OUR CLIENT’S GUIDE ON FILLING-OUT THE FORMS

Policy Change Request Form

Download Form at: https://axa-com-ph.cdn.axa-contento-118412.eu/axa-com-
ph%2F979d7dc2-f3dc-4d94-8837-5d7387fc97d5_policy+change+request+form+v2.pdf

HOW TO FILLOUT THE FORM

CLICK HERE TO VIEW A SAMPLE FORM

1) Indicate POLICY NUMBER on the upper right side of the 1st page

a. If you have 1 policy, indicate only 1 policy number.

b. Max of 3 policies per form, all 3 policies should have the same transaction.
c. For 4 or more policies, please fill up a new form and indicate the remaining policies.

2) Darken the TYPE OF TRANSACTION

a. Maximum of 5 service request per form, all 5 service request will be done on the policy number
indicated above.
b. If there is a policy/ies different transaction, use a separate Policy Change Request From for each
policy number.
 CLICK ON THE LINK FOR THE CHANGES YOU INTEND TO DO:
Non-Financial Changes Financial Changes
1) Contact Information 1) Payment Mode
2) Beneficiary Information 2) Payment Method
3) Transfer of Ownership 3) Index-Linked Increase Endorsement (IIE) /
4) Autopay Cycle Inflation Shield
5) Dividend Options 4) Policy Coverage Increase/Decrease
6) Death Benefit Option 5) Term Conversion
7) Non-Forfeiture Options
8) Personal Particulars

3) Fill out POLICY DETAILS

**Assignee – if the policy was used as a collateral for a loan in a bank

– If NO ASSIGNEE/NOT USED AS COLLATERAL, you may leave it BLANK.

4) Contact Information Changes if there are will be changes on the mailing address, telephone number,
mobile number and email address.
5) Beneficiary Changes

a. You may view your Beneficiary/ies on your policy contract

b. If unable to locate the beneficiary on your policy contract, you may contact our Customer
Service to assist you in identifying if the beneficiary/ies
c. P/C
i. Primary – will receive the Sum insured based on the Share (in %)
ii. Contingent – will receive the Sum insured based on the Share (in %) only if ALL Primary
beneficiaries have passed away.
d. Share (in %)
i. Total Share (in %) of beneficiay/ies should be 100%
ii. No limit on the number of beneficiay/ies as long as the total Share (in %) is 100%
e. Date of Birth
i. Indicate Date of Birth per Beneficiary
ii. For minor beneficiaries, please also submit a birth certificate and please advise us so
that we can provide the Minor Beneficiary Designation Form
f. A/D/C
i. A-dd – if you will be adding a new beneficiary
ii. D-elete – if you will be deleting a beneficiary
iii. C-hange – Change beneficiary
**Please note that if you will add a beneficiary, you need to change the Share (in %) of the existing
beneficiary to make it 100%. Likewise, if you will delete a beneficiary, you need to change the Share (in
%) of the existing beneficiary to make it 100%**
g. R / I
i. R-evocable – No need to sign on any transaction on the policy
ii. I-rrevocable – Needs to sign if there will be transaction on the policy
iii. IRREVOCABLE BENEFICIARY, he/she is required to sign over printed name on this current
form and will also submit 1 valid ID with 3 signatures as described below on ID’s to be
submitted
a. For minor IRREVOCABLE BENEFICIARY, a Notarized Affidavit of
Guardianship must be submitted, executed by a guardian other than the
Policy Owner.
b. Declared Guardian is required to sign over printed name and will also
submit 1 valid ID with 3 signatures as described below on ID’s to be
submitted, in behalf of the minor IRREVOCABLE BENEFICIARY.
 6) Transfer of Ownership – if the current policy owner will transfer the ownership of the policy to another
person.

7) Change in Payment Mode

a. Monthly payment mode needs to have an Auto Debit Arrangement or Auto Charge.
b. If you want to remove the Auto Debit Arrangement / Auto charge accounts on your policy and
pay in Cash / Over-the-Counter, you need to change your payment to either Quarterly, Semi
Annual and Annual
c. For GHA – only Quarterly, Semi-Annual and Annual is allowed, change is only every policy
anniversary
i. Quarterly mode needs to be enrolled in Auto-Debit/Auto-Charge facility
**Change to a longer payment mode may result in paying the remaining months for the change to be processed.
Kindly contact our Customer Service to provide this information**
8) Change in Payment Method

a. Auto-Debit Arrangement
i. You may download the forms of our accredited banks at https://www.axa.com.ph/self-
service, Category: Payment of Premiums
ii. The previous Bank Account will be automatically be removed from the system once the
new Credit Card/Bank Account is enrolled
b. Credit Card
i. You may enroll your credit card at https://www.axa.com.ph/payments/premium-
recurring
ii. The previous Credit Card will be automatically be removed from the system once the new
Credit Card/Bank Account is enrolled
c. Post-Dated Check
i. 12 months of post dated check should be submitted together with this form.
d. Cash
i. Is only available for Quarterly, Semi Annual and Annual mode of payment
e. Others
i. If there are other changes in Payment Method

