I, the Life Assured, do hereby declare that all the foregoing answers are true, that I
have not concealed nor withheld anything with which the Assurer should be acquainted with in order to assess my eligibility for assurance.
I agree that these and all statements I have made or shall make to the Assurer or to its medical examiner(s) in connection with this or previous
proposal(s) shall be the basis of this contract.
I irrevocably authorize and request any Doctor or other person who may be in possession of, or hereafter acquire, any information concerning my
health up to the present time and to disclose such information(s) to the Assured. I agree that this authority and request shall remain in force after my
death as well as prior thereto.
Declarations
1. It is my understanding that the premium I am going to pay when I purchase this plan shall be the Cash Back term Life Premium. I was also
made aware that Death Benefit is paid only if the risk covered crystallizes before the end of the policy term and the Cash-Back will only be
paid if the risk covered does not crystallizes before the end of the policy term.
2. I confirm having read and understood the information in this proposal that my Financial Advisor/Financial Executive fully explained to me
the features and benefits of my plan. I also confirm that I will fully assume all gains / risks associated with the purchase of this plan.
Acknowledgment of Variability
I acknowledge that:
I have applied with AXA Mansard for a Cash Back Term Life policy, and have reviewed the illustration(s) that shows how a life insurance policy performs
using AXA Mansard's assumptions.
I understand that the illustration(s) given to me will not become part of any issued policy, as these are provided only to show an illustration of the
benefits.
Product Transparency Declaration
By signing off on the items listed below, I acknowledge that the same have been discussed with and thoroughly explained to me.
I understand that I am buying a Cash Back Term Life insurance product.
I understand that the Death & Living Benefits stipulated in the Policy are subject to the terms and conditions of the Policy.
I understand that this product is NOT an investment product and I am not entitled to any policy/surrender value.
Restrictions – War and Kindred Risks
It is agreed and expressly understood that should the death of the Life Assured occur directly or indirectly from and his / her engaging in or taking part in
riot, strike, civil commotion, mutiny insurrection, war (whether war be declared or not), or any act incidental thereto, the total amount payable under
this policy shall be limited to the total contributions made together with the total interest accrued thereon.
The Assurer shall not recognize any claim arising from any medical impairment or condition of a Life Assured which occurred or which was diagnosed
prior to commencement of the term of assurance under this Policy, or within six (6) months of such commencement.
Disclosure of Conflict of Interest
The Company adopts a Conflict of Interest Policy and undertakes to disclose any material information which gives rise to actual or potential conflict of
interest to our customers. Company likewise takes all reasonable steps to ensure fair dealings with our customers.
General Disclaimer
All information and opinions provided are of a general nature and for information purposes only. The information and any opinions herein are based
upon sources believed to be reliable. AXA Mansard, its officers and directors make no representations or warranty, expressed or implied, with respect to
the correctness, completeness of the information and opinions in this document. Please carefully read the policy and endorsements and consider the
risks, charges and expenses before buying the policy. You should seek independent professional advice from your financial, tax, accounting or legal
consultant before buying the Policy.
Kindly ensure all payments are made directly into AXA Mansard's designated corporate account(s). All cash payments MUST be made in person,
as the company shall not be held liable for cash payments made to/through other third parties apart from NAICOM licensed Insurance brokers.
