Important Notice:
1. The forms and samples provided are for reference only.
New Business Forms
Form [A1] Appointment Form – (For Mainland Chinese Visitors (MCV) Verification) (Updated: 09 Jan 2023)
Form [B1] Bank Draft Declaration Form (Updated: 2 Jul 2024)
Form [B2] Business Insurance Questionnaire (For Corporate)(Updated: 19 Apr 2023)
Form [C1] Credit Card Payment Authorization Form (Updated: 11 Jan 2022)
Form [C2] Customer Protection Declaration Form (Updated: 19 Apr 2023)
Form [C3] Corporate Trustee Questionnaire (For Corporate Trustee) (Updated: 2 Jul 2024)
Form [D3] Declaration in Respect of Insurance Application with Minor Proposed Insured (Updated: 24 Oct 2018)
Form [F1] Financial Needs Analysis [Guideline] (Updated: 12 Feb 2025)
Form [I1] Important Fact Statement for Mainland Policy Holder (IFS-MP)
Form [I3] Initial Premium Payment Declaration Form (Updated: 15 Nov 2024)
Form [I4] Important Facts Statement — Policy Replacement (if applicable) (Eng)(Chi) (Updated: 16 Aug 2022)
Form [I5] Important Facts Statement – Premium Financing (Eng)(Chi) (Updated: 15 Apr 2025)
Form [L1] Life Insurance Application Form (Updated: 28 Aug 2024)
- Life Insurance Application Form - applicable to full-underwriting products only (Updated: 12 Feb 2025)
Form [L2] Life Insurance Application Form (Wealth Elite Saver 3 - Golden Years) (Pictorial Guide of Application Form (Wealth Elite Saver 3 - Golden Years)) For Simplified Underwriting Product (Updated: 14 Feb 2025)
Form [R1] Request for Pre-Assessment Form
Form [R3] Request for Payment by Visa Card or MasterCard Credit Card (Updated: 09 Jan 2023)
Form [S2] Supplementary Note (Updated: 16 Aug 2022
Form [S4] Self-Certification Form - Individual (Updated: 16 Aug 2022)
Form [S5] Self-Certification Form - Entity (Updated: 16 Aug 2022)
Form [S6] Self-Certification Form – Controlling Person (Updated: 16 Aug 2022)
Form [T1] Third Party Payment Declaration Form (Updated: 28 Aug 2024)
POS Forms
Form [A2] Assignment of Policy as Collateral Security (For Assignment) (Updated: 15 Nov 2024)
Form [A3] Life Insurance Absolute Assignment Form (Updated: 28 Jul 2025)
Form [C4] Change of Licensed Insurance Intermediary Request Form (Updated: 29 Aug 2024)
Form [C5] Change of Beneficiary & Death Benefit Payout / Settlement Option Form (Updated: 25 Feb 2025)
Form [C6] Change of Insured Person Application Form (Updated: 2 Jan 2025)
Form [C7] Change of Insured Person Application Form(For Wealth Elite Saver 3 – Golden Years) (Updated: 2 Jan 2025)
Form [C8] Cash Coupons Withdrawal for Initial Premium Payment Request Form (Updated: 15 Nov 2024)
Form [C9] Cash Coupons Withdrawal for Subsequent Premium Payment Request Form (Updated: 15 Nov 2024)
Form [D1] Death Claim Form [Part 1] [Part 2] (Updated: 16 Aug 2022)
Form [D2] Direct Debit Authorization (Updated: 09 Jan 2023)
Form [D4] Designation of Successor Owner /Contingent Insured Person Request Form (Updated: 28 Jul 2025)
Form [I2] Information Supplement Form for Corporate Bodies (Updated: 29 Dec 2017)
Form [M1] Minor Proposed Insured - Consent Form for Insurance Application (Grandparent as proposed policyowner) (Updated: 7 Jan 2020)
Form [P1] Policy Cancellation and Surrender Form (Updated: 28 Jul 2025)
Form [P2] Policy Value Withdrawal/Loan Application Form (Updated: 15 Nov 2024)
Form [P3] Personal Information Collection Statement (Updated: 09 Jan 2023)
Form [P4] Premium Holiday Application Form ((Updated: 28 Jul 2025)
Form [R2] Request for Policy Service Form (Updated: 28 Jul 2025)
Form [R4] Request for Personal Information Change Form (Updated: 06 Nov 2025)
Form [S1] Standing Instruction Application Form (Updated: 15 Nov 2024)
Form [S2] Supplementary Note (Updated:7 Jan 2020)
Form [S7] Supplementary Note (For Policy Service) (Updated: 20 Dec 2021)
Form [S8] Surrender Benefit Settlement Option Supplementary Form (28 Aug 2024)
Form [V1] Verification of Trust Agreement (Updated: 16 Aug 2022)
Form [W1] Waiver of Premium / Payor Benefit Claim Form [Part 1] (Updated: 31 Mar 2020) [Part 2] (Updated: 16 Aug 2022)
Fubon Brokerage Service (For NB/CS/Product Inquiries)
Hotline: 2516-0196
Email: [email protected]