PHILAM LIFE FINANCIAL ADVISOR APPLICATION

AIA PHILAM LIFE FINANCIAL ADVISOR APPLICATION
Jumpstart your entrepreneurial journey with AIA Philam Life! Please fill out the information below to proceed with your application as a financial advisor.
PERSONAL INFORMATION
Name*
First NameMiddle NameLast Name
Date of Birth*
MonthDayYear
Date
Gender*
MaleFemale
Civil Status*
Place of Birth*
City, Province
Nationality*
Tax Identification Number (TIN)*
Social Security Number (SSS)*
CONTACT INFORMATION
Mobile Number*
09xxxxxxxxx
Email Address*
example@example.com
Permanent Address*
No/Flr, Bldg, Street Name
Subdivision, Barangay
CityState / Province
Postal / Zip Code
Current Address
No/Flr, Bldg, Street Name
Subdivision, Barangay
CityState / Province
Postal / Zip Code
EMERGENCY CONTACT
Name*
First NameMiddle NameLast Name
Relationship*
Mobile Number*
09xxxxxxxxx
Address
No/Flr, Bldg, Street Name
Subdivision, Barangay
CityState / Province
Postal / Zip Code
EDUCATION BACKGROUND
Qualification (Level)*
Degree Program*
Institution Name*
From (Year)*
To (Year)*
EMPLOYMENT HISTORY
Do you have a working experience?*
YesNo
Details on a minimum of 2 prior work experiences are required. If you only have 1 prior work experience, please select accordingly.*
1 onlyMore than 1
Details on Your Most Recent Work Experience
Company Name*
Employed From (Year)*
Employed From (Month)*
Employed To (Year)*
Employed To (Month)*
Type of Employment*
Position*
Industry*
Final Base Salary (Per Annum)*
Supervisor Name*
First NameLast Name
Company Contact Number*
Company Address*
No/Flr, Bldg, Street Name
Subdivision, Barangay
CityState / Province
Postal / Zip Code
Reason for leaving*
indicate N/A if still connected
Details on Your 2nd Most Recent Work Experience
Company Name*
Employed From (Year)*
Employed From (Month)*
Employed To (Year)*
Employed To (Month)*
Type of Employment*
Position*
Industry*
Final Base Salary (Per Annum)*
Supervisor Name*
First NameLast Name
Company Contact Number*
Company Address*
No/Flr, Bldg, Street Name
Subdivision, Barangay
CityState / Province
Postal / Zip Code
Reason for leaving*
write N/A if still connected

PERSONAL DECLARATION
Do you have any members of your immediate family (parents, siblings, spouses, children) currently working for or previously connected with AIA Philam Life or any of its affiliates (i.e. BPI-Philam, PAMI, Philam Foundation, Philam Call Center)?*
YesNo
Are you currently working for or were you previously connected with AIA Philam Life or any of its affiliates?*
YesNo
Have you ever been connected/worked with another insurance company?*
YesNo
Have you completed any insurance regulatory examination?*
YesNo
Have you ever applied for a license to solicit insurance?*
YesNo
Have you ever been connected to any government office/agency/department as an employee/officer/consultant in the past 12 months?*
YesNo
Have you ever been unemployed for a specific period of time?*
YesNo
Date From*
MonthDayYear
Date
Date To*
MonthDayYear
Date
Please provide further details
CHARACTER REFERENCES
CHARACTER REFERENCE NO. 1
Full Name*
First NameLast Name
Mobile Number*
09xxxxxxxxx
Email Address*
example@example.com
Relationship*
Best time to call*
CHARACTER REFERENCE NO. 2
Full Name*
First NameLast Name
Mobile Number*
09xxxxxxxxx
Email Address*
example@example.com
Relationship*
Best time to call*
CHARACTER REFERENCE NO. 3
Full Name*
First NameLast Name
Mobile Number*
09xxxxxxxxx
Email Address*
example@example.com
Relationship*
Best time to call*
Should be Empty: