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    Insurable Life Uninsurable Life
 
 
Prepared for:
  Face Amount: * $ $
  Age: (last birthday)
  Sex: Male Female Male Female
  Smoker:
 
 
 
*Total applied for and placed with Manulife within the past 12 months
Individual Application    Survivorship Application

Additional APS will be required regardless of the amount for history of certain medical conditions. (click here for details) The underwriter reserves the right to ask for additional requirements based on medical history circumstances of a case, or facultative reinsurance.

 
Requirements:
To speed up the underwriting process, and to ensure that your clients receive our best possible offer, be sure to complete the application, health questionnaire and authorization forms.
Please make sure to include an illustration with the INPUT SUMMARY page.

Medical Examiners:
Examining M.D.'s/D.O.'s (Medical Doctor or Doctor of Osteopathy), licensed to practice medicine in the state where the exam is completed, may conduct exams for any amount.
Exams by proposed insured's attending doctor will be accepted for any amount.

Paramedical Companies:
Manulife has selected a number of paramedical companies to assist you. These companies are familiar with our u/w procedures and requirements and have been selected because of their proven ability to meet your needs.
The current list includes:
 

Examination Management Services, Inc.
Portamedic American Para Professional Systems, Inc
 

Product Approval and Forms:
Product approval, applications to be used, and illustration should reflect the state of residence of the OWNER of the policy, or if it is to be owned by a TRUST, the state where the trust is domiciled.

Licensing:
You must be licensed to sell this product in the state where the business is conducted.
You must be appointed with Manulife in order to sell this product.

Medical Conditions Requiring an Attending Physician Statement
An APS is also required regardless of the amount if the proposed insured has consulted a doctor for, or has had any history of the following within the past 10 years:
  • Alcohol/Drug abuse and/or treatment
  • Cancer - not basal cell or squamous cell skin cancer
  • By-pass surgery (CABG), angioplasty (PTCA), heart attack, myocardial infarct, chest pain, angina, arrhythmia, TIA, stroke, heart murmur, peripheral vascular disease (PVD), abnormal EKG/treadmills
  • Dementia, Alzheimer's Disease, memory loss
  • Diabetes
  • Emphysema, chronic bronchitis, COPD
  • Hepatitis, liver disease
  • Kidney/renal disease
  • Multiple Sclerosis
  • Parkinson's Disease
  • Ulcerative Colitis, Crohn's disease
A n APS is also required regardless of the amount if the proposed insured has consulted a doctor for, or has had any history of the following within the past 3 years
  • Depression
  • Epilepsy, seizures, convulsions
  • Hypertension

Manulife Financial and the block design are registered service marks of The Manufacturers Life Insurance Company and are used by it and its affiliates including Manulife Financial Corporation.
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