PRU LIFE INSURANCE CORPORATION OF U.K.

Please use CAPITAL LETTERS and black ink. Tick the appropriate box to indicate your choice. Please do not sign on a blank form. If not applicable, put “N/A” in all empty fields.

9/F Uptown Place Tower 1, 1 East 11th Drive, Uptown Bonifacio, 1634 Taguig City, Philippines Customer helpdesk: (632) 8683 9000, (632) 8884 8484, (632) 8887 LIFE within Metro Manila, 1 800 10 PRULINK for domestic toll-free Email: contact.us@prulifeuk.com.ph Website: www. prulifeuk.com.ph

Beneficial Owner refers to any natural person who ultimately owns or controls the customer, and/or on whose behalf a transaction or activity is being conducted, or has ultimate effective control over a legal person or arrangement.

In relation to an entity, Beneficial Owner/s are individuals either owning or controlling at least 20% of the entity’s shares or voting rights.

If any beneficiary designation is “IRREVOCABLE”, please accomplish the Endorsement for Designating Irrevocable Beneficiary Form. If more than one Beneficiary is named, equal sharing shall be presumed unless stated otherwise.

If there are more than two (2) beneficiaries, please answer the Supplemental Form for Additional Beneficiaries.

If you answer "YES" to any of the following questions, please indicate the question number and indicate details in the space provided.

a. flown in an aircraft other than as a passenger? (If yes, complete an Aviation Questionnaire)

b. driven a motorcycle or engaged in scuba diving, bungee jumping, or other hazardous sports? (If yes, complete pertinent questionnaire)

c. been active in politics as a candidate or in any other capacity during the last five (5) years?

If you answer "YES" to any of the following questions, please indicate the question number and indicate details in the space provided.

d. ever submitted an application for life insurance or reinstatement thereof which was declined, postponed, cancelled, or modified in kind, amount, or rate?

e. received any threat on your life, person or safety?

f. had any pending application with other insurance companies?

2) What insurance(s) is/are now in force on the life of Life Insured?

4) Will premiums for the insurance applied for be paid by a policy loan from any existing policy?

NOTE: If you answered “YES” to questions 3 and/or 4, please accomplish the Replacement Notification section in page 6

YOU ARE TO DISCLOSE IN THIS APPLICATION FORM (AND IN ANY PERSONAL STATEMENT CONCERNING HEALTH MADE TO THE COMPANY OR TO THE MEDICAL EXAMINER OF THE COMPANY) FULLY AND FAITHFULLY ALL THE FACTS WHICH YOU KNOW OR OUGHT TO KNOW, OTHERWISE THE POLICY ISSUED HEREUNDER MAY BE RESCINDED.

FAMILY HISTORY DETAILS(This section need not be answered if medical examination is performed)

POLICYOWNER (if applying for Payor Waiver and/or Payor Term)

HEIGHT AND WEIGHT(This section need not be answered if medical examination is performed)

POLICYOWNER(if applying for Payor Waiver and/or Payor Term)

NON-MEDICAL QUESTIONNAIRE FOR ADULTS (AGES 18 & ABOVE)(This section need not be answered if medical examination is performed)

If you answer "YES" to any of the following questions, please indicate the question number and provide details as to the nature of illness, operation or treatment, date and duration, severity and results, and name and address of attending physician/s, clinic/s or hospital/s. Note that Policyowner portion should only be answered if applying for Payor Waiver and/or Payor Term.

a. within the past five years, consulted or been treated or examined by any physician or medical practitioner?

b. ever had x-ray, electrocardiogram, blood studies, or other diagnostic tests?

c. ever been in a hospital, clinic, sanitarium, or institute for observation, diagnosis, operation, or treatment?

d. had or been told you had Acquired Immune Deficiency Syndrome (AIDS), AIDS-related complications, or AIDS-related conditions?

e. had any form of Sexually Transmitted Disease (STD)? Is there anything in your lifestyle which could expose you to risk of AIDS and/or STD?

f. been tested positive for antibodies to the AIDS virus?

g. had any abnormality, deformity, disease, or disorder?

h. received and/or are you presently receiving treatment or taking medication of any kind?

NON-MEDICAL QUESTIONNAIRE FOR ADULTS (AGES 18 & ABOVE)(This section need not be answered if medical examination is performed)

i. ever drank alcoholic beverages, taken habit-forming drugs, or sought advice or treatment for alcoholism, drug habit or other addiction?

ii) Alcohol intake per week (If yes, provide details)

i) How many years have you smoked/been smoking cigarettes and/or tobacco? (Please include past smoking history)

ii) What is the average number of sticks you smoke daily?

