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FS&U25 Revision No. 02 June 1, 2016PERSONAL ACCIDENT APPLICATION FORM INDIVIDUAL CLIENT information as mandated under the Phil. Antimony Laundering Act (AMLA) R. A No.10365 as amended. Complete information
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How to fill out personal accident application form

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Step 1: Start by entering your personal information such as full name, date of birth, and contact details.
02
Step 2: Provide details about your occupation, including your job title and employer information.
03
Step 3: Indicate the type of accident coverage you are applying for and specify the desired coverage amount.
04
Step 4: Answer questions related to your medical history, including any pre-existing conditions or disabilities.
05
Step 5: Provide information about your beneficiaries, such as their names and relationships to you.
06
Step 6: Review the application form carefully to ensure all information provided is accurate and complete.
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Step 7: Sign and date the application form to acknowledge that the information provided is true and correct.
08
Step 8: Submit the filled-out application form along with any required supporting documents to the insurance company.

Who needs personal accident application form?

01
Anyone who wishes to apply for personal accident insurance coverage needs to fill out the personal accident application form.
02
This form is typically required by individuals who want financial protection in the event of accidental injuries or disabilities.
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It is commonly needed by employees, self-employed individuals, and those who engage in high-risk activities.
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Personal accident application form is a document used to report details of an accident or injury that occurred to an individual.
Any individual who has been involved in an accident or suffered an injury is required to file a personal accident application form.
To fill out a personal accident application form, you need to provide details such as your personal information, details of the accident or injury, and any other relevant information requested on the form.
The purpose of a personal accident application form is to document and report any accidents or injuries that occur to individuals, in order to process any related claims or benefits.
Information such as personal details, accident/injury details, date and time of accident/injury, location, witnesses (if any), and any other relevant information need to be reported on a personal accident application form.
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