ETERNAL PLANS, INC.

Eternal Life Plan B

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The FIRST and ONLY micro life plan in the country.

Simple, Affordable and Reliable! A renewable life plan for Every Juan!

Memorial Service Benefit, equal to the Life Plan Value, may be used to render traditional memorial service or cremation service.
Memorial Service Benefit is for the SOLE benefit of the covered planholder only (not assignable).
Memorial Service Benefit is not contestable. The memorial service benefit may be availed within the 1st year or after the application is approved.
Cash Assistance (subject to 1 year contestability period) equivalent to 100% of the Life Plan Value is given to the beneficiary for death within the coverage period.
The plan is TRANSFERABLE limited to the unconsumed period of coverage.
Un-rendered Service Benefit - If the memorial service is not availed upon death of the planholder, seventy percent (70%) of the Life Plan Value shall be converted to cash and released to the beneficiary.

Planholder Information

Name (LN, FN MN Suffix)

Last Name *

First Name *

Middle Name

Suffix

Birth Information

Place of Birth *

Date of Birth *

Age *

General Information

Civil Status *

Religion *

Nationality *

Sex *

Height (ft'in" ex. 5'2") *

Weight (kg) *

Funds

Occupation *

Place of Work *

Source of Funds *

Permanent Address

Address (Address Line, City, Province, Zipcode) *

Billing Address

Same as Permanent Address

Billing Address (Address Line, City, Province, Zipcode) *

Contact Information

Contact Number * (09#########)

Email Address *

Beneficiary Information

Beneficiary 1

Full Name *

Age *

Relationship *

Declaration and Representation

Are you in good health and free from any deformity?

Yes

Are you currently pregnant?

Yes

Cases:

Injury

Consultation

Illness

Operation

Proof of Identity

ID Provided *

ID Number *

Image of ID *

Selfie with ID *

Plan Information

Program *

Plan Value *

Mode of Payment *

Year(s) to Pay *

Year(s) of Coverage *

AIP *

Contract Price *

Installment Amount *

BEFORE YOU CLICK SUBMIT PLEASE REVIEW YOUR INFORMATION BELOW

Planholder Information

Name

First Name:

Last Name:

Middle Name:

Suffix:

Birth Information

Place of Birth:

Date of Birth:

Age:

General Information

Civil Status:

Religion:

Nationality:

Sex:

Height:

Weight: kgs.

Funds

Occupation:

Place of Work:

Source of Funds:

Address

Permanent Address:

Billing Address:

Contact Information

Contact Number:

Email Address:

Proof of Identity

ID Provided:

ID Number:

Declaration and Representation

Healthy: Yes

Pregnant: No

Plan Information

Program: ETERNAL LIFE B

Plan Value:

Year(s) to Pay:

Year(s) of Coverage:

Mode of Payment:

AIP:

Contract Price:

Installment Amount:

Sales Counselor:

I hereby apply to purchase from ETERNAL PLANS, INC. a Pre-Need Plan in accordance with the data set forth in this application and hereby certify that the data and other information stated herein are true and correct and written by me or under my direction.

I Agree with the Terms and Conditions

You must agree before submitting!