How to Complete theNational Life Application

Document: November 2013

How to complete the National Insurance Application

The material in this presentation provides you with:

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• highlights of the changes to the new application.

• an overview of the New Business / Underwriting cycle.

• useful information to help you avoid the most common errors and omissions when completing the application.

Note: Accurate and full completion of the application form contributes to efficient processing, preventing delays for you and your client.

New Business Cycle Overview

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Application Received in

New Business1

Issue contract2

FinishData Entry

Underwriting

2 daysUnderwriting

Decision

File Received in New

Business

3 d

ays

Legend1 If application qualifies for Jet, the contract should be issued in 3 days.2 If there are no outstanding requirements, the case will be settled.

Summary of Key Changes

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General Information – Page 1 and 2Removal of the field "Social insurance number".Additional option for the policyowner identification

(outside Québec). Request for Change – Page 5Removal of the option "Level to enriched ($5,000 or

more) Eligibility – Page 6Improvement of comments for the Eligibility for the

Solo Disability coveragesImprovement of the wording of questions 1 and 2. Evidence of Insurability – Page 12Addition of sport "heli-skiing". Payment and Premium Instructions – Page 19Improvement of the section H1 to determine the

mode and method of payment.Addition of the option "To be provided on delivery".

Indicate that the banking information will be supplied upon delivery of the policy.

The signature for the "Pre-Authorized Debit Agreement (PAD)" was moved the section "Statements and Authorizations" (p.25). We grouped all signatures on pages 24, 25 and 26!

Authorization to Collect and Communicate Personal Information – Page 24Removal of the authorization for the use of social insurance number.New age provision for the signature of a guardian in Quebec and outside Quebec. Notice Applicable to MIB, Inc – Give to Policyowner and Personal Information Management – P 24Modifications to the wording. Statements and Authorizations – Page 25Modification to the wording of the first and the fifth statements. Removal of the signature for the children of 14 and more years old (Quebec) and 16 years and more (outside Quebec).New age provision for the signature of a guardian in Quebec and outside Quebec.Addition of the section "Signature" for the pre-authorized debit agreement (PAD). Logo DSFINLogos were updated.

Section A1 – General Information (Page 1)

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• Remove the field "Social insurance number".

• Addition of a new document for the identification of the policyowner identification (outside Québec)

Section A1 – General Information (Page 1)

Indicate the type of application by checking the box.

If "Request for Change(s) is selected, indicate the number of the contract being changed in this space.

Head Office use.

If the insured is a child, complete section A1 as well as F8.

Indicate if the insured is also the policyowner or just the insured. If a person is the policyowner only, that person should be identified in section A2.

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This section should be completed in full for each insured.

Note: For Solo Disability coverages, complete a separate application for each insured.

Section A1 – General Information (Page 1)

If the insured's place of birth is not Canada, it is important to indicate their arrival date in Canada.

Indicate the document used to validate the Policyowner's identity when the insured is also the owner.

If the insured doesn't understand English and French, download the Declaration form from Webi, complete and attach it with the application.

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Section A2 – Policyowner Only (Page 2)

If the policyowner is an individual, complete the area outlined in red.

If the policyowner is a company or is applying for Solo Business Expense, complete the area outlined in blue and submit a completed form 08295.

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Complete this section if the owner is NOT one of the insureds identified in A1.

Section A3 – Contingent Policyowner (Page 2)

When the owner is not an insured, we need direction regarding ownership transfer upon the death of the owner.

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if there is more than 1 policyowner, check this box to automatically transfer ownership to the surviving owner.

to transfer ownership to another person, check this box and provide details of that person in this section.

Section A4 – Company's Financial Position (Page 2)

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• This section is only required if applying for business insurance and the total amount in-force (including this application) exceeds $500,000.

• A balance sheet or financial questionnaire is required to be submitted with the application.

Section B1 – Beneficiary Upon Death (Page 3)

When there is more than 1 beneficiary, it is important to indicate the percentage split.

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• A beneficiary is required for each insured.

• Provide all information to avoid processing delays.

• There is space to indicate 3 beneficiaries. If additional space is required, used Special Instructions (Section G, page 18)

Section B2 – Designation of a Trustee for a Minor Beneficiary (Page 3)

This section only needs to be completed if any of the beneficiaries identified in B1 are a minor child.

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Information in these sections relates to the trustee.

