Premiums

Form

Description of Benefits

Benefit

Payable

Expiry /

Annual

Number

Amount

up to

Maturity

Premium

MP03

ACCIDENTAL DEATH AND DISABILITY BENEFIT

1,000,000.00

SEP-5-2059

SEP-5-2060

2,147.00

ACCIDENT HOSPITAL INCOME BENEFIT Daily Hospital Allowance Benefit

2,000.00 / day

PUBLIC LAND TRANSPORT ACCIDENT BENEFIT

Included

SEP-5-2059

SEP-5-2060

252.00

AIR TRAVEL ACCIDENT BENEFIT

Included

SEP-5-2059

SEP-5-2060

153.00

MOTORCYCLE ACCIDENT BENEFIT

Included

SEP-5-2059

SEP-5-2060

448.00

FOUR WHEELED VEHICLE ACCIDENT BENEFIT

Included

SEP-5-2059

SEP-5-2060

153.00

The Annual Premium is due every 5th of September until Sep-5-2059.

Premium Mode

Annual

Semi-Annual

Monthly

Total Premiums

3,153.00

1,655.34

305.84

The corresponding Documentary Stamp Taxes have been paid for this policy.

72240764-CARYL SHENN CATBAGAN BOLIVER

*72240764*

72240764-CARYL SHENN CATBAGAN BOLIVER

*72240764*

SCOPE OF BENEFITS AND LIMITATIONS

Benefits The Company will pay after receipt of due proof and approval by the Company of the claim the benefits, as follows:

Part A – Accidental Death and Disability Benefit Percentage of the Sum Assured as indicated in the Schedule of Indemnities shown below if the Insured suffers any of the covered losses as a result of Injury within one hundred eighty (180) days from the date of the accident that caused such injury.

Schedule of Indemnities

Loss of:

%

Life Sight of Both Eyes Speech and Hearing in Both Ears Both Hands or Both Feet One Hand and Sight of one eye One Foot and Sight of one eye Hearing in Both Ears Sight of One Eye or One Hand or One Foot Hearing in One Ear

 

100%

100%

100%

100%

100%

100%

75%

50%

15%

Toes

All Great, both phalanges Great, one phalanx Other than great, each toe lost

15%

5%

2%

1%

 

Right

Left

Hand

Hand

Four Fingers and thumb of one hand Four Fingers

70%

50%

40%

30%

Thumb

both phalanges

30%

30%

one phalanx

15%

15%

Index Finger

three phalanges

10%

7.5%

two phalanges

8%

6%

one phalanx

5%

3.75%

Middle Finger

three phalanges

8%

6%

two phalanges

6%

4.5%

one phalanx

4%

3%

Ring Finger

three phalanges

8%

6%

two phalanges

6%

4.5%

one phalanx

4%

3%

Little Finger

three phalanges

8%

6%

two phalanges

6%

4.5%

one phalanx

4%

3%

Note:

If an Insured is left-handed, the percentages under

“Right Hand” will apply to that Insured’s left hand and the percentages under “Left Hand” will apply to that Insured’s right hand.

Loss of hand means complete and permanent severance at or above the wrist. Loss of foot means complete and permanent severance at or above the ankle. However, loss of use of the hand or foot, if not severed, shall be presumed to be permanent if it had continued uninterruptedly for a period of at least six (6) months. Such permanent loss shall be considered as a loss of said hand or foot. Loss of sight means total and irrecoverable loss of sight.

If more than one of the losses specified in the Schedule of

Indemnities is sustained as a result of one accident, payment shall be made only for the loss for which the highest benefit is payable. Losses sustained as a result of any subsequent accident shall be considered for payment separately from and independently of other losses sustained in a previous accident.

In any policy year, the aggregate indemnity benefit payable in respect of one or more accidents which occur in such policy year shall not exceed the Sum Assured, provided however that any partial benefit already paid for any loss/es shall not be carried over to the subsequent policy year.

Payment of any indemnity benefit amounting to the Sum Assured shall not terminate the coverage in so far as the benefit for loss of life due to Injury is concerned.

