1. LOGO Qualified Application Form The Meaning of

2. LOGO AGENT CUSTOMER COMPANY

3. Contents Personal information 1 Occupation information 2 Financial information 3 Health information 4 5 Agent’s report

4. Occupation Health Personal information Financial status

5. What are the necessary information in the app form? 1.Information about Policy Owner, Life Assured, beneficiaries, dependant 2.Information about products 3.Information of health, finance, occupation 4.Family history 5.Medical documents 6.Signatures.

6. Personal information I. PO’s information: ID number, address, occupation, DOB II. LA’s information: ID/BC number, address, occupation, DOB III. Dependent’s information IV. Beneficiaries’ information Qualified information: right number, accuracy and detail

7. OCCUPATION

8. FINANCIAL INFORMATION AI (annual income): 1.8M (monthly income) x12months= 21.6M Annual premium: 9,5M => AP occupied # 44% AI

9. HEALTH QUESTION If client has any health question answered “yes”-> answer more details as: 1.Disease’s name 2.Time of diagnosis 3.Name of hospitals or Medical Center 4.Treatment method 5.Current situation

10.  Height & weight: BMI (body mass index) HEALTH QUESTION

11. SIGNATURE Note : 1. Signature of PO and LA: * PO # LA : both PO & LA’s signature & write down full name in lowercase letter. LA< 18 year old : PO’s signature and write down his/her full name in lowercase letter. 2. Signature of the witnesses : -If agent is also PO, LA or Beneficiary : he/she can not sign as a witness.

12. ME REQUIREMENT 1. Overweight (BMI > 27) Risk: hyperlipid, fatty liver, heart diseases, diabetes. 2. Underweight (BMI <17) Risk: HIV (?), cancer, tuberculosis, critical illness… 3. High blood pressure Risk: stroke, heart failure, myocardial infarction… 4. Diabetes Risk: high blood pressure, disability, coma 5. B Hepatitis Risk: chronic hepatitis, cirrhosis, liver cancer

13. SOME REGULATION 1. Newborn baby Postponed till≥ 1 month old 2. Pregnancy > 30 weeks (# 7 months) Postponed till 2 months after delivery. Risk: pregnant complication. 3. Out of sale areas Don’t accept. Risk: effectiveness to service quality of after sale. 4. Agent’s code Different agent’s code or name between app form/agent’s report & system-> don’t accept

14. AGENT REPORT

18. LOGO