The applicant who is at least eighteen (18) years old but not over sixty-five (65) years of age at the inception of the plan and is physically and mentally able to perform the usual and normal duties of their occupation shall be eligible under the Company's Group Insurance.
No applicant will be covered under the plan unless coverage is endorsed and is duly approved by the Company's Group Insurance.
The applicant has not consulted any physician for heart condition, hypertension, cancer, diabetes, lungs, kidneys or intestinal disorder, tuberculosis, or any other physical impairment nor has been confined in a hospital/ clinic and received any medical or surgical attention. If so, kindly give results:
I agree that this application form shall be the basis for the Insurance coverage issued under the Company’s Group Insurance. I understand further that the insurance coverage shall not become effective until it is accepted and confirmed in writing by the Company’s Group Insurance.
It is understood and agreed that the issuance of the plan is based on the truth of the stated representations. Any false statement of the applicant as to his/her age or health may render the Life Plan Contract rescissible. The undersigned further agrees that this contract and the declaration given above shall be the basis of the contract between the undersigned applicant and the company and shall be deemed to be an integral part of the contract, subject to the conditions stated in the Life Plan Contract.