Part B – Accident Hospital Income Benefit Daily Hospital Allowance Benefit for each day of confinement up to a maximum of thirty (30) days of continuous confinement, if the Insured, as a result of Injury, is confined and receives medical treatment in a Hospital.

The benefits provided under Parts C, D, E and F are optional and will only apply if shown in the Policy Schedule and the premiums therefor are paid.

Part C – Four Wheeled Vehicle Accident Benefit The Company will double the Accidental Death and Disability Benefit and the Accident Hospital Income Benefit if the Insured sustained the Injury, for which the benefits are payable, while he is riding as a passenger or as a driver in any licensed, motorized and private four-wheeled land-based vehicle that is not used for commercial purposes.

Part D – Motorcycle Accident Benefit The Company will double the Accidental Death and Disability Benefit and the Accident Hospital Income Benefit if the Insured sustained the Injury, for which the benefits are payable, while he is riding in a licensed and motorized two-wheeled land-based vehicle that is not used for commercial purposes.

Part E – Public Land Transport Accident Benefit The Company will double the Accidental Death and Disability Benefit and the Accident Hospital Income Benefit if the Insured sustained the Injury, for which the benefits are payable, while he is riding as a fare-paying passenger in any licensed public utility vehicle over an established land route for regular transport.

Part F – Air Travel Accident Benefit The Company will pay five (5) times the Accidental Death and Disability Benefit and the Accident Hospital Income Benefit if the Insured sustained the Injury, for which the benefits are payable, while he is riding in an aircraft, operating on a scheduled service by a commercial airline in an established passenger route, as a fare-paying passenger and not as member of the crew.

Definitions “Injury” shall mean accidental bodily injury, occurring while this Policy is in full force and effect, caused solely and directly by external, violent and accidental means and independent of all other causes, evidenced by a visible contusion or wound on the body except in case of drowning or of internal injury revealed by

72240764-CARYL SHENN CATBAGAN BOLIVER

*72240764*

an autopsy or medical examination.

“Other causes” shall mean any disease, infirmity or physical condition which the Insured is suffering from at the time of sustaining such accidental bodily injury or afterwards, is not related to the accidental bodily injury and is a contributing factor in bringing about the loss which would otherwise be covered by this Policy.

“Hospital” shall mean a facility that:

1. is licensed, lawfully operating institution duly constituted and registered hospital;

2. is open at all times;

3. is operated mainly to diagnose and treat disabilities on an inpatient basis and at the patient’s expense;

4. has organized facilities for major surgery;

5. has staff of one or more doctors on call at all times;

6. has twenty-four (24) hour nursing services by or under the supervision of registered nurses;

7. is not other than incidentally skilled nursing facility, clinic, place of alcoholics or drug addicts, nursing home, rest home, convalescent home, home for the aged, place for treatment of mental disorders or a similar establishment; and

8. maintains a daily medical report for each patient, which is accessible to the Company’s physician.

“Physician” shall mean a person legally licensed to practice medicine and/or surgery other than the Insured or a member of the Insured’s immediate family within the third (3rd) civil degree, whether by affinity or by consanguinity.

Exclusions No benefit will be payable if Injury results from any of the following causes:

1. Murder or provoked assault;

2. Suicide while sane or insane, or intentionally self-inflicted injuries;

3. Willful exposure to needless peril other than in an attempt to save human life;

4. Bodily or mental infirmity or disease of any kind or infection other than infection occurring simultaneously with and in consequence of an accidental cut or wound;

5. Committing or attempting to commit an assault, felony or other illegal act or resistance to lawful arrest;

6. Pregnancy, childbirth, miscarriage or any complications thereof;

7. Injury sustained from aviation or marine activities, other than riding as fare-paying passenger on an aircraft or ship operating on a scheduled service in an established passenger route;

8. Sports activity such as hunting, steeple chasing, racing of any kind (other than on foot), football, polo, motorcycling, mountaineering in the course of which it is necessary to use guides or ropes, winter sports, underwater pastimes, water-skiing, potholing, and professional sports, except and insofar as the Company has by endorsement agreed to extend this insurance;

9. War, whether declared or not, rebellion or insurrection;

10. Drugs or intoxicant overdose (unless under medical supervision);

11. Any poison, gas or fumes, voluntarily or otherwise taken, administered, absorbed or inhaled other than or as a result of an accident arising from a hazard incident to an

