The Manufacturers Life Insurance Co. (Phils.), Inc.

General Information
Policy No. Name of Policyowner (Last Name, First Name, Middle Name Do not know / not applicable)

Email Address Mobile Number (Country Code, Area Code, Telephone Number)

Current Office Address (for Institutional Client)

Details of Withdrawal
1. Withdraw Dividends of my Traditional Policy Amount in Words:
withdraw 100% of my dividends
withdraw partial amount of my dividends: Amount in Figures:
*Please indicate amount for withdrawal
2. Withdraw Funds from my Variable Life Funds
a. Fund Name: __________________________________________ Partial Withdrawal of Fund, please specify
Amount: ___________________________________________________
Withdraw 100% of Fund Balance
Units: _________________________
Excess of fund maintaining balance

b. Fund Name: __________________________________________ Partial Withdrawal of Fund, please specify

Withdraw 100% of Fund Balance Amount: ___________________________________________________
Units: _________________________
Excess of fund maintaining balance

c. Fund Name: __________________________________________ Partial Withdrawal of Fund, please specify

Amount: ___________________________________________________
Withdraw 100% of Fund Balance
Units: _________________________
Excess of fund maintaining balance

3. Surrender/Termination of policy
Surrender of my traditional policy
Surrender of my Paid-Up Addition (PUA)
Full withdrawal of my variable life policy

4. Reason for surrender/termination of policy

Form No. MP CPA WS (v. 09/2021)

The Manufacturers Life Insurance Co. (Phils.), Inc.

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Release Instructions
Pay for NB application Deposit to my Account Account Name:
Policy No.___________________ Account Number:
Amount for transfer: ____________ Curreny
________________________________ Bank Name:
Peso (Php)
Pay for Premium Dollar (USD) Bank Branch:
Policy No.___________________ Bank Address (for Dollar Account)
Amount for transfer: ____________
________________________________ Swift Code (for overseas and Dollar Account)

Pay for Policy Loan Currency of Account (for Dollar Account)

Policy No.___________________
Please make sure that your bank account details are updated and accurate to avoid unnecessary
Amount for transfer: ____________
delay in funds disbursement. Provide proof of account can be a picture of passbook or screen
________________________________
snapshot of online banking account indicating the complete bank account name and account number.
Charges may apply for other banks.

Additional Financial Questions

1. Have you or any of your immediate family members or close relationships and associates been entrusted with prominent public position/s in (a) the Philippines
with substantial authority over policy, operations or the use or allocation of government-owned resources; (b) a foreign State; or (c) an international organization?
Yes No

2. Is the Policyowner a United States citizen, resident or a resident alien (US Green Card Holder)?
Yes to any, please submit W-9 form if not yet submitted and skip Question Numbers 3 and 4 below No

3. Does the Policyowner have a United States Taxpayer Identification Number (SSN/TIN), address and/ or telephone number?
Yes to any, please submit W8-BEN for individual claimant or a W8-BEN-E for an entity claimant if not yet submitted No

4. Or was the Policyowner born in the US and renounced his US Citizenship?

Yes, please submit W8-BEN form and US Bureau of Consular Affairs’ Certificate of Loss of Nationality in the US form if not yet submitted No

5. Does this policy have a Beneficial Owner?

Yes, please submit Beneficial Owner form No

Reminders
1. Your Manulife policy is intended to secure your financial needs over the long term. If you surrender your policy, you will lose benefits in terms of price and other
features of your policy. If you have a traditional life policy, you may consider applying for a policy loan or conversion instead, if applicable. We strongly encourage
you to consult your Financial Advisor or any of our Customer Service Officers before you proceed.
2. Withdrawal depends on the type of policy you have. Withdrawal from Dividends and Paid-up addition will be applicable to traditional life products, while the
Withdrawal from variable life funds will be used for variable life products.
3. Partial withdrawals may have the minimum withdrawal amounts or maintaining balance requirements, depending on the product.
4. For Fund Withdrawals, please indicate the fund name and choose if you want to withdraw by percentage, units or amount.
5. Unit will be cancelled at the bid prices applicable on the next valuation date provided this request is received on or before the cut-off schedule.
6. If your product has a Level Death Benefit Option (Type II), your Death Benefit may be reduced by at most 125% of the amount of your withdrawal.

Declaration and Agreement

By signing this form, I/we declare and agree that:
1. The undersigned persons who will sign this form below are all of legal age.
2. I confirm that the information I provided, including bank details, if applicable, are accurate and up to date. I will not hold the Company responsible for any
delay, loss or liability resulting from the information I provided in this form.
3. I am not an undischarged bankrupt nor have committed any act of bankruptcy within the last twelve (12) months. No receiving order or adjudication order in
bankruptcy, made against me, is currently pending during the same period.
4. I/we agree that this transaction will be an amendment to the policy and will form part of the original application.
5. I am fully aware that partially withdrawing dividends may cancel the Self-Liquidating Policy Option (if applicable) should the dividends become insufficient to
pay for premium due.
6. I authorize the Company to correct or complete this request should there be errors or omissions discovered by it. I accept the changes to the Policy/Agreement
based on these corrections, which are stated in the space below.
7. I acknowledge and declare that the withdrawal proceeds once deposited to the account above mentioned shall be equivalent to payment to me of the same, and
I am therefore releasing Manulife, its successors-in-interest and assigns, including its directors, officers, employees, and agents from further claim, demand,
liability, or action whatsoever, which in law and equity I ever had, now have, or which I, my successors and assigns may have under the said application and/or policy.

Form No. MP CPA WS (v. 09/2021)

The Manufacturers Life Insurance Co. (Phils.), Inc.

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8. I/We agree to receive or access the policy contract, billing notice/s or any other corporate correspondence, documents or information pertaining to such policy
electronically/digitally by making use of a computer, mobile or any digital device.

I/We agree that the cost and expense to obtain and maintain or configure suitable software, device and/or equipment to receive or access such documents
shall be borne by me/us.

I/We agree and understand that transmission of information or communication over the internet may be subject to interruption, tranmission blackout and
delayed transmission due to the Internet traffic, or incorrect data may be transmitted due to the public and open nature of the Internet or otherwise.
The Company, shall not be responsible or liable for any loss of accuracy or timeliness of any information or communication arising from the said
reasons or in relation to any malfunctions in communication facilities that are out of control of the Company.

I/We understand that within Manulife office hours and subject to Manulife/s standard verification procedures, I/we can request for a printed copy of the policy
contract for a fee.
9. The Company collects and uses my personal and sensitive information to operate an insurance business. By signing this form and continuing to avail of the
Company’s products and services, I agree that the information I provided and any subsequent changes to it (including the information of third parties) can be
processed, shared, disclosed, transferred or used by the Company, including its shareholders, directors and employees, affiliates, subsidiaries, business
partners, any member of the Manulife Financial Group (including those located overseas), advisors, representatives, industry associations and databases, local
and foreign authorities having jurisdiction over companies within the Manulife Financial Group, external auditors/counsels, and its third party service providers
(whether within or outside the Philippines) within the rules set by the Data Privacy Act of 2012, as may be amended from time to time, relevant regulations and
the Company’s privacy policy available at www.manulife.com.ph/Customer-Privacy-Policy for purposes of:
· underwriting and approving my application;
· administering, serving and reinsuring my policy;
· marketing (including marketing of products and services offered by any member of the Manulife Financial Group and those of its business partners),
promoting, getting feedback on its products and services, and measuring client satisfaction;
· conducting data analytics and doing automated data processing;
· preventing money laundering or terrorist financing activities;
· complying with reportorial and regulatory requirements of both local and foreign regulatory authorities (including local and foreign tax authorities and stock
exchanges) as well as other legal, regulatory or contractual obligations of any member within the Manulife Financial Group, relating to information sharing, tax
reporting or otherwise;
· the Company’s internal purposes such as governance, risk, actuarial, claims and underwriting management, and reporting; and
· for other reasonable purposes related to the services provided.
10. During the effectivity of the contract/policy, I agree to the following: in case the Company is unable to comply with relevant customer due diligence (CDD)
measures, as required under the Anti-Money Laundering Act, as amended and relevant issuances, due to my fault, the Company may apply the following: (a)
measures to restrict the services available or prohibit any further transactions on the contract/policy until full and proper CDD measures have been successfully
conducted; and (b) in case the foregoing is unsuccessful, terminate business relationship, which shall only entitle me to receive the unused portions of premium
or withdrawal value, if any, whichever is applicable. I also agree to be bound by obligations set out in relevant United Nations Security Council Resolutions
relating to the prevention and suppression of proliferation financing of weapons of mass destruction, including the freezing and unfreezing actions as well as
prohibitions from conducting transactions with designated persons and entities
11. I/we have read the above questions, statements and answers and certify that the information provided above is true, correct and complete based on my/our
personal knowledge and official records. I/we also allow the Company to update my/our records based on the information found in this form and to use such
to administer and service the policy. If signing for the legal entity identified above, I/we certify that I/we have the capacity to sign for such legal entity.

