Insurance form - Good Intentions

Insurance Application

Please prepare clear copies of all the required documents. Unreadable and/or low resolution files may delay the verification of your application. Click below to see the full list of requirements. Upon completion of this insurance application form, you will receive a confirmation email containing a copy of your submission, followed by another email containing your personalized insurance quotation and access to our payment portal.

"*" indicates required fields

Step 1 - Fill out this online application form and submit it together with the required documents.

Step 2 - Receive an email from Good Intentions containing your insurance quotation and the payment link to our portal.

Step 3 - Receive another email from Good Intentions containing your E-Policy.

Please prepare clear copies of the required documents. Unreadable and/or low resolution files may delay the verification of your application. Click below to see the full list of requirements.

Requirements Customer Charter Internet Insurance Security Terms of Use

Personal Information

The information you provide here will be used in the verification of your application and stated in your insurance quotation and policy.

First Name*

Middle Name*

Last Name*

Birth Date*

Age*

Gender*

Occupation*

Mobile Number*

Email*

Enter Email Confirm Email

Residential/Mailing Address*

Please ensure that this address is searchable on Google Maps

Do you drive to and from your place of work?*

Yes

Complete Office Address*

Please ensure that this address is searchable on Google Maps

How did you find out about this Premium Refund Program?*

Social media post by Bethel

Personal referral by a friend or relative

Online advertisement

Print advertisement (poster, billboard, etc.)

Random online search

Influencer endorsement

One of Bethel's branches

None of the above

Please specify how you found out:

Indicate the exact branch location (and details):*

Is the information you're providing true, accurate, and your own?

Yes

This form is for the intended policyholder. If it is not the policyholder filling this out, then by choosing "Yes", you declare that you have the intended policyholder's full consent to do so.

Vehicle Information

We will determine the exact age of your vehicle by using the original registration date indicated in your Certificate of Registration.

See Private Motorcar Policy

Vehicle Unit and Year Model*

Plate Number*

Transmission Type*

Color*

Accessories*

Estimated Average Daily Use in Kilometers*

If non-standard, specify the accessories*

Magwheels

Air-conditioning

Stereo

Others

Specify the other accessories*

Required Documentation

Are you the registered owner of the vehicle?*

Yes

Notarized Deed of Sale*

Max. file size: 64 MB.

This is required if you are not the registered owner and the name indicated on the OR/CR is not yours.

Your Valid Driver's License*

Max. file size: 64 MB.

Your Vehicle's Certificate of Registration (CR)*

Max. file size: 64 MB.

Your Official Receipt (OR)*

Max. file size: 64 MB.

Photo of Your Vehicle's Current Odometer Reading*

Max. file size: 64 MB.

Photo must clearly display the vehicle's current odometer reading and match the reading visible in your video.

Policy Information

Do you currently hold an active car insurance policy?*

Yes

The policy may be with any insurance company (not only Bethel)

Your Certificate of Insurance*

Max. file size: 64 MB.

Photo of Vehicle's Front Side*

Max. file size: 64 MB.

Clear photo in PNG/JPG format

Photo of Vehicle's Rear Side*

Max. file size: 64 MB.

Clear photo in PNG/JPG format

Photo of Vehicle's Left Side*

Max. file size: 64 MB.

Clear photo in PNG/JPG format

Photo of Vehicle's Right Side*

Max. file size: 64 MB.

Clear photo in PNG/JPG format

Your Preferred Effectivity Date*

Your preferred start date of your policy (or policies) three (3) or more days from today.

Choose Your Insurance Package Add-On

Avail of additional Premium Refund policies.

Consent*

I Agree and Consent

I agree and consent to the collection and processing of all the personal information that I have provided to Good Intentions for the purpose of applying for insurance coverage. I acknowledge and agree with the manner by which my data will be processed as explained in GOOD INTENTIONS PRIVACY POLICY in accordance with the Data Privacy Act of 2012 .

Consent*

I Consent

I also give consent to Good Intentions to share my personal information to Bethel General Insurance and Surety Corporation for the purpose of procurement, servicing, and claims handling in relation to any non-life insurance products that I intend to avail and/or have availed, subject to the privacy policy of Bethel General Insurance and Surety Corporation.

Personal Accident

See Personal Accident Policy

Please explain the nature of your current occupation.

Your Beneficiaries

Full Name

Relationship

Click "+" to add more

Your Desired Coverage*

Consent*

I Agree and Consent

Consent*

I Consent

Private Residential

See Private Residential Home Policy

Location of Property*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Names of Surrounding Streets*

If not a street, describe physical attributes of bordering structure/environment

Left

If not a street, describe physical attributes of bordering structure/environment

Rear*

If not a street, describe physical attributes of bordering structure/environment

Right*

If not a street, describe physical attributes of bordering structure/environment

Property Attributes

Roof*

G.I. sheets

Concrete

Tegula

Roofdeck

Height*

Walls*

Concrete

Timber

Mixed

Value & Coverage

Building*

Declare value in PHP

Household Contents*

Declare value in PHP

Your Desired Type of Coverage*

Allied perils includes: earthquakes, floods, typhoons, extended coverage, riot strikes, and malicious damage.

Required Documentation

Exact Location on Google Maps*

Max. file size: 64 MB.

Take a screen shot and mark location with "X"

Photo of Property's Front Side*

Max. file size: 64 MB.

Preferably JPG/PDF format

Photo of Property's Right Side*

Max. file size: 64 MB.

Preferably JPG/PDF format

Photo of Property's Left Side*

Max. file size: 64 MB.

Preferably JPG/PDF format

Photo of Property's Rear Side*

Max. file size: 64 MB.

Preferably JPG/PDF format

Consent*

I Agree and Consent

I Consent*

I Consent

Personal Accident

See Personal Accident Policy

Please explain the nature of your current occupation.

Your Beneficiaries

Full Name

Relationship

Click "+" to add more

Your Desired Coverage*

Private Residential

See Private Residential Home Policy

Location of Property*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Names of Surrounding Streets*

If not a street, describe physical attributes of bordering structure/environment

Left

If not a street, describe physical attributes of bordering structure/environment

Rear*

If not a street, describe physical attributes of bordering structure/environment

Right*

If not a street, describe physical attributes of bordering structure/environment

Property Attributes

Roof*

G.I. sheets

Concrete

Tegula

Roofdeck

Height*

Walls*

Concrete

Timber

Mixed

Building*

Declare value in PHP

Household Contents*

Declare value in PHP

Your Desired Type of Coverage*

Allied perils includes: earthquakes, floods, typhoons, extended coverage, riot strikes, and malicious damage.

Required Documentation

Exact Location on Google Maps*

Max. file size: 64 MB.

Photo of Property's Front Side*

Max. file size: 64 MB.

Photo of Property's Right Side*

Max. file size: 64 MB.

Photo of Property's Left Side*

Max. file size: 64 MB.

Photo of Property's Rear Side*

Max. file size: 64 MB.

Consent*

I Agree and Consent

I agree and consent to the collection and processing of all the personal information that I have provided to Good Intentions for the purpose of inquiring about their products and services. I acknowledge and agree with the manner by which my data will be processed as explained in GOOD INTENTIONS PRIVACY POLICY in accordance with the Data Privacy Act of 2012 .

Consent*

I Consent

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Insurance Application

Personal Information

Vehicle Information

Required Documentation

Policy Information

Personal Accident

Private Residential

Property Attributes

Value & Coverage

Required Documentation

Personal Accident

Private Residential

Property Attributes

Required Documentation

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