SALARY LOAN ACCOUNT. 1. All salary loans Debtors of Land Bank should be covered by Credit Life Insurance (CLI).

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1 SALARY LOAN ACCOUNT 1. All salary loans Debtors of Land Bank should be covered by Credit Life Insurance (CLI). 2. Credit Life Insurance (CLI) is an insurance against the life of the debtors to answer for his/her loan in the event of death. 3. LBP thru LIBI has entered into an agreement with the Philippine Prudential Life Insurance Co.,Inc. to insure all debtors with salary loans subject to certain terms and conditions. 4. Philippine Prudential Life Insurance Co., Inc. issued a Master Policy now in the possession of LIBI insuring the LBP debtors. How to Insure Salary Loan Borrowers 1. Upon loan application, the debtors will be required to accomplish the application for credit life insurance coverage. (Please refer to Annex G). 2. All blank spaces have to be accomplished truly and faithfully. 3. The Branch will compile all the applications. 4. The Branch will submit a consolidated report (please refer to Annex H) with the following information as soon as possible by fax and the original list, together with the credit advice, by ASD or by regular mail Borrowers Name 4.2. Birth (Month/Day/Year) 4.3. Approved Loan 4.4. Premium 4.5. Term of Loan 5. The consolidated report will be forwarded to LIBI together with your premium payment. 6. LIBI will issue Premium Invoice and Official Receipt 7. LIBI will send to the Branches the Certificate of Cover together with the Premium Invoice and Official Receipts. 1

2 Annex G AMOUNT GRANTED P TERM OF LOAN : DATE OF RELEASE : MATURITY DATE : PREMIUM DUE P APPLICATION FOR CREDIT LIFE INSURANCE COVERAGE OF THE LANDBANK OF THE PHILIPPINES BORROWERS PERSONAL DATA 1 Name Given Middle Family 2 Date of Birth 4 Office Address Tel. No. 3 Place of Birth 5 Home Address Tel. No. 6 Name of Beneficiaries HEALTH DECLARATION I hereby warrant that on the date of the release of my loan, I possess sound health and am able to perform the normal activities in the pursuit of my livelihood. I hereby agree that if there be any misrepresentation in the above statement material to the risk, the insurance company shall have the right to reject and declare that such insurance null and void. Issued and signed at this day of 20. Witnessed and issued by: CREDITOR S Authorized Officer Signature of Applicant Right Thumbmark 2

3 Annex H LANDBANK OF THE PHILIPPINES BRANCH SCHEDULE OF CREDIT LIFE INSURANCE DATE GRANTED : EXPIRY DATE : NAME OF BORROWER BIRTHDATE AMOUNT OF LOAN PREMIUM AMOUNT GRAND TOTAL Prepared by: Checked by: Noted by: 3

4 How to compute the premium The premium rate is 7.44 per thousand per year regardless of age*. Pro-rata computation should be on a monthly basis. A fraction of a month is deemed to be one month. Example: Loan Amount x Premium Rate/1000 x No. of Years = Premium 100, x 7.44/ 1000 x 2 = P 1, How much is the maximum insurance cover? The maximum automatic cover is P500, any amount in excess thereof needs prior written approval from the insurer. Who are eligible for the coverage? * A borrower who is not less than neither 18 nor more than 64 years of age provided that at the time salary loan is granted he/she is physically able to perform the usual duties of his/her livelihood. Is medical examination required? No, provided the debtor accomplishes the required application form and the loan does not exceed P500, When does the insurance coverage start? Insurance coverage starts immediately upon release of the loan, provided the debtor complies with all the requirements of the bank and the insurance company. 4