2) Have you ever had or been told that you had or sought advice for:

1) Was the child's birth abnormal or premature? If “yes”, please provide details below.

2) Has the child ever been treated for, or ever had any indication of:

a. disorder of eyes, ears, nose, mouth, or throat; or slow physical or mental development?

b. epilepsy, febrile fits, or any other disorders of the brain or nervous system?

c. asthma, bronchitis, tuberculosis, or respiratory disorder?

d. rheumatic fever, heart defects, anaemia, or disorder of the blood, and other diseases of the heart or

e. diabetes, disorder of the stomach, intestines, kidney, bladder, reproductive organs, liver, gallbladder, or pancreas?

f. severe skin infections, enlarged glands, growth, cyst, tumor/cancer?

g. disorder of the muscles or bones, spine, back or joints, deformity, lameness, or amputation?

b. Has the child ever been referred to any specialist or hospital?

c. Has the child ever had or been advised to have any electrocardiogram (ECG), x-ray, blood or urine test, biopsy, AIDS test, or other diagnostic test?

d. Is the child currently receiving medical treatment or under medical care of any kind?

4) Please provide the name, address, and other details of the child's usual doctor(s If none, provide details of the last doctor consulted.

5) How long has he/she known the child?

6) When and for what reason did the child last consult him/her?

This form should be completed and signed.

Pru Life UK is considering an application for insurance on my life and I hereby authorize YOU* or any physician, surgeon, or other person in your or their employ or who you or they are connected with, in any way, or any hospital or other entity, to give Pru Life UK or its authorized medical doctor or representative, any information which may be desired and which was acquired while attending to me in a professional capacity. A photographic copy of this authorization shall be as valid as the original. This authorization is in connection with my application for insurance only.

*YOU refers to the person/party holding or possessing this AUTHORIZATION TO FURNISH MEDICAL INFORMATION.

REMINDERS: It is usually disadvantageous to REPLACE existing life insurance policy/ies with a new one. Some disadvantages are: (a) you may not be insurable under standard terms; (b) you may have to pay higher premiums in view of higher age; or (c) you may lose financial benefits accumulated over the years. Please note that in your own interest, we advise that you consult your present insurer before making a final decision. Hear from both sides and make a careful comparison. You can then be sure that you are making a final decision that is in your best interest.

FULL NAME (Surname, given name, middle name)

In connection with my decision to purchase a product from Pru Life Insurance Corporation of U.K. (”Pru Life UK”), I hereby certify the following:

(name of product) is a replacement for my existing Policy/ies with Pru Life UK and/or with another insurance

My agent has disclosed to me the fees and charges that I will bear in switching from my original Policy/ies to the 2. (”the Replacement Policy” I understand that the fees and charges would include all fees associated with the disposal of or reduction in coverage or interests under my original Policy/ies and/or fees incurred during the purchase of or increase in coverage or interests under the Replacement Policy.

My agent has advised me of the disadvantages (i.e. loss of financial benefits, higher premium, non-insurability, etc that I will or may suffer (temporarily or otherwise) as a result of switching 3. from my original Policy/ies to the Replacement Policy.

By signing this Application, I, (i.e. each of the Policyowner and Life Insured) declare, agree to, and authorize the following:

1. All the statements and answers in this Application and any information given to Pru Life UK or its medical examiners, including any amendments, are complete, true, correct, and binding on all parties in interest under the Policy applied for.

2. Pru Life UK reserves the right to request for additional medical evidence to assess my health. Any physician, hospital, clinic, or medical organization is authorized to furnish Pru Life UK with any medical information pertaining to me.

3. Prior to the issuance of the Policy applied for, I agree to inform Pru Life UK of any change in my (a) state of health, and (b) occupation or activities.

4. If a material fact is not disclosed in this Application, the Policy issued may not be valid. I understand that if in doubt as to whether a fact is material, it will be disclosed to Pru Life UK.

5. The insurance coverage will not commence until this Application has been approved, the initial premium has been received by Pru Life UK, and the Policy has been issued while I am in good health.

6. I will update Pru Life UK in a timely manner of any change in details previously provided especially with respect to a change in citizenship, tax status, or tax residency, correspondence address, or contact numbers, both local and foreign. If the Policyowner is a corporation, changes in registered address, address of place of business, substantial shareholders, legal or beneficial owners who own or control at least 20% of the Policyowner will also be disclosed.

I confirm that the benefit illustration, quotation proposal, product summary, and other relevant sales materials relating to this Application were received, completely and clearly explained, and fully understood. 7.

