Agency Movement Form

PRU LIFE INSURANCE CORPORATION OF U.K.

9/F Uptown Place Tower 1, 1 East 11th Drive, Uptown Bonifacio,
REMINDERS: 1634 Taguig City, Philippines
Please use CAPITAL LETTERS and black ink. Customer helpdesk: (632) 683 9000, (632) 884 8484, (632) 887 LIFE
within Metro Manila, 1 800 10 PRULINK for domestic toll-free
Tick the appropriate box to indicate your choice.
Email: contact.us@prulifeuk.com.ph Website: www. prulifeuk.com.ph
Attach necessary documents as proof of preferred movements.
Any alterations must be made in the agent-applicant’s own handwriting
and must be countersigned.

GENERAL INFORMATION

SURNAME GIVEN NAME MIDDLE NAME

BRANCH NAME AGENT CODE

MOVEMENT TYPE

Appointment as agency leader Realignment Deletion Others (please specify)

STATE REASON FOR MOVEMENT

EFFECTIVITY DATE (mm/dd/yyyy)

ENDORSEMENT AND APPROVAL

Signature over printed name of Mother Unit/Branch Manager Signature over printed name of Branch/Area/District Manager

DATE OF SIGNING (mm/dd/yyyy) DATE OF SIGNING (mm/dd/yyyy)

Signature over printed name of Sales Director Signature over printed name of National Sales Director

DATE OF SIGNING (mm/dd/yyyy) DATE OF SIGNING (mm/dd/yyyy)

Signature over printed name of Head of Agency Support

DATE OF SIGNING (mm/dd/yyyy)

FOR AGENCY LICENSING ONLY

RECEIVED BY APPROVED BY DATE OF APPROVAL (mm/dd/yyyy)

REMARKS PROCESSED BY DATE OF PROCESSING (mm/dd/yyyy)