Proposed Insured:

Mrs. STARBUCKS MUNA

Age 51, Female, Non-smoker

Policyowner or Payor:
Mrs. STARBUCKS MUNA
Age 51, Female

Dear STARBUCKS,

Thank you for your interest in AXA products. Life BasiX is a regular-pay variable life insurance product that addresses life's essential
needs for basic protection with opportunities for long-term investment. But unlike most investments, it provides multiple benefits as
follows:

KEY BENEFITS:

1. Guaranteed Death Benefit equivalent to at least 500% of the annual premium if no withdrawal is made.
2. Potential upsides from the portion of the premium placed in bonds, equities and/or money market instruments, depending on your
risk appetite.
3. Guaranteed loyalty bonus as a reward for keeping your investments with AXA.
For a premium of PHP 24,625.00 annually, you get to enjoy the following benefits:
BENEFITS
For You For Your Loved Ones
(Living Benefits) (Death Benefits)

When insured reaches age 65 Upon death of the Insured

Based on (PHP) Based on 8.00% annual rate (PHP)
4.00% annual rate of return, Account Value 283,695 Age 50 Not Applicable
Or 8.00% annual rate of return, Account Value 386,894 Age 60 500,000
Age 70 722,951
Or 10.00%annual rate of return, Account Value 453,179

Notes:
1. The values above are based on the projected performance of your chosen fund/s. Since the fund performance may vary, the values of your
units are not guaranteed and will depend on the actual investment performance at that given period. The illustrated returns on investments
are based on assumed annual rates of 4.00%, 8.00%, and 10.00%. These rates are for illustration purposes only and do not represent
maximum or minimum return on your fund.
2. If after purchasing the variable life insurance contract, you realize that it does not fit your financial needs, you may return the
contract to AXA Philippines within 15 days from the time you receive it. AXA Philippines will return to you the account value, the
bid-offer spread, and all initial charges.
3. Any withdrawal from the Living Benefit will correspondingly reduce the Death Benefit payable.

This is not a deposit product. Earnings are not assured and principal amount invested is exposed to
risk of loss. This product cannot be sold to you unless its benefits and risks have been thoroughly
explained. If you do not fully understand this product, do not purchase or invest in it.

Page 1 of 10 of Proposal No. 29224-201911091236-2-02

Printed on: 11/9/2019 12:38:51 PM Created on: 11/09/2019 Expiry Date: 01/08/2020
Version Number: 4.5.3 Date for Next Insurance Age: 08/15/2020
Plan Code: BAX/ Rider Code: N/A
 Philippine Peso
for: Mrs. STARBUCKS MUNA, 51, Female, Non-smoker

SPECIAL FEATURES

Top-up Subject to the rules set by AXA Philippines from time to time, you have the option to increase the
benefits of your Policy by paying additional premiums on top of your regular premium which will
be used to buy more units on your chosen investment fund(s).
Premium Holiday Premiums are paid throughout the life of your Policy, but you have the option to suspend
payment anytime as long as the Account Value is sufficient to cover these.
Loyalty Bonus As long as your Policy remains in force, a 5% Loyalty Bonus will be paid on the 15th and 25th
year to increase your Account Value. The Bonus will be equal to 5% of the average of the month-
end Account Values for the last 120 months.
Inflation Link You have the option to increase your insurance protection, with no further proof of insurability, at
a minimal cost of insurance deduction on each anniversary of your Policy, before age 60 with the
Inflation Index Endorsement (IIE). This also does not require that you provide further proof of
insurability. The amount by which you can increase your coverage is based on the current
Consumer Price Index subject to a minimum that AXA Philippines may determine from time to
time.

The succeeding pages of this proposal provide more details on the benefits and features of Life BasiX.

Again, thank you for your interest in AXA products. If you have questions, please call me at the number specified below, or call the AXA
Philippines Customer Care Hotline at Tel Nos: (02)85815-292 or (02)83231-292.

