PRUprestige Family Discount Declaration Form

PRUprestige Family Discount Declaration Form
Important Notes
For New proposal
• List of products eligible for PRUprestige Family Discount: PRUaccident cover, PRUcrisis cover vantage, PRUearly stage crisis
cover, PRUearly stage disability, PRUfracture care, PRUlife, PRUlife limited pay, PRUlife multiplier, PRUlink protection plus
account, PRUmortgage, PRUmultiple crisis cover, PRUterm ascend, PRUterm total refund, PRUterm vantage (SGD or USD),
PRUterm plus advantage
• This discount is to be applied by a PRUprestige customer and new policy premium must be paid on an annual basis.
For increase in regular premium on existing policy
• List of products eligible for PRUprestige Family Discount: PRUlink protection plus account, PRUlink protection account, PRUlink
assurance account.
• This discount is to be applied by a PRUprestige customer on increase in regular premium and premiums must be paid on an annual
basis.
• This form is to be submitted together with the new proposal form/ Supplementary Proposal Form.
* Mandatory to fill up all the fields in this declaration form
Details of PRUprestige Customer
Name:
NRIC/Passport/Birth Cert Number:
Details of Nomination
Name of Nominated Family Member:
(please refer to terms and conditions)
NRIC/Passport/Birth Cert Number of
Nominated Family Member:
Relationship to PRUprestige customer
(Please select or delete where applicable)
Parent Spouse Child
(Please tick one option only)
For new proposal (Proposal number to be provided if it is available at the point of form completion)
Proposal Number:
Proposal Number:
Proposal Number:
Proposal Number:
For increase in regular premium on existing policy
Policy Number:
Please specify existing policy type:
PRUlink assurance account PRUlink protection account PRUlink protection plus account
DECLARATION
I hereby consent to nominate the above-mentioned family member to enjoy the PRUprestige Family Discount of 10% off the
first year premium for the above proposal/policy. I confirm that the information provided above is correct and I agree to repay
PRUDENTIAL Assurance Company Singapore (Pte) Limited the monetary value of the discount applied to the above
proposal/policy in the event the information provided herein is found to be incorrect or false.
Signature of PRUprestige Customer
Date
BICPPFDF *Please refer to the next page for full terms and conditions Version Mar 2015

* Terms and Conditions
1. This discount is applicable to the following policies : PRUaccident cover, PRUcrisis cover vantage, PRUearly stage crisis cover,
PRUearly stage disability, PRUfracture care, PRUlife, PRUlife limited pay, PRUlife multiplier, PRUlink protection plus account,
PRUmortgage, PRUmultiple crisis cover, PRUterm ascend, PRUtermplus advantage, PRUterm total refund and PRUterm vantage
(SGD or USD).
2. This discount is not applicable to existing policies or the purchase of new riders on existing policies except for PRUlink protection
plus account (3PA), PRUlink protection account (PPA) and PRUlink assurance account (PAA) policies where:
a. An increase in regular premium is done on existing 3PA, PPA and/or PAA policies.
b. There is a purchase of new riders on existing 3PA, PPA and/or PAA policies policies on the condition that the purchase
must be made with an increase in regular premium.
c. Premiums must be paid on an annual basis.
d. The discount is valid for all riders except Enhanced Accumulator Option (Regular), Enhanced Accumulator Option (Lump
Sum), and Top-Up Premium (Lump Sum).
e. Single premium top-up do not qualify for this discount.
3. This discount is applicable to a new PRUlink protection plus account policy purchased under the PRUfirst gift plan, subject to the
rest of the terms and conditions.
4. The first-year premium must be paid on an annual basis for the purchase of new policies or increase in regular premium.
5. The nominated family member must be the spouse, parent or child (including those of adult age) of the PRUprestige customer.
6. The nominated family member must be the proposer of the new policy.
7. To qualify the nominated family member for the discount, the PRUprestige customer must submit the PRUprestige Family Discount
Declaration Form together with the new proposal form.
8. For policies that are cancelled within the 14-day free-look period, the amount refunded will be based on the discounted premium
amount paid by the customer.
9. This offer is not valid with other promotions unless otherwise stated.
10. Prudential reserves the right to add, modify or withdraw the offer, terms & conditions without prior notice.
11. Terms and conditions are subject to the interpretation of Prudential only.
12. All decisions made by Prudential shall be final and binding.
BICPPFDF Version Mar 2015