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  • Amendment Form

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    BISAYANG URAGON
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    The document is a request form to amend or correct an Angelica Plan agreement. It allows the planholder to request changes to [1] the planholder name, [2] birthdate, [3] address, [4] beneficiaries and their ages, [5] plan type, [6] payment mode, [7] contract price, and [8] installment amount. The planholder must submit the present policy or affidavit of loss and agrees that the current agreement will be cancelled upon surrender for re-issuance of the amended agreement.

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    The document is a request form to amend or correct an Angelica Plan agreement. It allows the planholder to request changes to [1] the planholder name, [2] birthdate, [3] address, [4] beneficiaries and their ages, [5] plan type, [6] payment mode, [7] contract price, and [8] installment amount. The planholder must submit the present policy or affidavit of loss and agrees that the current agreement will be cancelled upon surrender for re-issuance of the amended agreement.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    15 views1 page

    Amendment Form

    Uploaded by

    BISAYANG URAGON
    The document is a request form to amend or correct an Angelica Plan agreement. It allows the planholder to request changes to [1] the planholder name, [2] birthdate, [3] address, [4] beneficiaries and their ages, [5] plan type, [6] payment mode, [7] contract price, and [8] installment amount. The planholder must submit the present policy or affidavit of loss and agrees that the current agreement will be cancelled upon surrender for re-issuance of the amended agreement.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
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    REQUEST FOR AMENDMENT/CORRECTION OF ANGELICA PLAN AGREEMENT

    PLANHOLDER_____________________________________LPNumber:_____________________________
    ADDRESS ____________________________________________________________________________________
    AMENDMENT REQUESTED:
    1. Check the necessary box and give details.
    2. Submit present Angelica Plan Policy or Affidavit of Loss.
    FROM TO
    [ ] a. Planholder :________________________ ________________________*attached
    application of the new planholder.
    [ ] b. Birthdate :________________________ ________________________
    [ ] c. Address :________________________ ________________________
    [ ] d. Beneficiary/age :________________________ ________________________
    :________________________ ________________________
    :________________________ ________________________
    [ ] e. Plan type :________________________ ________________________
    [ ] f. Payment Mode :________________________ ________________________
    [ ] g. Contract Price :________________________ ________________________
    [ ] h. Installment Amount: ______________________ ________________________
    i.________________________ :________________________ ________________________
    (others please specify)
    It is hereby agreed that upon the surrender of the present CCLPI Agreement for a re-issue, the
    undersigned consents to its cancellation and releases/clears CCLPI from all claims/demands and
    liabilities.
    I hereby certify that all the above details are true and correct and any erroneous or untruthful
    statement shall not subject CCLPI to any liability whatsoever for any consequence arising therefrom.

    Signed this ______day of ____________2023 at ________________________________________

    ______________________________________________
    Printed Name & Signature of Planholder
    Verified by:_________________________________

    Agent’s Name:__________________________
    Code :__________________________

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