CADIENTE, MARIA CRISTINA M

43508
29224
639171681104

Page 2 of 10 of Proposal No. 29224-201911091236-2-02

Printed on: 11/9/2019 12:38:51 PM Created on: 11/09/2019 Expiry Date: 01/08/2020
Version Number: 4.5.3 Date for Next Insurance Age: 08/15/2020
Plan Code: BAX/ Rider Code: N/A
 Philippine Peso
for: Mrs. STARBUCKS MUNA, 51, Female, Non-smoker

Life BasiX is a regular-pay variable life insurance product where a portion of the premiums, net of the company’s charges, is invested
into your choice of funds. Subject to the rules set by AXA Philippines from time to time, you can increase your investment anytime by
paying top-up premiums, but the value of the funds (and your policy benefits) may go up or down depending on market conditions. The
death benefit option you have elected is Level. The minimum Death Benefit in this proposal is PHP 123,1251.
Below are important details of the proposal along with how your investment will be allocated between the available funds. You may
change this allocation anytime depending on your investment goals and/or risk appetite.

Basic Plan and Supplements Cover up to Age Sum Insured (PHP) Annual Premium (PHP)

Basic
Life BasiX 100 500,000 24,625.00
Total² 24,625.00

You may also pay your premium in the following modes:

Modes of Payment Modal Premium Fund Name ³ Fund Allocation
(PHP)
Semi-Annual 12,312.50 Chinese Tycoon Fund 100%
Quarterly 6,156.25
Monthly 2,052.10

Notes:
1. This is the minimum Death Benefit at policy inception. The minimum Death Benefit for any policy year is equal to 500% of the annual regular Life Basix premium, plus
125% of each paid top-up premium, if any, less 125% of each partial withdrawal, if any.
2. Premiums for all products are payable up to termination age. For the premium term of the supplement/s, if any, please refer to the supplement definition indicated in
the "Summary of the Riders Attached to this Proposal".
3. See Product Notes for description of the funds.

Page 3 of 10 of Proposal No. 29224-201911091236-2-02

Printed on: 11/9/2019 12:38:51 PM Created on: 11/09/2019 Expiry Date: 01/08/2020
Version Number: 4.5.3 Date for Next Insurance Age: 08/15/2020
Plan Code: BAX/ Rider Code: N/A
 Philippine Peso
for: Mrs. STARBUCKS MUNA, 51, Female, Non-smoker

ILLUSTRATION OF BENEFITS

The illustrated benefits of your policy (subject to actual market performance) are shown below.
ILLUSTRATION OF BENEFITS
Total Cumulative Regular
End of 4.00 % Rate of Return 8.00 % Rate of Return 10.00 % Rate of Return
Basic Premium, Rider
Policy
Premiums and Top-up, if
Year Living Benefit Death Benefit Living Benefit Death Benefit Living Benefit Death Benefit
any, Paid
1 24,625 11,103 500,000 11,615 500,000 11,872 500,000
2 49,250 22,527 500,000 24,040 500,000 24,814 500,000
3 73,875 34,279 500,000 37,339 500,000 38,933 500,000
4 98,500 46,358 500,000 51,572 500,000 54,343 500,000
5 123,125 58,756 500,000 66,802 500,000 71,166 500,000
10 246,250 173,628 500,000 215,117 500,000 239,728 500,000
15 369,375 323,542 500,000 451,841 500,000 535,806 535,806
20 492,500 508,977 508,977 804,864 804,864 1,012,701 1,012,701
25 615,625 769,951 769,951 1,364,190 1,364,190 1,832,030 1,832,030
30 738,750 1,062,230 1,062,230 2,145,693 2,145,693 3,100,283 3,100,283
35 861,875 1,417,832 1,417,832 3,293,979 3,293,979 5,142,816 5,142,816
40 985,000 1,850,477 1,850,477 4,981,186 4,981,186 8,432,336 8,432,336
45 1,108,125 2,376,855 2,376,855 7,460,248 7,460,248 13,730,142 13,730,142

Age60 221,625 148,896 500,000 180,579 500,000 199,026 500,000

Age65 344,750 283,695 500,000 386,894 500,000 453,179 500,000
Age70 467,875 467,210 500,000 722,951 722,951 898,334 898,334
The rates of return shown above are for illustration purposes and are not based on past performance nor guarantee future performance. The actual
return may differ. The illustrated values are net of premium charges of 35%/35%/35%/35%/35% of the basic premium for the 1st to 5th policy years; all top-ups
shall be subject to a premium charge of 2%; Cost of Insurance has been deducted monthly from the illustrated values as well as Administration Charge amounting
to Php1,200 p.a. The Annual Premiums for any attached Supplement shall be deducted monthly from the illustrated values if the Policy is under Premium Holiday.
An Asset Management Charge of 2% p.a. for Philippine Wealth Bond, Philippine Wealth Balanced and Philippine Wealth Equity Funds and 2.5% p.a. for
Opportunity, Chinese Tycoon and Spanish American Legacy Funds have already been deducted from the illustrated values. The illustrated values are still
subject to a surrender charge for withdrawals (partial or full) transacted up to the 5th policy year. The surrender charge is equal to the amount withdrawn multiplied
by a surrender factor of 100%/100%/25%/10%/5% for the 1st to 5th years respectively.

