SAMPLE FOR REFERENCE ONLY!
POS Forms
Form [A2] Alternation to Proposal LAXXA006 (Updated: 28 Jan 2021) (Sample) (Updated: 10 June 2016)
Form [A3] Application for Change in Policy (Updated: 16 Jul 2025) (Sample) (Updated: 10 June 2016)
Form Guideline for “Application for Change in Policy” (Updated: 21 Dec 2017)
Form [A4] Application for Change in Policy (with health questionnaire) (Updated: 18 Oct 2022)
Form [A5] Application Form for Financial Change in Policy (Updated: 25 Jun 2025) (Sample) (Updated: 7 June 2018)
Form [A6] Application for Change of Contact Details (Updated: O4 Jan 2024)
Form [A7] Application for Change of Personal Particulars (Updated: 19 Oct 2022) (Sample) (Updated: 10 June 2016)
Form [A9] Agent's Memo To Life Admin. (Updated: 16 Apr 2015) (Sample)
Form [A10] Application Form for Beneficiary Appointment (Updated: 28 Jul 2022) (Sample) (Updated: 10 June 2016)
** With effect from 20 July 2018, policyowners can submit Beneficiary Appointment request through myPrudential. The application will take immediate effect if complete and accurate information is submitted. Policyowners will receive SMS and brokers will receive email about the progress of the application. Besides, policyowners can check the application progress and download the confirmation letter for Beneficiary Appointment request through myPrudential. Kindly note that the paper letters used to be delivered to the policyowners will be suppressed. (Updated: 20 Jul 2018)
Form [B2] Broker Payment Instruction Worksheet (Updated: 08 Jul 2022)
Form [C1] Cashier Order Bank Draft Declaration Form (Customer's version) (Updated: 27 Jun 2024)
Form [C2] Change of Payment Mode and Direct Debit Authorization Form - Credit Card (Updated: 05 Oct 2020) - Sample (Updated: 10 June 2016)
Form [C3] Cashier Order Bank Draft Declaration Form (Consultant's version) (Updated: 27 Jun 2024)
Form [C4] Change of Payment Mode and Direct Debit Authorization Form and Electronic Direct Payout Authorization Form - Bank Account (Updated: 18 Jan 2024) - Sample (Updated: 10 June 2016)
Form [C5] Controlling Person Tax Residence Self-Certification Form (applicable to Corporate customers) (Updated: 3 Jan 2019)
Form [C7] Collateral Assignment of Policy (Updated: 19 Oct 2022)
Form [D2] Declaration of Loss of Policy and Reissue Form (Updated: 19 Oct 2022)
Form [F1] Financial Declaration (Updated: 28 Jan 2021) (Sample)
Form [P3] Premium Payment via Financial Consultant Authorization Request Form (Updated: 29 Nov 2022)
Form [P5] Policy Replacement Declaration (Updated: 26 Apr 2022)
Form [I3] Individual Tax Residence Self-Certification Form (applicable to Individual customers) (Updated: 29 Jan 2024)
Form [I4] Important Facts Statement – Policy Replacement (IFS-PR) (Updated: 15 Jan 2024)
Form [N1] Notification for Telegraphic Transfer Payment and Local Telegraphic Transfer of Policy Premium (Consultant version) (Updated: 12 Jun 2024)
Form [N3] Notification for Telegraphic Transfer Payment and Local Telegraphic Transfer of Policy Premium (Customer version) (Updated: 12 Jun 2024)
Form [R1] Registration Form for Pay Premium Online with UnionPay Debit Card / Credit Card via my Prudential (Updated: 21 Dec 2017)
Form [S1] Supplemenary Information Form LAXXD017E (Opt-out Procedure) (Updated: 28 Jan 2021) (Sample) (updated: 6 May 2016)
Form [T1] Third Party Payment Declaration Form (Updated: 08 Jul 2022)
Form [T2] Transfer of Policy Ownership Form (Updated: 13 Nov 2025)
Claim Forms
Form [A1] Accident Claim Form (Updated: 15 Apr 2024)
Form [C8] Crisis Cover Claim Form (Updated: 08 Jul 2022)
Form [D4] Disability Claim Form (Updated: 08 Jul 2022)
Form [H1] Hospital Claim Form (Updated: 15 Apr 2024)
Form [L1] Life Assurance Death Claim Form (Updated: 08 Jul 2022)
Form [P1] PRUmyhealth Prestige Medical Plan Claim-Dental Benefit Claim Form (Updated: 15 Apr 2024)
Form [P2] PRUmyhealth Prestige Medical Plan-Outpatient Benefit Claim Form (Updated: 15 Apr 2024)
Form [P4] PRUmyhealth Prestige Medical Plan-Claim Form (Updated: 15 Apr 2024)
Form [R2] Request For Certified True Copy Of Medical Receipt(s) (Updated: 08 Jul 2022)
Form [S7] SIF for deposit claims payment into PDA (Updated: 08 Jul 2022)
Prudential Customer Hotline: 22811333