9) Change in Autopay Cycle

a. Cycle 1 – Debits every 5th of the month and 2 rebilling that is every after 7 working days
b. Cycle 2 – Debits every 20th of the month and 2 rebilling that is every after 7 working days
10) Dividend Option/Non-forfeiture Option (NFO) Changes

a. Change of Divided Option

i. Accumulate with Interest – Dividends and Endowments are automatically accumulated
and transferred respectively to the policy until we have received a payout instruction
from the client
ii. Apply to Premium – Dividends and Endowments will be automatically pay the current
premium. If there no current premium, the Dividends and Endowments will be floating
until we have received a payout instruction from the client
iii. Pay in Cash – Dividends and Endowments will be automatically released to the last payout
instruction provided by the client.
1. Should you will to change the payout instruction, please submit the form 30 days
from the time of payout of the possible endowment

11) Death Benefit Option

a. For Variable Life policies only. Not available for Asset Master, Axelerator, Ambition X and Goal
Getter.
b. Increasing Death Benefit – Sum Insured will be HIGHER of:
i. Sum Insured + Account Value (AV)
ii. Minimum Death Benefit – 500% of the current annual premium, plus 125% of all top-up
premiums, minus 125% of all partial withdrawal
c. Level Death Benefit – Sum insure will be HIGHEST of:
i. Sum Insured less all partial withdrawals within the last 12 months
ii. Account Value
iii. Minimum Death Benefit – 500% of the current annual premium, plus 125% of all top-up
premiums, minus 125% of all partial withdrawal
12) Policy Coverage Changes

a. Decline Index – Only applicable if the Inflation Shield offer has been ACCEPTED.
b. Change of basic sum insured
i. Increase – Increase in Sum Insured can only be done in the FIRST POLICY YEAR.
ii. Decrease – Kindly indicate the new Sum Insured based on the Minimum of the specific
Policy that you have. You may get in touch with your agent/customer service to assist on
the Minimum Sum Insured for your specific policy.
iii. Supplementary Benefit/Rider
iv. Add, Delete, Increase, Decrease of Rider – You may get in touch with your agent/customer
service to assist you since this will vary depending on the policy specifications of the plan
and/or rider provisions

13) Term/Conversion
a. Only for policy/rider with convertible option
14) Personal Particulars
a. Please include any legal document supporting the change such as Birth Certificate, Marriage
Certificate, Annulment Documents, etc

15) Sign on the 3 boxes on the CERTIFICATION OF CUSTOMARY SIGNATURE

a. If your CURRENT signature is different from your signature during your New Business
Application, please sign a Certificate of Customary Signature found at https://axa-com-
ph.cdn.axa-contento-118412.eu/axa-com-ph%2Fcbb7e19f-4e93-41a8-a682-
8a5840d5c4fd_certificate+of+customary+signature.pdf. The 3 signatures on the right is for your
old signature and the 3 signatures on the left is for your new signature.
b. If no changes on your signature, sign on all 3 boxes
16) Read and accomplish the DECLARATIONS AND AGREEMENT

a. Indicate the following: Signed (PLACE SIGNED) this (CURRENT DAY) day of (MONTH YEAR)
b. Signature over Printed name of POLICY OWNER
c. Signature over Printed name of ASSIGNEE
ii. ASSIGNEE - if the policy was used as a collateral for a loan in a bank
iii. If there is an ASSIGNEE, he/she is required to sign over printed name and will also
submit 1 valid ID with 3 signatures as described below on ID’s to be submitted.
1. Bank clearance is needed for the following transactions:
a. Change Ownership
b. Change Beneficiary
c. Decrease Sum Insured
d. Delete Rider
iv. If NO ASSIGNEE/NOT USED AS COLLATERAL, you may leave it blank.
d. Signature over Printed Name of IRREVOCABLE BENEFICIARY, if any.
v. By default, all beneficiaries are REVOCABLE unless indicated on your New Business
Application that the beneficiary/ies are IRREVOCABLE.
vi. You may check on your policy contract if the beneficiary/ies are REVOCABLE/
IRREVOCABLE.
vii. If unable to locate the beneficiary on your policy contract, you may contact our
Customer Service to assist you in identifying if the beneficiary/ies are REVOCABLE/
IRREVOCABLE.
viii. If there is an IRREVOCABLE BENEFICIARY, he/she is required to sign over printed name
and will also submit 1 valid ID with 3 signatures as described below on ID’s to be
submitted
a. For minor IRREVOCABLE BENEFICIARY, a Notarized Affidavit of
Guardianship must be submitted, executed by a guardian other than the
Policy Owner.
b. Declared Guardian is required to sign over printed name and will also
submit 1 valid ID with 3 signatures as described below on ID’s to be
submitted, in behalf of the minor IRREVOCABLE BENEFICIARY.
ix. If NO IRREVOCABLE BENEFICIARY, you may leave it blank.
 ID’s to be submitted
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Valid Primary and Secondary ID’s

Sample of ID with 3 signatures to be submitted

 SAMPLE FORM
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