This illustration shall form part of the insurance contract once the Policy is issued.

Page 4 of 10 of Proposal No. 29224-201911091236-2-02

Printed on: 11/9/2019 12:38:52 PM Created on: 11/09/2019 Expiry Date: 01/08/2020
Version Number: 4.5.3 Date for Next Insurance Age: 08/15/2020
Plan Code: BAX/ Rider Code: N/A
 Philippine Peso
for: Mrs. STARBUCKS MUNA, 51, Female, Non-smoker

ILLUSTRATION OF BENEFITS (with Premium Holiday on Year 10)

You can choose to suspend payment for regular premium and top-ups as long as the Account Value of your Policy is sufficient to cover
the charges and pay for the premium of any supplement. This feature is called a Premium Holiday which you can apply for. Note that
under this feature, there is a possibility that your Account Value may be depleted and may result to your policy being terminated.

The following table is an example of the impact of a premium holiday at year 10 and/or withdrawals from the fund assuming different
rates of return. However, note that the rates of return are for illustration purposes only. They are not based on past performance nor
guarantee future returns.

Total Cumulative ILLUSTRATION OF BENEFITS (with Premium Holiday on Year 10)

End of Regular Basic 4.00 % Rate of Return 8.00 % Rate of Return 10.00 % Rate of Return
Policy Premium, Rider
Year Premiums and Top Living Benefit Death Benefit Living Benefit Death Benefit Living Benefit Death Benefit
-up, if any, Paid
1 24,625 11,103 500,000 11,615 500,000 11,872 500,000
2 49,250 22,527 500,000 24,040 500,000 24,814 500,000
3 73,875 34,279 500,000 37,339 500,000 38,933 500,000
4 98,500 46,358 500,000 51,572 500,000 54,343 500,000
5 123,125 58,756 500,000 66,802 500,000 71,166 500,000
10 246,250 173,628 500,000 215,117 500,000 239,728 500,000
15 246,250 182,324 500,000 292,901 500,000 367,379 500,000
20 246,250 171,233 500,000 399,241 500,000 575,894 575,894
25 246,250 137,803 500,000 590,930 590,930 948,358 948,358
30 246,250 26,497 500,000 860,929 860,929 1,519,623 1,519,623
35 246,250 *** *** 1,257,645 1,257,645 2,439,650 2,439,650
40 246,250 *** *** 1,840,552 1,840,552 3,921,364 3,921,364
45 246,250 *** *** 2,697,033 2,697,033 6,307,679 6,307,679

Age60 221,625 148,896 500,000 180,579 500,000 199,026 500,000

Age65 246,250 175,690 500,000 267,792 500,000 328,198 500,000
Age70 246,250 175,197 500,000 374,064 500,000 524,689 524,689
The rates of return shown above are for illustration purposes and are not based on past performance nor guarantee future performance. The actual
return may differ. The illustrated values are net of premium charges of 35%/35%/35%/35%/35% of the basic premium for the 1st to 5th policy years; all top-ups
shall be subject to a premium charge of 2%; Cost of Insurance has been deducted monthly from the illustrated values as well as Administration Charge amounting
to Php1,200 p.a. The Annual Premiums for any attached Supplement shall be deducted monthly from the illustrated values if the Policy is under Premium Holiday.
An Asset Management Charge of 2% p.a. for Philippine Wealth Bond, Philippine Wealth Balanced and Philippine Wealth Equity Funds and 2.5% p.a. for
Opportunity, Chinese Tycoon and Spanish American Legacy Funds have already been deducted from the illustrated values. The illustrated values are still
subject to a surrender charge for withdrawals (partial or full) transacted up to the 5th policy year. The surrender charge is equal to the amount withdrawn multiplied
by a surrender factor of 100%/100%/25%/10%/5% for the 1st to 5th years respectively.

