BlueTee Marketing

Information Sheet

						Date:

Name:				Age:	Sex:	Birthdate:
	LAST	FIRST	M.I.				mm/dd/yyyy
Civil Status: Nationality: E-mail:
Cell #:
Resident Country Address:
Year of stay in the country: Contact Nos:
Address in the Philippines:
Contact Nos:

*Note for Construction Workers, Miners and other high-risk occupations: AD &D insurance coverage is applicable only when
accident happens outside the course of duty. (To be evaluated upon submission of this form.)

Occupation:
Office/Employer Address: Contact Nos:
Name of Beneficiary: Age of Beneficiary:
Relationship to beneficiary:
Spouse's Name (if married): Age:
Address: Contact Nos:
Endorsed by:

* Fax proof of remittance to: (632) 886-3727 or e-mail scanned sheet(s) to eltormes@blueteem.com

*Free airport transfer to a Hotel or Bus Terminal in Metro Manila upon arrival.

*20% discount at any accredited hotels in Manila, Baguio, Bicol, and Palawan.

*PhP 100,000 accidental death and disability benefits.

*Fee for every endorsed account or closed business referrals.