What to submit
Please submit a photocopy (both sides) of any valid ID, together with
this Customer Information Form.
The following are considered
as valid IDs:
•Passport
•Driver’s license
•Professional Regulatory
Commission (PRC) license
•National Bureau of Investigation
(NBI) clearance
•Police clearance
•Firearms license
•Bureau of Internal Revenue (BIR)
ID with photo
•Social Security System (SSS) ID
with photo
•Government Service and Insurance
System (GSIS) ID with photo
•PhilHealth card
•Senior Citizen card
•Postal ID
•Voter’s ID
For minors (persons under 18 years
of age):
•Photo-bearing school ID signed by
the principal or head of school
•Birth certificate
•Library ID
Where to submit
Metro Manila Regional Office
G/F SSHG Law Center
105 Paseo de Roxas
Legaspi Village, 1226 Makati City
Tel No.: (+63 2) 884-8484
Cebu Regional Office
G/F TGU Towers, Asia Town
IT Park Salinas Drive, Apas,
Cebu City 6000
Tel No.: (+63 32) 238-7888
Head Office Customer Center
G/F Marajo Tower, 312 26th Street
West corner Fourth Ave.
Bonifacio Global City.
1634 Taguig City
Tel No.: (+63 2) 884-8484
Davao Regional Office
5/F Units 52 to 55 Landco
Business Center, Bajada
Davao City 8000
Tel No.: (+63 82) 224-4777
Customer
Information
Form
Pru Life UK Branches and General Agencies
(To know the complete adddress of our Branches and General Agencies in your area,
please contact our Pru Customer Action Team, through the hotlines below.)
Luzon
Albay (Legazpi)
Baguio
Bataan
Batangas (Lipa)
Bulacan
Cagayan (Tuguegarao)
Camarines Sur (Naga)
Cavite
Ilocos Norte (Laoag)
Isabela (Cauayan and
Santiago)
La Union
Laguna (Calamba and
Sta. Rosa)
Nueva Ecija (Cabanatuan)
Pampanga (San Fernando)
Pangasinan (Dagupan)
Pangasinan (Mangaldan)
Quezon (Lucena)
Rizal (Antipolo)
Sorsogon
Tarlac
Visayas
Bohol (Tagbilaran)
Capiz (Roxas City)
Cebu
Iloilo
Leyte (Ormoc and
Tacloban)
Negros Occidental
(Bacolod)
Negros Oriental
(Dumaguete)
Mindanao
Agusan del Norte (Butuan)
Davao
General Santos City
Lanao del Norte
(Iligan City)
Misamis Oriental
(Cagayan De Oro)
SVETCIUF052511-10012013
Metro Manila
Las Piñas
Mandaluyong
Manila (Escolta)
Makati (Salcedo Village)
Muntinlupa (Alabang)
Pasig (Ortigas)
Quezon City – SM
North EDSA
Quezon CIty – Novaliches
You can also fax or e-mail the Customer Information Form through the
following:
Pru Customer Action Team
Hotlines
Fax: (+63 2) 840-1528
E-mail: contact.us@prulifeuk.com.ph
Hotline: (632) 887-LIFE (5433) within
Metro Manila
Domestic Toll Free:
1-800-10-PRULINK (7785465)
Support Services – Conservation
Fax: (+63 2) 370-2990 local 3333
Tel.: (+63 2) 884-8484 local 5563
and 5575
Always Listening. Always Understanding.
In compliance with the Anti-Money Laundering Act (AMLA)
Dear PRUPolicyholder,
Contact information
Pru Life UK is a Company that listens to and understands your
needs. We have committed ourselves to providing you with
innovative products and services that fulfill your changing financial
security and risk protection needs.
As one of our valued PolicyHolders, we want to ensure that the
information that we have on record about you and your Policy/
ies are always updated so that we can properly address your
queries and attend to your policy-servicing needs. Kindly fill out
this Cusomer Information Form and submit this to us together with
a copy of your valid ID. Rest assured that all customer information
will be kept confidential.
Home address
_______________________________
_____________________________________
Room / house / building
Street / barangay / municipality
________________________________________________
____________________
Town / city / province
Zip code
Home phone (landline)
Personal mobile phone
E-mail address
Employer or business name (if self-employed)
Position in the company
Thank you for entrusting your future to Pru Life UK.
Employer / business address (if self-employed)
George M. Opeda
Executive Vice President and Chief Operations Officer
Survey instructions
Personal information
Street / barangay / municipality
________________________________________________
____________________
Town / city / province
Zip code
c Male
c Female
Middle name
Date of birth (mm/dd/yy)
Place of birth
Citizenship
Country of origin
Do you carry any other citizenship/passport/work permit or permanent residence certificate
from any other country other than what you stated above? If yes, please state which country.
c Yes __________________________________
SSS/GSIS no./Other ID (Indicate ID type)
c No
TIN no.
c Divorced/Annulled
c Separated
c Widowed
Spouse’s name
Where do you wish to receive your billing statement and other correspondences
from Pru Life UK?
c Business address
Policy number
Kindly indicate the policy numbers of your Pru Life UK policies
1.
6.
2.
7.
3.
8.
4.
9.
5.
10.
Policy Owner declaration and authorization
Spouse’s date of birth
I certify that the above information are true and correct. I further authorize
Pru Life UK to (Please check.):
Mother’s full maiden name
Child/children’s name/s (Last name/First name/MI)
Business mobile phone
E-mail address
c Home address
First name
Marital status
c Unmarried/Single
c Married
_____________________________________
Room / house / building
Business phone (landline)
Please provide complete information by answering all the fields in the
Customer Information Form and indicate N/A in fields that are not
applicable.
Last name
_______________________________
c Amend my existing customer information/record to reflect the above information in
Birth date (mm/dd/yy)
relation to my Policy/ies
c Share specific information with partners and affiliates and allow me to avail of special
1.
offers and benefits resulting from cross-marketing and co-branding initiatives
2.
Signature over printed name
3.
4.
X
Date completed