5 Will the Branch have a copy of the policy? LIBI is the custodian of a group Master Policy No. CLI-745 issued by Philippine Prudential Life Insurance Co., Inc. in favor of Land Bank of the Philippines. In lieu of a policy, LIBI will furnish the Branch the premium invoice, official receipt and Certificate of Cover (COC). The Certificate of Cover (COC) is the individual or group (batch) insurance policy. This will suffice as proof of cover. When will the Branch receive the Certificate of Cover (COC)? Within 30 days after payment has been cleared (Manager's Check, IOM, Direct deposit), the COC together with LIBI's premium invoice and official receipt will be forwarded to the Branch. How to file a claim? In the event of death of the debtor, the Branch will have to notify LIBI within 60 days and the following documents will have to be submitted, to wit: 1. Certification Of Insured Debtors 2. Complete Remittance Schedule 3. Proof Of Prem. Payment To Libi (Credit Advice/Or) 4. Death Certificate-Original Or Certified True Copy, With Official Seal Of The City Civil Registrar. 5. Salary Loan Application/ Promissory Note 6. Group Application/Health Declaration 7. Statement Of Account 8. Loan Ledger 9. Disclosure Statement/Dicount Sheet 10. Identification Statement 11. Claimant Statement 12. Attending Physician s Statement 13. Birth/Baptismal Certificate 14. Marriage Contract 15. Medical Record/ Certificate 16. NBI/ Police/ Accident Report 17. Barangay Certificate (in case died at home) 5

6 LBP INSURANCE BROKERAGE, INC. 12 th Floor, SSHG Law Centre 105 Paseo De Roxas Legaspi Village, Makati City General Data of Deceased CERTIFICATE OF CLAIMANT 1. a.full name (Please print) b. If deceased was a married woman, state maiden name 2. a. Date of birth b. Place of birth c. Source from which date of birth was obtained) (Family record or other record or certificate of birth should be referred to). 3. Residence at death 4. a. Place of death b. Date of death c. Cause of death d. Age of death 5. a. Occupation at date of death b. Date deceased last attended his usual work Insurance Policies of Deceased Name of Company Policy Number Date Issued Amount Health History of Deceased 1. Date deceased first complained or showed symptoms of last illness 2. Date deceased first consulted a physician of last illness 3. Name and address of all physicians who attended deceased during last illness and during the three years immediately proceeding it and/or hospitals or other institutions in which the deceased was confined or received treatment within the last three years: Name of Address Date of Attendance/ Disease Physician/Hosp/Institution Confinement or From To Condition 6

7 Data of Beneficiary-Claimant 1. a. In what capacity, or by what title, do you claim this insurance? b. What is your relation to the deceased? 2. Do you elect one of the optional modes of settlement in lieu of an immediate cash payment?. If so, which mode of settlement? (Not applicable if the claim does not involve a lump sum cash payment.) 3. Please state your date of birth (If a married minor or surviving spouse, please submit marriage certificate.) Having been duly sworn, I hereby depose and say that the statement in the foregoing answers are true and full, to the best of my knowledge and belief and that there are no material facts in the case which are not disclosed. Date at this day of,. Witness _ Address Claimant On this day of,, personally appeared before me the above named, with Res. Cert. No. issued on at to me known, who being by me duly sworn, deposed that the answer to the above questions and subscribed the same in my presence. Doc. No. Page No. Book No. Notary Public My Commission Expires 7

8 Policy no. LBP INSURANCE BROKERAGE INC. 12 th Floor, SSHG Law Centre 105 Paseo De Roxas Legaspi Village, Makati City IDENTIFICATION This form is to be accomplished by a competent person acquainted with the deceased, fully sware of his/her death, but not interested in the claim. 1. (a) Deceased s full name. (b) Res. Address at the time of death. (c) Occupation at death. (d) Place and date of birth. 2. (a) Place of death. (b) Date and time of death. (c) Cause of death. (d) Place of interment. (e) Date of interment. 3. (a) How long have you known the deceased?. (b) Have you seen the cadaver of the deceased?. (c) Was it the cadaver (body) of the person insured ender the policy numbered above? if so, please give basis for your identification. 4. Do you guarantee that these statements are true and correct to the best of your knowledge and belief?. Dated at this day of,. Signed in the presence of: Witness Address Witness Address Name in Print & Signature Occupation Name in Print & Signature Occupation 8