For Manulife use only

Form No. MP CPA WS (v. 09/2021)

The Manufacturers Life Insurance Co. (Phils.), Inc.

I, ____________________________, of legal age, Filipino, and presently residing at _______________________________________________________, for and in consideration
of the sum of Philippine Pesos/US Dollar: _____________________________________ (Php/USD ___________), receipt and sufficiency of which is hereby acknowledged,
and after having been duly sworn in accordance with law hereby depose and state that:

1. I am the policy owner (“PO”)/duly authorized representative of the PO in the Life Insurance Policy issued by MANULIFE PHILIPPINES (“Manulife”) on the life of
_____________________________________________ [state the name of Life Insured]. The Life Insurance Policy (“the Policy”) is more specifically described as follows:

Policy No: _______________________________

Issue Date: _______________________________

2. In consideration of the aforementioned sum of money which represents the full settlement of the account value/cash value of the Policy, I release, waive, protect,
defend, indemnify, hold free and harmless, and forever discharge Manulife, its successors-in-interest, directors, officers, and duly authorized representatives, from
any action, sum of money claims and demands, losses, damages, of every kind whatsoever, which in law or in equity, I, my successors and assigns, including the
insured’s relatives have, ever had, now have, or which may have upon or by reason of any matter, cause or thing whatsoever, up to the time of these presents, the
intention hereof being to completely and absolutely release Manulife, successors-in-interest, its directors, officers, and duly authorized representatives, from any
and all demands, costs, and/or liabilities, if any, arising wholly or partially, from the Policy, any matter related thereto, cause that may arise in the future, or any
collateral issue pertaining to such transaction with Manulife.

3. The aforesaid sum represents all amounts that is due me under the Policy, and if hereafter I may be found to be entitled to any other amount, for any reason,
arising out of, or related to the Policy, the receipt of the above stated amount shall constitute as full and final satisfaction of any such demand or action which I,
my heirs or the insured’s heirs/representatives may have commenced before any office, court, bureau or regulatory agency against Manulife and its representatives.
Such action or demand shall be considered voluntary withdrawn as of the date indicated below.

4. I further agree that this Discharge Form may be pleaded in bar of any suit or proceedings which either I, or my successors and/or assigns, may have against
Manulife in connection with the said Policy.

5. Finally, I declare that I have read, understood, and willingly signed this document with full knowledge of my rights under the law.

IN WITNESS WHEREOF, I have hereunto set our hand on this ____ day of ____________________, 20___ at _____________________________.

__________________________________________________
Policy Owner’s/Authorized Representative’s
Signature Over Printed Name
Signed in the Presence of:

_________________________________ _______________________________

_____________________ _____________________
Date Signed Date Signed

ACKNOWLEDGMENT

BEFORE ME, a Notary Public, on this ________ day of ________________, at ________________________ personally appeared the following person/s,
exhibiting to me their valid and current identification documents with their pictures and signatures appearing thereon:

Name/s Competent Evidence of Identity Date and Place Issued

known to me and to me known to be the same person/s who executed the foregoing document and they acknowledged to me that the same is their
true and voluntary act and deed.

WITNESS MY HAND AND SEAL, on the date and at the place above written.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of _____.

Form No. MP CPA WS (v. 09/2021)