ANS MORTUARY CARE SERVICES

Door 8 , 2/F, GWC Bldg., Confessor Corner GenSan Drive , Zone III, City of Koronadal, So. Cotabato
DTI Permit No. 4382280; Non-VAT TIN: 616-830-353-000
Contact Nos.: 09460995596/ 09263754309/ 09652569118
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PLAN Type: DUO560-TP05
(2 in 1 Program Package)
1. PRINCIPAL MEMBER’S INFORMATION Date :__________________

(Family name) (First Name) (Middle Name)

Present Address: _________________ ____________________ _________________ ________________________
(Purok/ Sitio) (Brgy) (City/ Mun) (Prov)

(Civil Status) (Gender) (Religion) (Birthday) (Age) (Place of Birth) (Contact No)
II. ADDITIONAL ONE (1) FAMILY MEMBER-BENEFICIARY
Name : B.Date : Age : Gender : Civil Status : Contact No. : Relationship
______________________ : _______ : ____ : ______ : ________ : _______________________: ________________
Name of Beneficiary/: ___________________________ Relationship: ________________CP #: _____________________
III. FEATURES AND SERVICES PACKAGE :
 Full Funeral Services Package
* Full Glass Casket * 9 days embalming
* Flower/ Bouquet * Tarpaulin
* Granite Lapida * Flower/ Bouquet
* Decoration * Free 25 km radius (full-out and delivery)
 Non-Forfeiture
 Transferable
 Assignable

IV. REQUIREMENTS/ QUALIFICATIONS

 Must be 18 years old and above (NO AGE LIMIT)
 No Health/ Medical Requirements

 V. GENERAL RULES/ TERMS AND CONDITIONS

 Full Memorial Services after completing the given Contestability Period (1 Year 18-65 years of age and
1.5 YEAR for 66 years old and above) and maintain an active status;
 Monthly payment of at least 560.00 for a maximum of 5 years.
 30 days grace period after due date. Unpaid account after a given grace period shall be considered lapsed;
 Inactive member with lapsed status may reinstate his/ her account by paying the amount due and
activation fee, thereafter, the current policies and rules on contestability shall be applied;
 In cases where death occur at contestability period a member may avail the services at discounted package.

Conformed: Evaluated/Endorsed by: Approved by :

_______________________ _______________________ _____________________

Name/Signature of Planholder Sales Coordinator President
= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = == = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = ==== = = = = = =

ANS MORTUARY CARE SERVICES

Door 8 , 2/F, GWC Bldg., Confessor Corner GenSan Drive , Zone III, City of Koronadal, So. Cotabato
DTI Permit No.: 4382280; Non-VAT TIN: 616-830-353-000; Contact Nos.: 09460995596/09263754309/ 09652569118

ACKNOWLEDGMENT RECEIPT

Plan Type:._________ No: ______ Date : ________________

Received from ________________________________ the amount of_________________________________________

___________________ (P_____________) as payment for _______________________________________________.

Received by: _______________________________

Authorized Agent Signature over Printed Name
 ANS MORTUARY CARE SERVICES
Door 8 , 2/F, GWC Bldg., Confessor Corner GenSan Drive , Zone III, City of Koronadal, So. Cotabato
DTI Permit No. 4382280; Non-VAT TIN: 616-830-353-000
Contact Nos.: 09460995596/ 09263754309/ 09652569118
------------------------------------------------------------------------------------
PLAN Type: DUO350-TP08
(2 in 1 Program Package)
1. PRINCIPAL MEMBER’S INFORMATION Date :__________________

(Family name) (First Name) (Middle Name)

Present Address: _________________ ____________________ _________________ ________________________
(Purok/ Sitio) (Brgy) (City/ Mun) (Prov)

(Civil Status) (Gender) (Religion) (Birthday) (Age) (Place of Birth) (Contact No)
II. ADDITIONAL ONE (1) FAMILY MEMBER-BENEFICIARY
Name : B.Date : Age : Gender : Civil Status : Contact No. : Relationship
______________________ : _______ : ____ : ______ : ________ : _______________________: ________________
Name of Beneficiary/: ____________________________ Relationship: ________________CP #: _____________________
III. FEATURES AND SERVICES PACKAGE :
 Full Funeral Services Package
* Full Glass Casket * 9 days embalming
* Flower/ Bouquet * Tarpaulin
* Granite Lapida * Flower/ Bouquet
* Decoration * Free 25 km radius (full-out and delivery)
 Non-Forfeiture
 Transferable
 Assignable

