FWD Life Insurance Corporation

9/F W Fifth Building. 5th Avenue

Bonifacio Global City, Taguig City, 1634 Philippines 1 x 1 Picture
Tel: 8888-FWD 1 x 1 Picture
PERSONAL INFORMATION SHEET

Please write legibly in UPPERCASE (ex. JUAN DELA CRUZ)

Designation: Financial Weath Director Financial Wealth Manager Financial Wealth Officer Financial Wealth Planner

Referred by: _____________________________________________ Referror Agent ID: ______________________________

Signature over Printed Name of Recruiter
PERSONAL DATA:
Title First Name Middle Name Last Name Nickname

Residence Address: Residence Telephone No.

Zip Code:
Business Address: Office Telephone No.

Zip Code:
Age: Date of Birth: Place of Birth: Gender: Mobile No. 1
Male Female
Marital Status: Nationality: Religion: Passport# Mobile No. 2

TIN#: SSS# Preferred Address for Correspondence: Email Address: (yahoo or gmail)
Residence Office
ACADEMIC BACKGROUND:
COURSE SCHOOL ATTENDED YEAR ATTENDED DEGREE OBTAINED YEAR GRADUATED
Highschool
College
Graduate School
OCCUPATION DETAILS (For the Last 5 Years):
COMPANY POSITION PERIOD (MM/DD/YYYY REASON FOR LEAVING
FROM TO

(Please write at the back if the space provided is not sufficient)

DEPENDENTS:
NAME AGE STATUS RELATION TO AGENT

Contact Person In Case of Emergency: Mobile Number:

I hereby affirm that my answers to the foregoing questions are true and correct and that any falsification made herein shall be taken as sufficient
grounds for disqualification on my application or my dismissal from the Company. I authorize the Company to collect, process, store, modify and destroy my
information, as well as disclose, share or transfer this informationto its principal, subsidiaries, affiliates, partners, agents, representatives, outsourced service
providers, and to regulatory authorities or government entities, for legitimate purposes, including but not limited to:
i. Process my application, including assisting me in my application for license to the Insurance Commission, conducting any background checks;
ii. Administer my commissions, overrides, other benefits and entitlements, if any;
iii. Provide advice or information covering products, services, promotions, contest, customer related services and the like, or communicate with me through
mail/email/social media account/fax/SMS/telephone for any purpose;
iv. Manage, review and analyse results of my information, production, and other performance based results for data analytics;
v. Comply with applicable laws or regulations.

__________________________________
Signature over Printed Name of Applicant Date signed: _________________________

For Agency Leaders:

I hereby certify that the agent - applicant possess the qualifications presecuted by the Office of the Insurance Commission in the licensing of agents.

Signature over printed name of Immediate Agency Leader Immediate Leader Agent ID: _____________ Date signed: ___________________

Endorsed by: ___________________________________

Signature over printed name of FWM/FWD FWM/ FWD Agent ID: ________________ Date signed: ___________________
FWD Bank Account Details
Account to be used
BPI - Please provide a *CLEAR COPY of the front and back of the ATM Card or deposit slip with validation of the Teller.
* New Application - FWD will provide bank endorsement; Agent will process the opening of their account at the branch
of their own choice, and pay the Php100 as required by BPI for initial deposit.
* With existing account - submit proof as stated above.

Security Bank. Company will be opening the bank account on the applicant's behalf.
Preferred Branch: Head Office - Ayala Cebu Business Park SBC Building - Baguio
SLMC - BGC Limketkai - CDO Clark - Angeles
Araneta Center - Cubao Magsaysay - Davao Others: ___________________
Alabang - Insular Gen. Emilio Aguinaldo Hway - Dasmarinas, Cavite

Note: Security Bank will only release ATM cards in the above preferred branches.
In case there is no branch preferred, the Company will elect SLMC - BGC - main branch of Account

Previous Hierarchy within 2 years (If previously from another Life Insurance Company)
Previous Company Designation/Inclusive Years Unit Manager or its equivalent Branch Manager or its equivalent Area Manager or its equivalent

I hereby certify that above information are true and correct based on my personal knowledge.

Signature over printed name of Agent-Applicant Date signed: ________________________