Search for:

Add or Remove Assignee
Add/Remove/Change Beneficiary
Average Agreement Form
Claims
Client Details
Complaint Form Page
Decrease in Premium
Decrease my Sum Insured
Exercise Early Maturity Option
Exercise Early Maturity TEST
H&M Renewal Form
Homeowner’s Proposal Form
Increase in Premium
Life Certificate
Make a change to my Policy Benefits
Make a change to Premium
Motor Proposal Form
Motor Proposal Form Before Add Driver
NEW Insured Motor Claim Form
NEW Third Party Claim Form
PDF Documentations
Proposal
- Motor Vehicle Proposal Form
QT-100
Registered Mail Clients
Reinstate Policy
Report a Death
Report a lost Policy
Report Death Claim
Request Statement
Standard Fire Survey Report
Surrender Policy
Telephone Listing
Transaction Financial Form
Transaction Form
Underwriter’s Sheet
Update Client information
Withdrawal
- Indemnity Form

Surrender Policy

Please Select Policy Type*
Policy No.*
GEM Policy Number only
Policy No.*
D Policy Number only
Policy No.*
URA Policy Number only
Policy No.*
ERA Policy Number only
Policy No.*
T0 Policy Number only
Policy No.*
RAP Policy Number only
Policy No.*
TD Policy Number only
Policy No.*
EDM Policy Number only
Salutation
First Name*
Middle Name
Last Name*
BIR Number*
Identification Type*
Identification Number*
Contact No.*
Email
Address 1*
Address 2
Town/City*
Country*
Is the policy assigned?*
- Yes
- No
Please select assignee from listing below
Other
Are you in possession of the policy contract?*
- Yes
- No
Was a Lost Policy Declaration Form Completed?*
- Yes
- No
Please Do Not Continue Request UNLESS a Lost Declaration Form was completed.
Please select reason for Surrender*
Other
Were any of the Beneficiaries added from inception of the policy?*
- Yes
- No
Please select the relationship of the Beneficiaries
Is Beneficiary still a minor?*
- Yes
- No
Was a Minor/Child Letter Completed?*
- Yes
- No
Please Do Not Continue Request UNLESS a Minor Letter was completed.
Please select your preferred method of payment*
Please enter your account details
Name of Institution*
Other/Credit Union*
Account number*
Please enter a number greater than or equal to 0.
Branch of Account*
Branch of Request/CSR*
Preferred Branch to Collect Payment*
Signature of Policyholder*
- Type-in Signature
- Digital Signature
Signature*
Signature*
Date
Date Format: MM slash DD slash YYYY
Signature of Beneficiary
- Type-in Signature
- Digital Signature
Signature*
Beneficiary Signature*
Additional Comments
Declaration*
- I hereby agree that by surrendering my policy the cost of insurance may be subject to change should I decide to effect new coverage with the Company.
Declaration*
- I confirm that I am the owner and payor of the above-mentioned policy, and would like to request the Cash Surrender Value of the policy, for the sole benefit of my named beneficiary.
Date*
Date Format: MM slash DD slash YYYY

Surrender Policy

Please Do Not Continue Request UNLESS a Lost Declaration Form was completed.

Please Do Not Continue Request UNLESS a Minor Letter was completed.

Please enter your account details