Insured’s non-hazardous occupation;

12. Contamination or pollution of soil, air or water;

13. Any nuclear reaction;

14. Being under the influence of alcohol;

15. Any injury received while being a participant in a brawl, assembly or demonstration, civil commotion, riots, strikes, military or popular uprising;

16. While engaging in any duty directly or indirectly pertaining to hazardous occupations such as bodyguards, detectives, security guards, conductors, drivers of Public Utility Vehicles (PUVs), truck drivers, cattle dealers, farmers, horse trainers, carpenters, construction workers, logging / masonry / sawmill workers, threshing machinists, well sinkers, aircraft flight crew / ship crew members, military personnel, arrastre workers / operators, asylum attendants, automobile / motorcycle racing drivers, divers, stuntmen, explosive makers, handlers or custodians, firemen, jockeys, policemen and other authorities with police power, steeplejacks, window cleaners, tree climbers, coconut/ tuba gatherers, underground workers and miners.

GENERAL PROVISIONS

Entire Contract The Company issues this Policy in consideration of its application and the receipt of its initial premium. This Policy, its application, a copy of which is attached, and all attached Rider Supplemental Provisions and endorsements constitute the entire contract.

The application includes any medical evidence forms, any written statements and answers furnished as evidence of insurability on application for insurance or any subsequent policy changes or reinstatement.

Only the Chairman of the Board of Directors, the President, or officers duly authorized in writing by the Board of Directors have the authority to modify this Policy. Any such modification must be in writing and duly signed by any of the authorized officers.

Effectivity This Policy becomes effective only upon the payment of the initial premium and its delivery to the Policy Owner while the Insured is alive and in good health. The Effective Date shown in the Policy Schedule will be used to determine premium due dates, policy years and policy anniversaries.

Premium Payment All premiums are payable at the Home Office or through offices, banks and other facilities which the Company may designate; or through its agents in exchange for a receipt duly signed by the said agent.

The mode of payment as stated in the Policy Schedule, shall govern the payment of the initial and subsequent premiums, unless changed subject to the following rules: (1) a premium must fall due on each policy anniversary during the premium paying period; and (2) each premium must be in accordance with the rules in effect on the date of such change.

Grace Period After the payment of initial premium, any premium due must be paid not later than thirty-one (31) days after the due date during which time this Policy shall continue to be in force. Any outstanding premium is deductible from the benefits that may arise during the 31-day Grace Period.

72240764-CARYL SHENN CATBAGAN BOLIVER

*72240764*

Misstatement of Age and Sex The age at issue of the Insured is his age on the Effective Date. The Company shall require proof of age before any claim under this Policy is paid.

If the age and/or sex of the Insured have/has been misstated,

the Benefit Amounts shall be adjusted to the amount which the premium would have purchased at the correct age and/or sex, applicable risk class and applicable premium rates as of the Effective Date. However, if based on the correct age and/or sex

of the Insured, he is not eligible for coverage under this Policy or

its riders, the Company will refund the corresponding premiums

actually received by it.

Ownership During the lifetime of the Insured, the Policy Owner may exercise all rights and enjoy all privileges expressly specified in this Policy, subject to the written consent of all living irrevocable beneficiary/ ies. If the Policy Owner dies before the Insured, every right shall be passed to the Insured, subject to the rights of the assignee on record.

Beneficiary The Policy Owner can change any Beneficiary or beneficiary designation by written notice satisfactory to the Company, together with the written consent of all living irrevocable Beneficiaries, subject to any assignment of this Policy in the records of the Company.

To Whom Payable The benefit for loss of life shall be payable to beneficiary/ies surviving at the death of the Insured. Surviving Beneficiaries shall share equally in the death benefit proceeds for that beneficiary classification, unless otherwise specified.

If no Beneficiary survives the Insured, the proceeds shall be

payable to the Policy Owner, if alive, otherwise, in the order named below, where two or more beneficiaries in the same class shall share equally in the proceeds, to the Insured’s:

1. surviving legal spouse;

2. surviving legitimate, legitimated and legally adopted children;

3. surviving illegitimate children known and recognized at the time of the Insured’s death;

4. surviving parents;

5. surviving brothers and sisters of full blood;

6. surviving brothers and sisters of half blood; or

7. estate.

