TRUSTEESHIP PLANS, INC

							                                        TRUSTEESHIP PLANS, INC.
               SUITE 211 RICHMACK BUILDING, #72 MINDANAO AVE., PROJECT 6, QUEZON CITY
                                    TELEPHONE NUMBER 927-93-14
               MEMBER: PHILIPPINE FEDERATION OF PRE-NEED PLAN COMPANIES, IN (PFPPCI)


                    APPLICATION FOR TRUSTEESHIP LIFE PLAN
       The undersigned PLANHOLDER. Whose name, personal data, and other information are inscribed in the
schedule below, written by him or under his direction, hereby applies to purchase TRUSTEESHIP PENSION PLAN for
pension program described and indicated thereat.

        TRUSTEESHIP EDUCATION AND PENSION PLANS, INC, hereinafter referred to as TRUSTEESHIP, upon
approval of the application shall issue to the undersigned PLANHOLDER a TRUSTEEHIP AGREEMENT duly signed and
authenticated by its authorized official.

         The undersigned PLANHOLDER accepts, consents, and agrees that the contract is perfected when said
TRUSTEESHIP PENSION AGREEMENT is issued, and further accepts, consents, and agrees to the General Provisions
in said TRUSTEESHIP AGREEMENT herein applied for, which General Provisions are in the contract.


                                                    PLEASE PRINT

PLANHOLDER:                                                       BENEFICIARY

ADDRESS:                                                          ADDRESS:



TEL. NO                          OCCUPATION:                      DATE OF BIRTH:                       AGE:

SEX:                             CIVIL STATUS:

DATE OF BIRTH:                   AGE:                             COUNSELOR:

PLACE OF BIRTH:                                                   DIVISION:

RELATIONSHIP TP BENEFICIARY:                                      PROVINCE:

NO. OF UNITS                     PENSION PROG.                    MODE OF PAYMENT

MATURITY VALUE                                                    PAYMENT TERM

PENSION OPTION #        1    2    3     Pls. check only one       INSTALLMENT AMOUNT

PRE-NEED PRICE                                                    PAYMENT DUE DATE

TYPECOF PLANHOLDER:                        NEW                                           OLD
IF OLD PLANHOLDER:            NUMBER OF PLAN/S HELD                                      TYPE OF PLAN/S HELD

                                      DECLARATIONS AND REPRESENTATIONS

I, hereby represent and declare to the best of my knowledge that:

 1.)   I am no below eighteen (18) years old nor                      3.)        I have not been for heart condition, high blood
       more than sixty (60) years old                                            pressure, cancer, diabetes, lung, kidney, or
                                                                                 stomach disorder or any physical impairment.

 2.)   I have not been confined in the hospital for                   4.)        I am, now, in good health and physical condition
       the last five (5) years nor received medical or
       surgical treatment.


SIGNED this                       day of                      , 200         at                   ,                        .




       SIGNATURE OF COUNSELOR                                                                SIGNATURE OF PLANHOLDER