The contract term is specified in the illustration of benefits in this proposal. Please refer to the assumptions below used in the above
example.
Other Assumptions:
1. This example assumes that all premiums shown in the above table are paid in full when due and as planned with no premium holiday in the first
10 policy years. It assumes the current scale of charges remains unchanged.
2. A loyalty bonus estimated to be 5% of the average Account Value from 6th to 15th policy years on the 15th year, 5% of the average Account
Value from the 16th to 25th policy years on the 25th year is included in this illustration. The bonus will be equal to 5% of the average of the
month-end Account Values over the last 120 months.
3. The proposed policy charges used in this illustration summary are based on the standard risk class without taking into account your own
circumstances (e.g. occupation and health condition, etc). Risk class will be determined according to our underwriting guidelines. The
investment gains/risks associated with this plan are solely to your account.

Page 5 of 10 of Proposal No. 29224-201911091236-2-02

Printed on: 11/9/2019 12:38:52 PM Created on: 11/09/2019 Expiry Date: 01/08/2020
Version Number: 4.5.3 Date for Next Insurance Age: 08/15/2020
Plan Code: BAX/ Rider Code: N/A
 Philippine Peso
for: Mrs. STARBUCKS MUNA, 51, Female, Non-smoker

Notes on the illustration of Benefits

1. All payments and benefits shown are in Philippine pesos. Payments are acceptable in policy currency only.
2. AXA Philippines reserves the right to adjust the Basic and Supplement premiums, and any charges in this plan.
3. The quoted values are illustrations only of the key features, benefits and assumptions of the chosen insurance plans. If your
application is accepted, you will receive a policy contract, which will include detailed terms, conditions, and exclusions. A new
Illustration of Benefits will be provided in the contract, which may differ from this proposed illustration.
4. The benefits and premiums of the Index-linked Increase Endorsement, if any, are not included in the summary in the previous page.
5. The benefits are based on the projected performance of your chosen fund/s. Since fund performance may vary, the values of your
units are not guaranteed and will depend on the actual investment performance at that given period. The illustrated returns on
investments are based on assumed annual rates of 4.00.00%, 8.00.00%, and 10.00.00%. These rates are for illustration purposes
only and do not represent maximum or minimum return on your fund value.
6. A bid-offer spread, which is the difference between the bid price and the offer price units, may be determined by AXA Philippines from
time to time. The above illustration is based on a bid-offer spread of 5%.
7. This illustration summary relates to your Life BasiX only, and excludes any Supplements in this proposal. It assumes that all premiums
are paid in full when due and as planned with no premium holiday and the current scale of charges remains unchanged. Any deviation
from this will change the illustrated values accordingly.
8. A loyalty bonus, credited on the 15th and 25th policy years, is included in the illustration. The bonus is estimated to be 5% of the
average of the month-end Account Values over the last 120 months.
9. The proposed policy charges used in this illustration summary are based on the standard risk class without taking into account your
own circumstances (e.g. occupation and health condition, etc). Risk class will be determined according to our underwriting guidelines.
The investment gains/risks associated with this plan are solely to your account.

Product Notes
1. Life Basix is a regular-pay variable life insurance plan. Only the minimum Death Benefit is guaranteed while the Policy is in-force. The
rest of the benefits, namely the partial and full withdrawal values and the actual Death Benefit at time of death, all depend on the
investment experience of separate account(s) linked to the Policy.
Under the INCREASING DEATH BENEFIT OPTION, your beneficiaries will receive the Policy Sum Insured plus the Account Value at time
of death. While under the LEVEL DEATH BENEFIT option, your beneficiaries will receive the Policy Sum Insured less the partial
withdrawals made for the past twelve (12) months, or the Account Value at time of death, whichever is higher.
2. The living benefits shown in the illustration summary are equal to the Account Value of the Policy.
3. The client may choose from the following funds. If client chooses to invest in more than one fund, a minimum allocation of 10% on
one fund is required. The total allocation should always be 100%.
a. Philippine Wealth Bond Fund - This Bond Fund is an actively managed fixed income fund that seeks to capitalize on
capital and income growth through investments in interest-bearing securities issued by the Philippine Government and
money market instruments issued by banks.
b. Philippine Wealth Balanced Fund - This Balanced Fund is designed to achieve long-term growth through both interest
income and capital gains with an emphasis on providing a modest level of risk. It seeks to manage risk by diversifying asset
classes and industry groups through investment in bonds issued by the Philippine government and equities issued by
Philippine corporations comprising the Philippine Stock Exchange Index.
c. Philippine Wealth Equity Fund - This Equity Fund seeks to achieve long-term growth of capital by investing mainly in
equities of Philippine corporations comprising the Philippine Stock Exchange Index. The fund aims to provide access to a
diversified portfolio of equities from different industries.
d. Opportunity Fund - This equity fund aims to achieve long term growth through capital gains and dividends by investing in
equities of Philippine corporations that will provide access to a diversified portfolio of equities from different industries.
e. Chinese Tycoon Fund - This equity fund aims to achieve medium to long term growth through capital gains and dividends
by investing in equities that will provide access to a management themed-portfolio reflective of the Chinese-Filipino
entrepreneurial spirit through strategic investments in Philippine companies from different industries.
f. Spanish American Legacy Fund - This equity fund aims to achieve medium to long term growth through capital gains and
dividends by investing in equities that will provide access to a management themed-portfolio through strategic investments
in Philippine companies from different industries with Spanish/American heritage.
4. The Bid Price of an Investment Fund is the price for cancelling a Unit of the Investment Fund as determined in accordance with the
Valuation provision.
5. The Offer Price of an Investment Fund is the price for creating a Unit of the Investment Fund as determined in accordance with the
Valuation provision.

