Mode of Release Form

for funds with payout 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) 8683 9000, (632) 8884 8484, (632) 8887 LIFE
Tick the appropriate box to indicate your choice. within Metro Manila, 1 800 10 PRULINK for domestic toll-free
Please do not sign on a blank form. Email: contact.us@prulifeuk.com.ph Website: www.prulifeuk.com.ph
If not applicable, put “N/A” in all empty fields.

POLICY NUMBER

CLIENT INFORMATION

Name of Policyowner (Last name, First name, Middle initial)

Name of Life Insured (if different from Policyowner) (Last name, First name, Middle initial)

I hereby authorize Pru Life UK to release my _______________________________ payouts* through:

(name of PRUlink fund)

Fund transfer to dollar account (applies to US dollar funds only)

Account holder (Last name, First name, Middle initial)

Name of bank Account type and number

Bank address/branch Swift code/routing number

Requirement: Scanned copy of the bank statement showing account number and account name only

Fund transfer to peso account (applies to both peso and US dollar funds)
Account holder (Last name, First name, Middle initial)

Name of bank Account type and number

Bank address/branch Swift code/routing number

Requirement: Scanned copy of the bank statement showing account number and account name only
Note: Dollar payouts shall be converted to their equivalent in Philippine Pesos. The foreign exchange rate to be applied will be the Closing Spot Rate on the Declaration Date.

I am fully aware of the foreign exchange risk involved and accept its possible consequences.
 Automatic account opening with Security Bank (no bank charges)

PH peso account opening US dollar account opening

Account holder (Last name, First name, Middle initial)

Address

Date of birth (mm/dd/yyyy) Place of birth Nationality

TIN or SSS/GSIS number Other ID Number Civil status

Email address Mobile number (for SMS notification) Mother’s maiden name (Surname, First name, Middle name)

Note:
By choosing this option, you authorize Pru Life UK to provide your personal information and documents to Security Bank to assist you in opening a bank account.
In addition, you shall submit to Pru Life UK the following documents in relation to the opening of your bank account with Security Bank:
a. Photocopy of your valid ID; and
b. Specimen signature (Please accomplish attached Security Bank specimen signature form.)
The initial and maintaining balance requirements are waived by Security Bank under this option.

*PRULink fund payouts are not guaranteed. The actual distribution of payouts shall be at the discretion of Eastspring Investments (Singapore) Limited (the “Fund Manager”)
and shall be made out of either a) income; or (b) net capital gains; or (c) capital of the fund or a combination of (a) and/or (b) and/or (c). Payouts are based on the percentage
of the fund value held by the Policyowner as of the relevant Declaration Date, in accordance with the fund’s published annual payout rates, as declared by the Fund Manager
and Pru Life UK. The amount of payout may vary over time and there may be periods when no payout distribution is declared.

Purpose Statement:

We will process the information you have provided in this form for the purpose of handling your request in accordance with applicable privacy laws and regulations.
During processing, we may share the information you provided to our authorized data processors, including couriers and contractors for anti-money laundering systems,
photocopying, scanning, indexing and printing services. We may share your information with governmental and other regulatory authorities, or self-regulatory bodies in
various jurisdictions as required or allowed by applicable laws and regulations. Any information collected may be retained by Pru Life UK and our authorized data
processors until ten (10) years from the date of termination of the policy.

You may revisit our privacy policy through our website at (https://www.prulifeuk.com.ph/en/footer/privacy-policy/). For data privacy concerns, please contact
our Data Privacy Officer at:

Telephone: (632) 8887 5433 for Metro Manila, 1 800 10 7785465 via PLDT landline for domestic toll-free
Email: dpo@prulifeuk.com.ph

By signing this form, I confirm that the information I have provided is true and correct and agree to hold Pru Life UK free and harmless from any liability arising from its
processing and implementation of the transaction or service requested.

(mm/dd/yyyy)

Signature over printed name of Policyowner DATE RECEIVED

 FOR PRU LIFE UK ARRANGEMENT ONLY

CIF CIF

(Surname, First Name, Middle Name) (Surname, First Name, Middle Name)

in signing. in signing.
1. 1.

2. 2.

3. 3.

SIGNATURE TAKEN BY: SIGNATURE VERIFIED BY: BRANCH CODE: SIGNATURE TAKEN BY: SIGNATURE VERIFIED BY: BRANCH CODE:

Signature Over Printed Name / Date Signature Over Printed Name / Date Signature Over Printed Name / Date Signature Over Printed Name / Date

By affixing my specimen signature, I hereby authorize Security Bank to disburse funds as well as honor other related
banking transactions on the basis hereof, in relation to my accounts and/ or business accounts to which I am a signatory
that I/we maintain in the Bank as well as all other accounts I/we may establish in the future. I likewise hereby
acknowledge receipt of and agree to be bound by the appropriate Terms and Conditions governing the operation of each
of my/our aforementioned accounts. The term "account" in its singular or plural form shall refer to deposit, loan, money
market, Trust, Treasury, credit card, and other financial accounts which the client has or may enter into with Security Bank.
For Payroll Accounts: Further, I hereby certify that my employer is duly authorized to provide the Bank with my personal
information as needed in opening my payroll account. My employer is likewise authorized herein to name and appoint
officers to receive from Security Bank, in my behalf, my ATM Card and PIN mailer. I am aware that the said officers are
designated for control purposes, such that one shall receive my ATM Card while the other shall receive my PIN mailer.
By affixing my specimen signature, I hereby authorize Security Bank to disburse funds as well as honor other related
banking transactions on the basis hereof, in relation to my accounts and/ or business accounts to which I am a signatory
that I/we maintain in the Bank as well as all other accounts I/we may establish in the future. I likewise hereby
acknowledge receipt of and agree to be bound by the appropriate Terms and Conditions governing the operation of each
of my/our aforementioned accounts. The term "account" in its singular or plural form shall refer to deposit, loan, money
market, Trust, Treasury, credit card, and other financial accounts which the client has or may enter into with Security Bank.
For Payroll Accounts: Further, I hereby certify that my employer is duly authorized to provide the Bank with my personal
information as needed in opening my payroll account. My employer is likewise authorized herein to name and appoint
officers to receive from Security Bank, in my behalf, my ATM Card and PIN mailer. I am aware that the said officers are
designated for control purposes, such that one shall receive my ATM Card while the other shall receive my PIN mailer.

This form is a proprietary product of Security Bank Corporation intended for its sole use. Any unauthorized review, alteration, amendment, use, disclosure, distribution, importation, removal, alteration, substitution, modification, storage, uploading,down-
loading, communication, making available to the public, or broadcasting of this material without the consent and knowledge of Security Bank Corporation is prohibited and is punishable by a fine and/or imprisonment under Republic Act No. 8792,
otherwise known as the Electronic Commerce Act.