Transamerica Canada Project

Client Information

Client Name: John Doe

Client #: C123456

General

Birth Date: 12DEC1970

Gender: Male

Language: English

Smoker Class: Non-Smoker

Address:

15-123 Happy Lane
Toronto ON 1A1 A1A
CA
Resident Type: House

Home Phone: 416 555-5555
Business Phone: 416 555-5555
Email Address: TestingScreen@transamerica.com

Withholding Tax: Yes

Hold Mail: No

Policy #	Policy Relation	Policy Status
X1234567	Primary Insured	Pending
X9876543	Primary Insured	Inforce

Underwriting Requirements

Requirement	Seq	Message/Reason for Decision	Status	Date	Designation
Paramedical Exam (Para)	001		Reviewed	23Mar2013	Nurse
Urine Specimen (HOS)	001		Ordered	23Mar2013	OSB

Underwriting Decisions

Client Decision: Pending

Underwriter: Mickey Mouse

Policy #	SA Code	Coverage	UW Class	Face Amount	Policy Decision	Decision Date	NB Message
X1234567	102775	001	Non-Smoker	$150000.00	Approved	30 AUG 1999	Mailed on 2002-02-07
X1234567	102775	002	Standard	$150000.00	Non-Risk	30 AUG 1999	Yes

Delivery Requirements

Policy #: 080123456 -

Cash With App Amt: $230.25

Print Date: 30Aug1999

Mail Date: 31Aug1999

End of Delivery Date: 30Oct1999

Final Deposition Date: 30Nov1999

Requirement	Seq	Message/Reason for Decision	Status	Date	Designation
Cash with App (CWA)	001		Cancelled	23Aug1999
Initial Premium Balance (CASH)	001		Reviewed	23Aug1999	INDEX 100%