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Pre GN16 Version
App Signed State
Illustration*
Illustration Model
Product
Universal Life and Savings Plan
Illustration Date
Illustration Backdated
Back Date
the Illustration
up to 11 months
Warning: earliest effective date for UL Alpha is 1 April 2017
Note: Illustration for UL 1.1 new business proposals submitted until 30th April 2018.
Use old Declared CIR (3.45%)
Lock-in Crediting Interest Rate Period
Illustrated with Bonus Lock-In Crediting Interest Rate
-For eligible applications submitted during the promotion period (2 Apr 2018 to 29 Jun 2018)
Subject to terms and conditions and only applicable to policies with sum assured of USD5M or above
Please note that the earliest policy effective date to qualify this 4% bonus Lock-in Crediting Interest Rate promotion is 12 April 2018.
(Last submission date of applications for policies with premium charge waiver promotion is 31st December, 2018)
Using Old COI rates
Proposed Insured
Insured
Full Name
DOB (dd/mm/yyyy) / Age
(Age Last Birthday)
POLICY OWNER is an accredited investor
Country of Residence
1
Residential Guide
Residential Guide
Country
Gender
Joint Life
(The two persons must be legally married to each other at the time of the Policy Application)
Smoking Status
Risk Class
Substandard
Flat Extra Amount
Flat Extra Year(s)
If the case has table loading and/or medical Flat Extra, please select Rated risk class
Insured 2
Full Name
DOB (dd/mm/yyyy) / Age
(Age Last Birthday)
Country of Residence
1
Country
Gender
Smoking Status
Risk Class
Substandard
Flat Extra Amount
Flat Extra Year(s)
Policy Design
Solve
Solve
Death Benefit Option
Income Option
Income Payment Frequency
Premium Specifications
Planned Initial Lump Sum/Single Premium
Month
Premium Mode
Planned Periodic Premiums
Premium
Start
End
Plan Specifics
Target Cash Value
Target Year
Loan Interest
Activity
Start
End
Policy Changes
Schedule Change
Year
Type
Level
Policy Riders
Waiver of Premium
Waiver of Premium
Choose a Waiver of Premium Rider.
Children's Insurance
Units
Units Minimum: 1 Maximum: 99 ($1,000 level term per unit)
Accident Indemnity
Amount
Minimum: $10,000, Maximum: $300,000
Return Of Premium
Return of Premium
Choose a Waiver of Premium Rider.
Monthly Disability Income
Units
Units Minimum 3 Maximum 20 ($100 monthly income per unit)
Honeymoon Provision
Honeymoon Provision
Choose a Honeymoon Provision Rider.
Illustration Options
Start
End
Rate
User Defined Crediting Interest Rate
Variable Cost of Insurance
Guaranteed Maximum Cost of Insurance
Variable Cost of Insurance
Start
End
Rate
First Day Cash Value
Payment Date (dd/mm/yyyy)
Policy Number
Salutation
Addressee
Distributor Name
Address Line 1
Address Line 2
Address Line 3
Address Line 4
Producer
Preparer's Name
Preparer's Title