Page 6 of 10 of Proposal No. 29224-201911091236-2-02

Printed on: 11/9/2019 12:38:52 PM Created on: 11/09/2019 Expiry Date: 01/08/2020
Version Number: 4.5.3 Date for Next Insurance Age: 08/15/2020
Plan Code: BAX/ Rider Code: N/A
 Philippine Peso
for: Mrs. STARBUCKS MUNA, 51, Female, Non-smoker

Attached Supplements
Summary of the Riders Attached to this Proposal
1. The Index-linked Increase Endorsement (IIE) allows you to increase your insurance benefits at the rate of inflation with no
additional medical or processing requirements so you can be sure the value of your benefits cope with future costs.

NOTES:
1. The rates shown, if any, are those currently in effect. The rates applicable upon renewal of the Supplement will be those in effect at the date of
renewal.
2. For a detailed description of the Supplements, including exclusions and other provisions, please refer to the policy contract.

Page 7 of 10 of Proposal No. 29224-201911091236-2-02

Printed on: 11/9/2019 12:38:52 PM Created on: 11/09/2019 Expiry Date: 01/08/2020
Version Number: 4.5.3 Date for Next Insurance Age: 08/15/2020
Plan Code: BAX/ Rider Code: N/A
 Philippine Peso
for: Mrs. STARBUCKS MUNA, 51, Female, Non-smoker

DECLARATIONS AND ACKNOWLEDGMENTS

DECLARATIONS

1. It is my understanding that the total premium I am going to pay when I purchase this plan shall consist of the Life BasiX premium, regular
top-up premium, and Supplement premiums shown above, if any. I was also made aware that only the Life BasiX premium and top-up
premiums will be allocated to purchase units of the investment fund/s I will choose.
2. I confirm having read and understood the information in this proposal. My Financial Advisor/Financial Executive fully explained to me the
features and charges that will be made on my plan, and that the actual variable plan benefits will reflect the actual investment experience of
the separate account into which my fund is invested. I also confirm that I will fully assume all investment gains / risks associated with the
purchase of this plan.
Acknowledgment of Variability
Variable Life Insurance Plan
I acknowledge that:

I have applied with AXA Philippines for a Variable Life Policy, and have reviewed the illustration(s) that shows how a variable life insurance
policy performs using AXA Philippines’ assumptions and based on Insurance Commission’s guidelines on interest rates.

I understand that since fund performance may vary, the values of my units are not guaranteed and will depend on the actual performance at
that given period and that the value of my Policy could be less than the capital invested. The unit values of my Variable Life Insurance are
periodically published.

I understand that the investment risks under the Policy are to be borne solely by me, as the policyholder.
Product Transparency Declaration

By signing off on the items listed below, I acknowledge that the same have been discussed with and thoroughly explained to me.
· I understand that I am buying an investment-linked insurance product.
· I understand that the principal and earnings are not guaranteed and that the value of my unit investment (NAVPU) may go up or down depending on
the performance of the separate funds.
· I understand that the funds will be invested in Equities and/or Bonds or a combination thereof, and will be subject to changes in market conditions.
· The available funds and the risks that they bear have been thoroughly discussed with me, and I have made my Fund Allocation decision based on my
own judgment of and tolerance for these risks.
· I understand that this product is appropriate for a long-term investment horizon.
· I understand that I will have zero (0) withdrawal value during the first two (2) years of the policy because the amount withdrawn will be subject to
100% surrender charge on the first two (2) years.

