Download Application for Alteration (Form 1)

PruCustomer Line: 1800 -333 0 333
APPLICATION FOR ALTERATION (FORM 1)
Policy Number
Name and NRIC/Passport of Life Assured
Financial Consultant’s Code and Name
Type Of Alteration:
A. Payment Frequency
D. Maturity Payout Option
G. New Certificate of Life Assurance
B. Payment Method
E. Cashback /Cash Benefit Start Period
H. Fund Distribution Option
C. Advance Premium Payment
F. Regular Benefits Payout Option
I. Portfolio Solutions
• Tick all the required boxes, fill in the details and sign next to any amendments made.
• A copy of the bank book or bank statement stating account holder name and number must be submitted for a direct credit request
unless the direct credit account was previously provided to and accepted by Prudential.
A. Payment Frequency
Change of payment frequency from Monthly to Non-Monthly can only be effected on the next policy anniversary date. Otherwise,
advance premium payment is required for immediate processing. E.g. from monthly to annual mode, the policyholder will have to pay up
the balance of premiums that make up one annual premium before the annual premium can be effected.
Annually
Quarterly
Half-Yearly
Monthly (for credit card and GIRO payment mode only)
B. Payment Method
For change to other payment methods, please submit a GIRO/Credit Card application form.
Cash/Cheque (not applicable for Monthly payment frequency)
C. Advance Premium Payment (not applicable for PRULink single premium and PRUSelect policies)
The maximum amount of advance payment allowed is 2 years of premiums (current year plus one more year of premium due)
Advance the payment of
for premium due from
$
/
mm/yyyy
D. Maturity Payout Option
*Yearly Instalment for Policies which provide settlement options:
Lump Sum
3 Years
4 Years
10 Years
15 Years
20 Years
*The settlement option monies during the maturity installment payout period are not covered under the Policyowners’ Protection Scheme
and rank after policy liabilities and equally with our unsecured liabilities in the event of our insolvency.
E. CashBack / Cash Benefit Start Period (for PRUFlexiCash & PRUFlexiCash Protection Plus)
I wish to start receiving the Yearly CashBack/Cash Benefit after the following Policy Anniversary:
From 2nd year onwards.
1.
2.
Please specify ______ year (e.g.11th – Up to your policy term)
The policy term of 20 years does not apply to PRUFlexiCash Protection Plus.
Once the 1st payout is made, alteration to payout option is not allowed.
F. Regular Benefits Payout Option (for Yearly CashBack/Cash Benefit, Non-Guaranteed Monthly Income and Cash Reward)
Direct Credit to: Name of Bank and Branch
Bank Account Number
Name of Account Holder (The name of the bank
account holder must be Policyowner/Trustee(s)/Assignee)
P14022017
Leave in the policy (Not applicable for PRUSave Privilege Accelerator plans)
G. New Certificate of Life Assurance
Issue a new Certificate of Life Assurance (Doc ID: L2DUPPOL)
Prudential Assurance Company Singapore (Pte) Limited (Reg. No.: 199002477Z)
Postal Address: Robinson Road P.O. Box 492, Singapore 900942
Tel: +65 6333 0333 Fax: +65 6734 9555 Website: www.prudential.com.sg
Part of Prudential Corporation plc
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Page 1 of 2
H. Fund Distribution Option
1. The below fund selections are only available for selected plans.
2. If the selected option or bank details submitted are incomplete, the distribution will be reinvested in accordance with the policy terms.
3. For SRS plan, fund would be credited back to the same SRS account as per the existing records for direct credit option.
Select the fund:
PRULink Asian Income Fund
PRUlink Dynamic Income Fund
PRUlink Emerging Income Bond
PRUlink Asian Income and Growth Fund (Distribution)
Direct Credit to SRS account (only applicable for SRS policies)
Direct Credit to:
Name of Bank and Branch
(For Cash Policy)
*Bank Account Number
Name of Account Holder (The name of the bank
account holder must be Policyowner/Trustee(s)/Assignee)
* This account supersedes previous bank details submitted for direct credit of distributions for the policy
Reinvest into the Fund
I. Portfolio Solutions (applicable for investment linked policies, PruSelect Vantage and PruSelect Vantage Premier)
I would like to sign up for Portfolio Solutions and agree that a quarterly report will be sent to my email address at
I hereby confirm that this email supersedes any existing email records. I acknowledge and accept the terms and conditions as stipulated
below:
Terms and Conditions for Portfolio Solutions Application:
1. I acknowledge that the reports and/ or information that I shall receive in connection with the Portfolio Solutions is for reference and
general information only. All investment decisions are made independently by me, after duly considering and understanding the
investment product(s), benefits and risks.
2. The Portfolio Solutions that you are signing up for will give you access to confidential and proprietary information of Mercer
(Singapore) Pte Ltd (“Mercer”) and is intended for your exclusive reference, for general information purposes only. This information is
not intended as investment advice and shall not be relied on as such.
3. Notwithstanding any information provided to you in connection with the Portfolio Solutions, you are advised to read the fund
information booklet(s) with respect to the relevant investment products before deciding whether to invest in such products. Neither
Prudential nor Mercer gives any representations or warranties as to the accuracy of any information provided to you in connection
with the Portfolio Solutions. Neither Prudential nor Mercer accepts any responsibility or liability for any loss or damage which you may
suffer arising out of or in connection with your use of the Portfolio Solutions. Where appropriate, you are encouraged to seek
independent legal, tax and other professional advice.
4. As there may be market fluctuations and change in market conditions, you are also encouraged to refer to the subsequent model
portfolios that will be updated on a quarterly basis. Such subsequent updated model portfolios can be obtained via PruAccess.
5. Any opinion on or rating of investment products contained under the model portfolio or provided by Mercer, Prudential or any
Prudential Financial Consultant in connection with the Portfolio Solutions is not intended to convey any guarantee as to the future
investment performance of such investment products. In addition, past performances of investment products cannot be relied upon
as a guide to future performance of such products.
6. Notwithstanding anything above, Prudential reserves the right to discontinue the Portfolio Solutions at anytime without reference or
notification to you.
Declaration (Please read carefully before signing this application)
•
•
I / We understand that the alteration will not be effective until an official letter is sent by Prudential Assurance Company Singapore
(Pte) Limited (“Prudential”) confirming acceptance of the change.
I / We hereby authorise Prudential to credit payments due to me / us to the above account. Amounts so credited would constitute
valid discharge of payments due to me / us under the above policy(ies).
Signature of Policyowner/Trustee/Assignee
Signature of Trustee(s )/ Joint Owner(s) (if any)
Name:
Name:
Date (dd/mm/yyyy):
Date (dd/mm/yyyy):
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