IV. REQUIREMENTS/ QUALIFICATIONS

 Must be 18 years old and above (NO AGE LIMIT)
 No Health/ Medical Requirements

 V. GENERAL RULES/ TERMS AND CONDITIONS

 Full Memorial Services after completing the given Contestability Period (1 Year 18-65 years of age and
1.5 YEAR for 66 years old and above) and maintain an active status;
 Monthly payment of at least 350.00 for a maximum of 8 years.
 30 days grace period after due date. Unpaid account after a given grace period shall be considered lapsed;
 Inactive member with lapsed status may reinstate his/ her account by paying the amount due and
activation fee, thereafter, the current policies and rules on contestability shall be applied;
 In cases where death occur at contestability period a member may avail the services at discounted package.

Conformed: Evaluated/Endorsed by: Approved by :

_______________________ _______________________ _____________________

Name/Signature of Planholder Sales Coordinator President
= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = == = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = ==== = = = = = =

ANS MORTUARY CARE SERVICES

Door 8 , 2/F, GWC Bldg., Confessor Corner GenSan Drive , Zone III, City of Koronadal, So. Cotabato
DTI Permit No.: 4382280; Non-VAT TIN: 616-830-353-000; Contact Nos.: 09460995596/09263754309/ 09652569118

ACKNOWLEDGMENT RECEIPT

Plan Type:._________ No: ______ Date : ________________

Received from ________________________________ the amount of_________________________________________

___________________ (P_____________) as payment for _______________________________________________.

Received by: _______________________________

Authorized Agent Signature over Printed Name
 ANS MORTUARY CARE SERVICES
Door 8 , 2/F, GWC Bldg., Confessor Corner GenSan Drive , Zone III, City of Koronadal, So. Cotabato
DTI Permit No. 4382280; Non-VAT TIN: 616-830-353-000
Contact Nos.: 09460995596/ 09263754309/ 09652569118
------------------------------------------------------------------------------------
PLAN Type: IND145-TP20
(Individual Program Package)
1. PRINCIPAL MEMBER’S INFORMATION Date :__________________

(Family name) (First Name) (Middle Name)

Present Address: _________________ ____________________ _________________ ________________________
(Purok/ Sitio) (Brgy) (City/ Mun) (Prov)

(Civil Status) (Gender) (Religion) (Birthday) (Age) (Place of Birth) (Contact No)
II. ADDITIONAL ONE (1) FAMILY MEMBER-BENEFICIARY
Name : B.Date : Age : Gender : Civil Status : Contact No. : Relationship
______________________ : _______ : ____ : ______ : ________ : _______________________: ________________
Name of Beneficiary/: ____________________________ Relationship: ________________CP #: _____________________
III. FEATURES AND SERVICES PACKAGE :
 Full Funeral Services Package
* Full Glass Casket * 9 days embalming
* Flower/ Bouquet * Tarpaulin
* Granite Lapida * Flower/ Bouquet
* Decoration * Free 25 km radius (full-out and delivery)
 Non-Forfeiture
 Transferable
 Assignable

IV. REQUIREMENTS/ QUALIFICATIONS

 Must be 18 years old and above (NO AGE LIMIT)
 No Health/ Medical Requirements

 V. GENERAL RULES/ TERMS AND CONDITIONS

 Full Memorial Services after completing the given Contestability Period (1 Year 18-65 years of age and
1.5 YEAR for 66 years old and above) and maintain an active status;
 Monthly payment of at least 145.00 for a maximum of 20 years.
 30 days grace period after due date. Unpaid account after a given grace period shall be considered lapsed;
 Inactive member with lapsed status may reinstate his/ her account by paying the amount due and
activation fee, thereafter, the current policies and rules on contestability shall be applied;
 In cases where death occur at contestability period a member may avail the services at discounted package.

Conformed: Evaluated/Endorsed by: Approved by :

_______________________ _______________________ _____________________

Name/Signature of Planholder Sales Coordinator President
= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = == = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = ==== = = = = = =

ANS MORTUARY CARE SERVICES

Door 8 , 2/F, GWC Bldg., Confessor Corner GenSan Drive , Zone III, City of Koronadal, So. Cotabato
DTI Permit No.: 4382280; Non-VAT TIN: 616-830-353-000; Contact Nos.: 09460995596/09263754309/ 09652569118

ACKNOWLEDGMENT RECEIPT

Plan Type:._________ No: ______ Date : ________________

Received from ________________________________ the amount of_________________________________________

___________________ (P_____________) as payment for _______________________________________________.

Received by: _______________________________

Authorized Agent Signature over Printed Name