9 LBP INSURANCE BROKERAGE, INC. 12 TH Floor, SSHG Law Centre 105 Paseo De Roxas Legaspi Village, Makati City ATTENDING PHYSICIAN S STATEMENT This statement must be made by the Physician in attendance during the last illness of the deceased, and must be entirely in his own handwriting. If more than one physician was employed, the statement of each must be furnished upon separate forms, which will be sent if required. When an autopsy has been made by order of the court, a copy of the verdict, and of the evidence upon which it was based duly certified must be furnished. 1. Name of the deceased in full 2. Residence 3. Last Occupation of the deceased 4. How long did you attend the deceased? 5. Did you attend or were you consulted by the deceased before the last illness? If so, when and for what illness, giving details including date 6. A. Did you attend the deceased during his last illness? A. B. If so, for what decease? B. 7. A. Date and hour of your first visit A. B. Date and hour of your last visit B. 8. A. Did any other physician attend the deceased during last illness? A. B. Give name and address of each date of his first visit and the duration of his attendance B. 9. A. Place of death A. B. Date of death B. 10. A. What disease was the immediate cause of death? A. B. How long in your opinion, did the deceased suffer from the disease? B. 11. A. What were the first indications of the failing health? A. B. When were they first noticed? Give date and hour if possible. B. 12. A. From what other disease if any, did the deceased suffer? A. _ B. Give as nearly as you can, the duration of each one. B. 13. Did previous illness, family history or habits in any way predispose the deceased to the cause of death? If so, describe fully. 14. For how long before death occurred was the deceased confined to the house or prevented from attending to business 9

10 15. From physical findings and appearances, what would you judge to be the age of the deceased? 16. A. Was death caused, directly or indirectly, by the habits, A. occupation? B. Does the deceased use alcoholic beverage of any kind? B. If so, to what extent or effect? 17. A. Where did you receive your medical education? A. B. When and where did you graduate? B. 18. A. Was there an autopsy or a postmortem examination A. on the body of the deceased? B. If so, state which, by whom and give the result. B. 19. Did you personally see the remains of the deceased? 20. Do you guarantee that all the statements and answers made by you in this questionnaire are true and that you have not concealed any material fact from the Company? ============================================================================ Having been duly sworn, I hereby depose and say that the statement in the foregoing answers are true and full, to the best of my knowledge and belief, and that there are no material facts in the case which are not disclosed. Dated at this day of, 20. Witness Address Attending Physician Address On this day of 20, personally appeared before me the above named to me known as a physician in regular standing, who being by me duly sworn, and subscribed the same in my presence; affiant exhibited to me his Residence Cert. No. on 20 Doc. No. Page No. Book No. Series of 20. NOTARY PUBLIC ============================================================================ THIS STATEMENT SHOULD BE SWORN TO BEFORE A NOTARY PUBLIC OR OTHER DULY AUTHORIZED TO ADMINISTER OATHS AND HIS OFFICIAL SEAL ATTACHED, OR IF HE HAS NO SEAL, HIS AUTHORITY AND THE GENUINENESS OF HIS SIGNATURE MUST BE ATTESTED BY A JUSTICE OF THE PEACE OR BY A CLERK OF A COURT OF RECORD. IMPORTANT NOTICE The physician who fills this blank will facilitate the PROMPT PAYMENT OF THE CLAIM by giving in answer to Questions No. 10, 11, 12, 13, 14 and 16, a full statement of each. Pathological process especially as to its Duration and results. Such indefinite terms as Heart Failure, Exhaustion and the like, are to be avoided unless full details are added. Where death is the result of Accident or Injury, the word LESION may be understood to replace DESEASE in question no. 10. Where the spaces set apart for the answers are too small, such details as seem desirable may be given on the page, under ADDITIONAL REMARKS. ============================================================================ 10