PRU LIFE INSURANCE CORPORATION OF U.K.
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
Credit Card
Enrollment form
Last name First name M.I.
Billing option (Please check)
One-time payment Amount :
Recurring payment
(Required for monthly mode)
Policyowner:
Policy no.:
Primary Card Alternate card
Last name First name M.I.
Cardholder:
Relationship to Policyowner:
Contact nos.:
Card no.:
Expiry date:
Month Year
Bank issuer:
Cardholder declaration and authorization
I hereby declare under the penalty of perjury that the information provided above is true and correct.
I hereby also state that I have read and agreed to the terms and conditions stipulated at the back of this
form. By affixing my signature below, I hereby authorize Pru Life UK to charge the payments due for
the insurance application/policy number indicated above to my credit card account. I likewise confirm
that the payments herein charged to my credit card account are valid and accurate, despite the
absence of my signature in the sales slip or terminal receipt for such payments, I further waive the
requirement that Pru Life UK prepare, issue, submit or deliver to me a true and completed copy of the
sales slip or terminal receipt covering these payments.This authorization will be cancelled after five (5)
days from receipt by Pru Life UK of my written notice to cancel it.
Cardholder’s signature:
Effectivity date:
Policyowner’s signature:
(if other than the cardholder)
Visa
Mastercard
Last name First name M.I.
Cardholder:
Relationship to Policyowner:
Contact nos.:
Card no.:
Expiry date:
Month Year
Bank issuer:
Cardholder declaration and authorization
I hereby declare under the penalty of perjury that the information provided above is true and correct.
I hereby also state that I have read and agreed to the terms and conditions stipulated at the back of this
form. By affixing my signature below, I hereby authorize Pru Life UK to charge the payments due for
the insurance application/policy number indicated above to my credit card account. I likewise confirm
that the payments herein charged to my credit card account are valid and accurate, despite the
absence of my signature in the sales slip or terminal receipt for such payments, I further waive the
requirement that Pru Life UK prepare, issue, submit or deliver to me a true and completed copy of the
sales slip or terminal receipt covering these payments.This authorization will be cancelled after five (5)
days from receipt by Pru Life UK of my written notice to cancel it.
Cardholder’s signature:
Effectivity date:
Policyowner’s signature:
(if other than the cardholder)
Visa
Mastercard
Terms and conditions
Credit card enrollment requirements Hold or stop billing request
Change in credit card details
Change of payment method
Credit card billing
Card Type
Card Ownership
Eligible Plans
Premium
Requirements
Change in card
expiry date
Change in card
number
Visa and Mastercard, both local and international
debit cards are not allowed
Valid credit cards for enrollment are those owned by the
policyholder or immediate family members (e.g. parents or
siblings, if single; spouse or children, if married)
All peso & dollar-denominated plans except PIA
Initial & renewal premiums. APL/loan repayment via credit card
is not allowed.
(1) Duly accomplished Credit Card Enrollment Form
(2) Photocopy of the credit card's front side
(3) KYC for third party payor, if applicable
For New Business applications, the credit card enrollment
requirements must be attached to the Insurance Application Form
Written notice signed by the policyowner or agent
(1) Duly accomplished Credit Card Enrollment Form
(2) Photocopy of the credit card's front side
LO/CCE/JEC/052418
Credit card billing of policies enrolled to the recurring billing option is done on the policy's due
date provided that the policy is updated. If due date falls on a weekend or a holiday, billing is done
on the following working day. Declined transactions are automatically rebilled for two (2)
consecutive weeks from the date of first unsuccessful billing. If subsequent billing attempts are
unsuccessful, you will be notified by mail to settle youroutstanding premium in cash or check
through any of our Pru Life branches or accredited banks.
Pru Life UK's credit card billing is subject to the security policies of the card issuer-bank.You may
be required to call your card issuer to authorize our premium billing in cases involving large
amount, unusual billing location, unusual transactions or unsettled balance.
Billing of the alternate card is activated in case of declined billing attempt on the primarycard.
Re-billing is not applicable on policies under one-time billing option.
A written request must be submitted to Pru Life UK branches or through your servicing agent at
least five (5) working days before premium due date.
For request to hold billing, effectivity date and duration must be indicated. All back premiums
shall be collected upon resumption of credit card billing.
Please update Pru Life UK of your new card details by submitting the following documents to any
of our branches or through your servicing agent to avoid unsuccessful billing due to expired, lost,
stolen or replaced credit cards.
Policyowner must submit a duly accomplished Policy Amendment Request Form at least five (5)
working days before premium due date. Enrollment to automatic debit arrangement (ADA)
facility or submission of post-dated checks (PDC) is required for policies under monthly mode of
payment.
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