Policy Loan Agreement Form printable pdf download

FORTUNE LIFE INSURANCE CO., INC.

Fortune Life Building, 162 Legazpi Street,

Legazpi Village, 1229 Makati City

Tel. Nos.: 892 9841 to 49 (connecting all departments)

Fax Nos.: 813 7339

E-mail Address:

URL:

POLICY LOAN AGREEMENT FORM

Policy Number

Insured / Policy Owner

TIN

IN CONSIDERATION OF THE SUM OF PESOS _______________________________

_________________________________________________________________________________

(P_______________ ) advanced by FORTUNE LIFE INSURANCE CO., INC. of Manila, Philippines, receipt

whereof is hereby acknowledge, as a loan on the sole security of and in accordance with the Policy Loan

Provision issued or assumed by the said Company, I (We) hereby assign said policy and all sums of money

now due of hereafter to become due thereunder, to said Company as security for the repayment of the said loan

and interest thereon. Interest shall not be less than 10% nor more than the maximum allowed by the law and

approved by the Insurance Commission; Interest is charged monthly commencing on the date of the loan was

granted. Any interest which is not paid when due shall be added to the principal of the loan and shall become a

part thereof and shall bear interest at the same rate and conditions as the loan.

If at any time the entire indebtedness evidenced by this loan, together with any other indebtedness

on said policy, shall equal or exceed the cash value of the policy, the Company’s liability under the policy shall

terminate upon compliance by the Company with the requirements of law and the policy, if any, respecting notice.

It is also agreed that the said Company has by virtue of said loan, a first lien upon said policy and

the total indebtedness of the loan including interest due or accrued, shall be first charge upon said policy.

It is expressly represented that all natural persons signing below are of legal age and that no

proceedings in bankruptcy or insolvency have been instituted or are pending against any of the undersigned.

Signed at ____________________________________ this ________________ day of

______________________________ 20_____.

WITNESS:

Signature over Printed Name

Signature of Insured

Signature of Policy Owner

Address of Witness

(if insured is below 21 years old)

NOTE: PLEASE CHECK ANY OF THE BOXES BELOW

Signature of Irrevocable Beneficiary/ies

Mail the check to this address:

_________________________________________

Signature of Assignee, if any

The check will be picked up by me or my duly

authorized representative

MEMBER

Policy Loan Agreement Form