New Business Forms
Form [A1] Application for Life Insurance (Updated: 14 Jul 2023) [Sample for Non-FATCA Products] (Updated: 30 Oct 2019)
- Sample application for Always Term
- Sample application for Cancer Free Protection
- Sample application for Easy Pro
Form [A2] Application Supplementary Form
Form [A3] Application Supplementary Form - No Health & Information Change
Form [A4] Application Supplementary Form - No Information Change
Form [A5] Application Supplementary Form - Signature Differ
Form [A6] Application Supplementary Form - Cancer Free Protection
Form [A7] Agent’s / Broker’s Report (Updated: 30 Oct 2019)
Form [A13] Agent's /Broker's Report (NF2F Application Arrangement) (Updated: 20 Apr 2020)
Form [A11] Application for Insurance FATCA (Updated: 23 Dec 2019) [Sample for FATCA Products] (Updated: 30 Oct 2019)
Form [A12] Application for Cancer Free Protection (Updated: 14 Jul 2023)
Form [D1] Direct Debit Authorization Form (Updated: 14 Aug 2020)
Form [D2] Direct Debit Authorization & Credit Card Form (Updated: 30 Oct 2019)
Form [F1] Financial Questionnaire
Form [F2] Financial Questionnaire - PRC
Form [F3] Needs Analysis Form (Updated: 1 Apr 2021)
Form [I1] IFS-MP
Form [I2] Important Facts Statement – Policy Replacement (Updated: 27 Jul 2023)
Form [L1] Laboratory Report Request Form
Form [M1] Medicorp Medical Examination Services Request Form (Updated: 30 Oct 2019)
Form [M2] Shiny Medical Examination Services Request Form (Updated: 30 Oct 2019)
Form [S1] Self-Certification Form – Individual [Sample] (Updated: 30 Oct 2019)
Form [S2] Self-Certification Form – Entity
Form [S3] Self-Certification Form - Controlling Person
POS Forms
Form [A8] Application Form for Withdrawal of Policy Dividend, Policy Loan or Policy Surrender (Updated: 20 Apr 2023)
Form [C2] Collateral Assignment Form
Form [R1] Request For Policy Change Form (Updated: 14 Aug 2020)
Form [S4] Statement of Insurability (Updated: 30 Oct 2019)
Claim Forms
Form [A10] Authorization
Form [D3] Death Claim Form
Form [D4] Dread Disease Claim Form Part I
Form [H1] Hospitalization Claim Form
Website: http://www.pacificlife.com.hk/