CONFORME: These declarations and acknowledgments are made with the knowledge of
the AXA representative whose signature appears below:

_____________________________ ____________________ _____________________________________ ________________________

Applicant/Policy Owner Date Financial Advisor/Financial Executive Date
Signature over Printed Name Signature over Printed Name

TO BE FILLED UP BY AXA PHILIPPINES

_________________________ _________________________
These declarations and acknowledgments are valid for _________________________ _________________________
the following policy/ies with policy number/s: _________________________ _________________________
Disclosure of Conflict of Interest

The Company adopts a Conflict of Interest Policy and undertakes to disclose any material information which gives rise to actual or potential conflict of interest to
our customers. Company likewise takes all reasonable steps to ensure fair dealings with our customers.

General Disclaimer

All information and opinions provided are of a general nature and for information purposes only. The information and any opinions herein are based upon
sources believed to be reliable. AXA Philippines, its officers and directors make no representations or warranty, expressed or implied, with respect to the
correctness, completeness of the information and opinions in this document. Investment or participation in the Fund(s) is subject to risk and possible loss of
principal. Please carefully read the policy and endorsements and consider the investment objectives, risks, charges and expenses before investing. You should
seek professional advice from your financial, tax, accounting or legal consultant before making an investment. Past performance is not indicative of future
performance.

THIS FINANCIAL PRODUCT OF AXA PHILIPPINES IS NOT INSURED BY THE PHILIPPINE DEPOSIT
INSURANCE CORPORATION (PDIC) AND IS NOT GUARANTEED BY METROBANK OR PS BANK.

Page 8 of 10 of Proposal No. 29224-201911091236-2-02

Printed on: 11/9/2019 12:38:52 PM Created on: 11/09/2019 Expiry Date: 01/08/2020
Version Number: 4.5.3 Date for Next Insurance Age: 08/15/2020
Plan Code: BAX/ Rider Code: N/A
 Reference no.: 29224-201911091236-2-
02
INVESTMENT PORTFOLIO RISK ASSESSMENT
You prefer a growth investment portfolio
Growth Investment Portfolio : A growth investment portfolio is characterized by a willingness to accept higher than
average level of risks and price volatility in pursuit of above average returns.

- You understand that investing allows for higher returns than savings, but there is a risk that your investments
might yield negative returns and the value of your investments can even be lower than the amount you
invested
- You understand that diversifying your investments over different equity funds and bond funds reduce the
volatility of the average annual returns on your investments
- You understand that a market can be volatile and that a longer holding period in general reduces the risk of
negative average annual returns
- You prefer the possibility of a higher average annual return on your investments even if this means that there
is a probability of higher negative return in any given year.

INVESTMENT PORTFOLIO RISK ACKNOWLEDGMENT

I acknowledge that the descriptions above match the risk profile of my intended investment portfolio. I also
acknowledge that the recommended fund allocation ranges resulting from my investment portfolio risk profile is only
intended as reference to help me assess my investment portfolio’s risk appetite and investment objectives.

WAIVER FOR RISK PORTFOLIO RE-CLASSIFICATION (For Clients Investing in Products with Different Risks)

I waive the results of my investment portfolio risk profile assessment and have decided to invest instead in another
investment fund or a combination investment funds which falls outside of the recommended fund allocation ranges
indicated by my investment portfolio risk profile.

INVESTMENT POLICY STATEMENT

I acknowledge that my fund allocation represents the Investment Policy of my portfolio. I have carefully read and
understood the investment objective(s) of my selected fund(s) as well as the risk(s) that it(they) bear(s).

Conforme:

Applicant/Policy Owner Date

Signature over Printed Name
 Reference Number: 29224-201911091236-2-02

FINANCIAL UNDERSTANDING SUMMARY

Dear STARBUCKS

Thank you for providing us with relevant information with regards to your financial needs.

Based on your current financial situation, which includes, among others, your personal
monthly gross income of 50,000.00, and after taking into consideration your objectives, risk
profile and priorities, you have selected Life BasiX for your Income Protection need.

The details of your insurance coverage and your insurance premium are summarized in your
Life BasiX sales illustration.

CADIENTE, MARIA CRISTINA M

43508
29224
639171681104

This document is not intended to be a part of your sales illustration of your application form. This is a
summary of the financial needs that you have provided during assessment by your distributor.