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Customer Information Update Form

1) The document is a customer information update form from Pru Life Insurance Corporation of U.K. It requests to update the policyowner's contact details such as name, addresses, identification information, and beneficial owner details if applicable. 2) The policyowner needs to provide their signature to certify that the information provided is true and correct. A witness signature is also required. 3) The form also certifies that the signature of the policyowner appearing on all forms and valid IDs is their customary signature.

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Arnold Thony
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109 views

Customer Information Update Form

1) The document is a customer information update form from Pru Life Insurance Corporation of U.K. It requests to update the policyowner's contact details such as name, addresses, identification information, and beneficial owner details if applicable. 2) The policyowner needs to provide their signature to certify that the information provided is true and correct. A witness signature is also required. 3) The form also certifies that the signature of the policyowner appearing on all forms and valid IDs is their customary signature.

Uploaded by

Arnold Thony
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Customer Information Update

PRU LIFE INSURANCE CORPORATION OF U.K.


CIU 9/F Uptown Place Tower 1, 1 East 11th Drive, Uptown Bonifacio,
1634 Taguig City, Philippines
Customer helpdesk: (632) 683 9000, (632) 884 8484, (632) 887 LIFE
within Metro Manila, 1 800 10 PRULINK for domestic toll-free
Email: contact.us@prulifeuk.com.ph Website: www. prulifeuk.com.ph
REMINDERS:
Please use CAPITAL LETTERS and black ink.
Tick the appropriate box to indicate your POLICY NUMBERS
choice. Please do not sign on a blank form.

DETAILS OF POLICYOWNER
SURNAME PRESENT ADDRESS (number, street, municipality/city, provice)

GIVEN NAME

COUNTRY ZIP CODE

MIDDLE NAME Tick if same as


PERMANENT ADDRESS (number, street, municipality/city, provice) present address

OTHER LEGAL NAME/ALIAS

NATIONALITY EMAIL ADDRESS


COUNTRY ZIP CODE

MOBILE NUMBER TELEPHONE NUMBER


EMPLOYER/BUSINESS ADDRESS Tick if same as
(number, street, municipality/city, provice) present address
IDENTIFICATION INFORMATION
SSS/GSIS TIN

OTHERS ID NUMBER
COUNTRY ZIP CODE

Preferred billing address for Pru Life UK correspondence:


OCCUPATION (State exact duties; if member of AFP/PNP, state rank.)
Present address Permanent address Employer/Business address

NATURE OF WORK OR NATURE OF BUSINESS (if self-employed) REASON FOR CHANGE IN ADDRESS (Note: If the new address is the same as the
servicing agent’s address, please indicate the relationship with the agent and
reason for such request. This request is subject to further evaluation and approval in
EMPLOYER NATURE OF BUSINESS OF EMPLOYER compliance with Pru Life UK guidelines.)

SOURCES OF FUNDS
Salary Business Others

DETAILS OF BENEFICIAL OWNER


Beneficial Owner refers to any natural person who ultimately owns or controls the customer, and/or on whose behalf a transaction or activity is being conducted, or has
ultimate effective control over a legal person or arrangement.
In relation to an entity, Beneficial Owner/s are individuals either owning or controlling at least 20% of the entity’s shares or voting rights.
Do you have a Beneficial Owner? Yes No If “YES”, please accomplish the KYC for Beneficial Owner and Third Party Payor Form.

POLICYOWNER VERIFICATION
I certify that the information provided in this form is true and correct. I consent to the use and processing of the above information in relation to my Policy/ies and authorize
Pru Life UK to update my existing record to reflect the above information.
(mm/dd/yyyy)
EXECUTED AT THIS
PLACE DATE COMPLETED

Signature over printed name of POLICYOWNER Signature over printed name of WITNESS

Page 1 of 2 CIU
CERTIFICATION OF CUSTOMARY SIGNATURE FOR POLICYOWNER

This is to certify that I am the same person who signed the


Application for Life Insurance. I confirm that the declarations
and information therein were given by me personally and
that they are true and complete to the best of my knowledge.

Finally, I certify that the signature appearing on all my forms


and valid IDs is my customary signature, as follows:

FOR OFFICIAL USE ONLY


BRANCH RECEIPT DETAILS HEAD OFFICE RECEIPT DETAILS

PROCESSED BY: APPROVED BY:

Signature over printed name of Processor Signature over printed name of Approver

Page 2 of 2 CIU

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