A receipt for any death benefit proceeds under this Policy, signed

by all beneficiaries designated either in this Policy or in accordance with this provision or by a duly authorized representative, will be a good and valid discharge to the Company with respect to the benefits so paid and that all claims and demands against the Company regarding the said benefits so paid shall be deemed to have been fully satisfied.

All other benefits are payable to the Policy Owner.

Claim Settlement In case of a claim, this Policy must be submitted at the Home Office, or any office that the Company may designate, together with due proof for the claim and all other documents to be required by the Company.

Settlement Option Settlement options other than lump sum are available upon written application to the Company.

Currency and Place of Payment All amounts payable or receivable under this Policy will be in the currency stated in the Policy Schedule and shall be paid only in the Philippines. This Policy will be governed by and interpreted according to the laws of the Republic of the Philippines.

Civil Code Article 1250 Waiver Article 1250 of the Civil Code of the Philippines (Republic Act No. 386) which reads, in part:

“In case an extraordinary inflation or deflation of the currency stipulated should supervene, the value of the currency at the time of establishment of the obligation shall be the basis of payment, unless there is an agreement to the contrary.”

shall not apply to any payments made or to be made either to or by the Company.

Lapsation If any premium is not paid by the end of the Grace Period, this Policy will automatically lapse and all its benefits will end.

Reinstatement Subject to the approval of the Company, this Policy may be reinstated at any time within three (3) years from the due date of the premium in default provided:

1. a written application for the reinstatement is submitted to the Company; and

2. the Company receives all amounts necessary to put this Policy in force.

Assignment No assignment of this Policy shall be binding upon the Company until a copy of the assignment document is filed at its Home Office, or at any office that the Company may designate, and duly endorsed on this Policy. The Company assumes no responsibility for the effect, sufficiency or validity of any assignment. The Company has the right not to endorse any reassignment by any assignee.

Non-Participating This Policy is non-participating and shall not share in the divisible surplus of the Company.

Notice of Claim Written notice of claim must be given to the Company within thirty (30) days after the date of accident causing the loss covered by the policy, or soon thereafter as is reasonably possible. In the event of accidental death, immediate notice thereof must be given to the Company.

Sufficiency of Notice Written notice of claim given by or in behalf of a Beneficiary, to the Company or to any authorized representative of the Company, with information sufficient to identify the Insured, shall be deemed to be notice to the Company.

Claim Forms The Company, upon receipt of a notice of claim, shall furnish to

72240764-CARYL SHENN CATBAGAN BOLIVER

*72240764*

the claimant such forms required by the Company for filing proofs of loss. If such forms are not furnished by the Company within fifteen (15) days after the receipt of notice of claim, the claimant shall be deemed to have complied with the requirements of this Policy as to proof of loss upon submitting, within the time fixed in this Policy for filing proofs of loss, written proof covering the occurrence, character and extent of the loss for which claim is made. All certificates, information and evidence, other than the usual claim forms, which the Company may reasonably require in support of a claim, shall be furnished by the claimant.

Proof of Loss Accomplished claim forms and written proof of loss, in the form and nature acceptable to the Company, must be furnished within ninety (90) days after the date of loss for which claim is made. Failure to give written proof of loss within the time specified shall neither invalidate nor reduce any claim if it can be shown that it was not reasonably possible to give such proof within such time and that proof was given as soon as it was reasonably possible.

The hospital confinement must be certified by the attending physician supported by admission and discharge clinical abstract summary and certified statement of account of hospitalization acceptable to the Company and medically necessary, as determined by the Company.

When Claim is Payable The amount of any loss for which the Company may be liable under the Policy, shall be paid within thirty (30) days after proof of loss is received by the Company and ascertainment of the loss is made by the agreement between the Insured and the Company or by arbitration; but if such ascertainment is not had or made within sixty (60) days after such receipt by the Company of the proof of loss, then the loss shall be paid within ninety (90) days after such receipt. Refusal or failure to pay the loss within the time prescribed herein will entitle the Insured to collect interest on the proceeds of the policy for the duration of the delay at the rate of twice the ceiling prescribed by the Monetary Board, unless such refusal or failure to pay is based on the ground that the claim is fraudulent.