B3 – Contingent Beneficiaries (Page 4)

• Name the person who is to become the beneficiary when a beneficiary predeceases the proposed insured.

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B4 – Beneficiaries for Harmony Executive Benefit (Page 4)

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• For Harmony Executive Benefit, use this section to name the beneficiaries for each type of benefit

• We made the sections for CI and death benefits easier to use for corporate beneficiaries

Section C – Type & Amount of Insurance Applied for (Page 5)

• If the information provided in this section does not match the illustration, an amendment form will be required on delivery of the contract. To speed up the process:

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ensure your illustration program (Fusion) version is current;

submit an illustration (Head Office Copy) with the application; and

submit a signed Comparative Analysis for UL (PACE) products.

Section D – Request for Change (Page 5)

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• If the change requested does not require medical evidence, use form 09219E – Request for Change without Evidence of Insurability.

• Any change requested in this section requires evidence of insurability. Applicable sections in Part 1, 2, and 3 of this application should be completed.

• For UL (PACE) products, have the policyowner sign the in-force illustration and submit it with the application.

Section E – Eligibility (Page 6 - 8)

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New items are:

• Improvement of comments for the Eligibility for the Solo Disability coverages

• Improvement of the formulation of the questions 1 and 2.

Section E1 – Eligibility for SOLO Disability coverages (Page 6 - 8)

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Scenario Separate App for other insured?

Questions to answer

for

Remarks

Applying for SOLO DI Yes Q1 to 25 Both insureds answer Q1 to Q25 on separate applications.

Applying for SOLO Healthcare

Section E1 is not applicable

Applying for SOLO Loan

– If both insureds are employed

Yes Q1 to 17 plus Q18 if applying for occupation

class upgrade

Both insureds answer Q1 to Q17 (and Q18 if applicable) on separate applications.

Applying for SOLO Loan

– If one insured is employed but not the other

Yes Q1 to 17 plus Q18 if applying for occupation

class upgrade

• Employed spouse answers Q1 to Q17 on one application.

• Unemployed spouse, completes separate application & on page 6, only indicates employed spouse's name and DOB in appropriate space at the top. Submit applications together.

• The following chart summarizes the instructions for completing this section

• If applying for SOLO Healthcare, this section must be completed..

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Section E2 – Eligibility for SOLO Healthcare coverages (Page 8)

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Section F1 –Identification of Proposed Insureds (Page 9)

• This section is for insured adults. For Children's Protection Benefit or Solo Healthcare family coverage, children should be identified in section F8 (page 15).

• If there are more than 2 insured adults, use another application form and submit together.

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Section F2 –Insurance in force (Page 9)

• Report any insurance in force in this section (excluding this application).

Section F3 – Identification of Personal Physician (Page 10)

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• To avoid delays in the Underwriting process, provide contact information on the personal physician and/or Medical Clinic that has the medical records for each proposed insured.

Indicate the results of any tests and visits. For example, if the reason for the last visit was for an annual checkup and there were no problems, indicate "everything OK", "normal, etc."

Section F4 – Examinations ordered by the Representative (Page 10)

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• Only complete this section if an examination has been ordered.

• Indicate all examinations ordered for each insured.

• For Elite applications, specify to the Paramedical and Inspection service provider that it is an Elite case.

Section F5 – Mandatory Questions (Page 11)

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• There are 7 questions in this section and all of them must be answered.

• If this application will be used to replace any insurance in force, observe applicable replacement rules and regulations, and complete a replacement declaration form as needed.

Section F6 – Supplementary Questions (Page 12 -14)

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• If paramedical or medical examinations comes from an insurance company other than DFS, this section must be completed for that insured.

• If examinations come from DFS, completing this section is optional. However, if completed, communication of a decision by the Underwriter with the representative will be easier.

Note the reference to WEBI when questionnaires are available on-line.

Section F7 – Additional Questions for Harmony New Generation (Page 14 - 15)

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• If applying for Harmony New Generation, there are 9 questions in this section that need to be answered in addition to all other relevant sections regarding Evidence of Insurability.

Section F8 – Questionnaire for Policyowner's Children to be insured (Page 15 - 16)

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• Completion of this section is only required when Children's Protection Benefit or Solo Healthcare family coverage is being requested.

• This section is not required for Harmony New Generation.

Section F9 – Explanations (Page 17)

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• Use this section to provide any further details for questions in sections:

F6 – Supplementary Questions

F7 – Additional Questions for Harmony New Generation

F8 – Questionnaire for the Policyowner's Children to be insured

Section G – Special Instructions (Page 18)

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• Use this section to provide any further information for the following situations:

to indicate additional policyowners without coverages not mentioned in section A2

to indicate additional beneficiaries not mentioned in section B1

if any cash values will be drawn from other policies not mentioned in section H1;

to provide additional details relevant to contract issues or request for change.

Section H1 – General Information – Payment & Premium Instructions (Page 19)

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Improvement of the section H1 to determine the mode and method of payment.

Addition of the case "To be provided on delivery". Indicate that the banking information will be supplied in the delivery of the policy.

The signature for the "Pre-Authorized Debit Agreement (PAD)" was moved the section "Statements and Authorizations" (p.25). We grouped all signatures on pages 24, 25 and 26!

Note: If this application generates more than 1 insurance contract, indicate the total premium amount for all contracts.

Section H2 – Pre-Authorized Debit (PAD) Agreement (Page 19)

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• Either provide a "VOID" cheque or complete the table in this section.

• If the client chooses not to provide banking information until the application is approved, indicate "To be provided" in the table. In this situation, a PAD Agreement will be required on contract issue.

Section H2 – Pre-Authorized Debit Agreement (Page 19)

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Select a payment frequency.

Indicate the draw date (between the 1st to 28th).

Write the premium amount.

Provide information if specific amounts are to be withdrawn for other contracts.

If applying for Premium Deposit Account (PDA), provide details here.

Section H2 – Pre-Authorized Debit Agreement (Page 19)

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If it is a business bank account, check the "Business" box, otherwise check the "Personal" box.

If it is a joint or business account that requires two account holder signatures, all account holders must sign and date here, otherwise one account holder signature and date is sufficient.

Temporary / Conditional Insurance Agreement

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Section I, J, K– Temporary Insurance Agreement / Conditional Insurance Agreement (Page 20 - 22)

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• There are 2 different TIA's (Death & Critical Illness) and 1 CIA (Disability).

• Signatures are captured on page 25.

• Answer the questions for the applicable agreement (I, J or K), detach the corresponding agreement from page 21 and give to the policyowner.

• To qualify:

• If the insured qualifies:

age of the proposed insured(s) must be within a specific range (refer to the appropriate TIA/CIA);

the answers to all questions must be "No";

initial premium must be paid with the application;

section O (page 25) must be fully signed and dated.

complete the Receipt for the Initial Premium slip (Section M on page 24), tear it off and give to the policyowner.

tear off the applicable Agreement for the application (page 21) and give to the policyowner.

Section L – Authorization to Collect & Communicate Personal Information (Page 24)

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Remove the authorization for the use of social insurance number.New age provision for the signature of a guardian in Quebec and outside

Quebec.

Section M – Receipt for the Initial Premium (Page 24)

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• When the initial premium is paid with the application, this slip must be completed, torn off and given to the policyowner.

Section N – Notice Applicable to MIB & Personal Information Management (Page 24)

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• This slip must always be torn off and given to the policyowner.

Section O – Statements & Authorizations (Page 25)

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• Modification to the text of the first and the fifth statements.

• Remove of the signature for the children of 14 and more years old (Quebec) and 16 years and more (outside Quebec).

• New age provision for the signature of a guardian in Quebec and outside Quebec.

• Addition of the section "Signature" for the pre-authorized debit agreement (PAD).

New items are:

Section O – Statements & Authorizations (Page 25)

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• Each policyowner and insured must sign and date in this section.

• It is important to indicate the date and place the application is signed.

• An insured who is also a policyowner only needs to sign once.

Section O – Statements & Authorizations (Page 25)

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Signature of the person who is a policyowner only (no coverage) or the person who is a policyowner and an insured

Signature of the second policyowner only (no coverage) or the second person who is a policyowner and an insured

Signature of insured 1 who is not a policyowner

Signature of insured 2 who is not a policyowner

Section P – Representative Information & Declaration (Page 26)

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Indicate the type of compensation.

Rep's first name.

Rep's surname or company name.

5 digit rep's code.

3 digit office code.

Rep's contact email address.

Percentage if more than one rep sharing the commission (must add up to 100%).

Referrals (Addendum)

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• If the client has referred any potential clients, record the information on this page and detach from the application.

For representative use only.