Physical Examination and Autopsy The Company, at its own expense, shall have the right and opportunity to examine the person of the Insured when and as often as it may reasonably require during the pendency of a claim or during the entire period that the Company is liable to pay an indemnity or benefit. In the case of death, the Company shall have the right to cause an autopsy unless forbidden by law.

Renewal Unless the Company mails or delivers to the Policy Owner, at least forty-five (45) days prior to the policy anniversary, notice of its intention not to renew this Policy or to condition its renewal upon reduction of limits or elimination of coverage, the Policy Owner shall be entitled to renew this Policy upon payment of the premium at the Company’s premium rate on the effective date of renewal.

Cancellation This Policy shall not be cancelled by the Company except upon prior notice thereof to the Policy Owner, and no notice of cancellation shall be effective unless it is based on occurrence,

after the Effective Date of this Policy, of one or more of the following:

1. Conviction of a crime or felony arising out of acts increasing the hazard insured against;

2. Discovery of fraud or material misrepresentation;

3. Discovery of willful or reckless acts or omissions increasing the hazard insured against; or

4. A determination by the Commissioner that the continuation of this Policy would violate or would place the Company in violation of the Insurance Code.

All notices of cancellation shall be in writing, mailed or delivered to the Policy Owner and shall state (a) which of the grounds set forth in this provision is relied upon and (b) that upon request of the Policy Owner, the Company will furnish the facts on which cancellation is based.

Short Period Rate Scale In the event of cancellation, the Company shall refund the paid premiums less the earned portion thereof to the Policy Owner.

The computation of the earned premiums shall be based on the short period rate scale set forth below but in no case may the earned premiums be less than the Company’s customary minimum premiums.

Period of

Earned Premiums as % of Annual Rate

Coverage

Up to 2 months

40%

Up to 3 months

50%

Up to 4 months

60%

Up to 5 months

70%

Up to 6 months

80%

Over 6 months

100%

The short period rate scale shall not apply if such cancellation occurs during the Free Look Period.

Automatic Termination This Policy shall automatically terminate on the earliest of the following:

1. The date of receipt by the Company of the Policy Owner’s written notice to cancel this Policy;

2. The date following the end of the Grace Period if the premium is not paid;

3. The date of death of the Insured;

4. The policy anniversary following the sixty-fifth (65th) birthday of the Insured; or

5. On the Expiry Date as shown in the Policy Schedule.

Any automatic termination of this Policy shall not prejudice any claim arising prior to such termination.

Limitation of Action No legal action in this Policy may be filed after five (5) years from the time the cause of action accrues.

72240764-CARYL SHENN CATBAGAN BOLIVER

*72240764*

THIS CONTRACT IS BETWEEN THE POLICY OWNER AND BDO LIFE ASSURANCE COMPANY, INC.,

A SUBSIDIARY OF BDO UNIBANK, INC. ALL TRANSACTIONS ARISING OUT OF OR RELATED TO

THIS CONTRACT SHALL BE BINDING ONLY BETWEEN THESE TWO (2) CONTRACTING PARTIES.

IT IS UNDERSTOOD THAT THIS TRANSACTION IS NEITHER INSURED BY THE PHILIPPINE DEPOSIT

INSURANCE CORPORATION NOR GUARANTEED BY BDO UNIBANK, INC.

IMPORTANT NOTICE

The Insurance Commission, with offices in Manila, Cebu and Davao, is the government office in charge of the enforcement of all laws related to insurance and has supervision over insurance providers and intermediaries. It is ready at all times to assist the general public in matters pertaining to insurance. For any inquiries or complaints, please contact the Public Assistance and Mediation Division (PAMD) at the Insurance Commission at 1071 United Nations Avenue, Manila with the telephone numbers +632-5238461 to 70 and email address pubassist@insurance.gov.ph. The official website of the Insurance Commission is www.insurance.gov.ph.