8. The amounts to be invested in the Policy have been declared to relevant tax authorities and were not derived, directly or indirectly, from illegal activities or sources and/or tax evasion. 9. This Application and any policy issued pursuant to it shall be subject to all laws, regulations, resolutions and guidelines on financial underwriting, anti-money laundering, counter terrorist financing and financial and economic sanctions regimes (“Issuances” In the event that Pru Life UK is unable to comply with such Issuances, including the relevant Customer Due Diligence ("CDD") measures as required under the Anti-Money Laundering Act, as amended, due to any act or omission on my part, Pru Life UK may (i) disapprove this Application; (ii) apply measures to restrict the services available or prohibit any further transactions on the Policy; and (iii) in case such measures are unsuccessful, terminate the business relationship. In the event of termination, any refund of premiums or payment of withdrawal value shall be subject to the terms of the Policy. I am bound by obligations set out in relevant United Nations Security Council Resolutions relating to the prevention and suppression of proliferation financing of weapons of mass destruction, including the freezing and unfreezing actions as well as prohibitions from conducting transactions with designated persons and entities.

If this Application is declined by Pru Life UK, its only obligation is to return the premium paid. If the Application is cancelled for failure to submit requirements, Pru Life UK will return the premium paid less fees for 10. medical examinations it incurred.

I accept, agree with, and understand the features, benefits, nature, limitations, exclusions, risks, terms, and conditions of the Policy, product and attached riders. For unit-linked products, the next computed unit price 11. following the issue date of the Policy will be applied. I agree to receive financial and other-policy related information and notifications through the mobile number and email address I have provided to Pru Life UK.

I agree to be pre-registered to PRUAccess, an online facility that will enable me to manage and request certain transactions involving my Policy. I acknowledge that Pru Life UK shall not be liable for claims or liabilities 12. incurred as a result of the dissemination of my personal information through the said facilities. I understand that if I no longer wish to receive such information or notification through email or mobile and/or be registered to PRUAccess, I may contact Pru Life UK at telephone numbers (632) 8887 LIFE (8887 5433) for Metro Manila and 1800 10 PRULINK (1 800 10 7785465) for domestic toll-free, or email contact.us@prulifeuk.com.ph.

“Pru Life UK” shall refer to Pru Life Insurance Corporation of U.K., its directors, ocers, employees, insurance agents, insurance brokers, other agents and representatives, reinsurers, contractors, legal advisers, and Pru Life UK’s subsidiaries, aliates and other related entities, and their directors, ocers, employees, insurance agents, insurance brokers, other agents and representatives, contractors, and legal advisers. “Data Subject” shall mean the Policyowner, the Life Insured, the Beneficial Owner, Beneficiaries, and all other individuals whose personal information or sensitive personal information is or will be disclosed to Pru Life UK. b.

The information provided by you in this application form will be used for general data processing to be done by Pru Life UK for the issuance, implementation and handling of insurance policies, risk assessment, underwriting and administration of insurance coverage and claims, provision of any service, data analytics, any legitimate interest of Pru Life UK, or any purpose permitted or required by applicable law. This processing may be either manual or automated and within or outside of the Philippines.

To enable Pru Life UK to eectively address insurance requirements and provide better service, your personal information may also, upon your explicit consent, be used for profiling, automated decision-making, and direct marketing, which includes products and other oers.

During processing, we may share the information you provided to our authorized data processors to whom we outsource the processing of your information for your policy, including couriers and contractors for anti-money laundering systems, claims investigations and processing, risk assessment, photocopying, scanning, indexing and printing services, and other value-added services.

Our collection and processing of your personal data, including any sensitive personal information, is based on your application for insurance and other related services, any contract we may enter into with you, our legitimate interests, or a requirement under applicable law. Any information collected may be retained by Pru Life UK and our authorized data processors until ten (10) years from the date of maturity or termination of the policy or date of denial of this application, whichever comes earlier.

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, including the Medical Information Database administered by the Philippine Life Insurance Association, Inc. In accordance with the Insurance Commission’s Circular Letter No. 2016-54, your medical information will be uploaded to a Medical Information Database accessible to life insurance companies for the purpose of enhancing risk assessment and preventing fraud. Once uploaded, all life insurance companies will only have limited access to your information in order to protect your right to privacy in accordance with law. A copy of Circular Letter No. 2016-54 may be accessed at the Insurance Commission’s website at http://www.insurance.gov.ph/.

For more information about your rights as a data subject and how we protect your information, you may access our privacy policy through our website at https://www.prulifeuk.com.ph/en/footer/privacy-policy/. Should you have any questions or requests in relation to the processing of your personal or sensitive personal information, or your rights as a data subject you may get in touch with our Data Protection Ocer through the following:

• information for purposes of compliance with regulatory requirements and applicable laws, the processing of this application, and the administration of the policy issued. You also undertake to provide Pru Life UK with proof of your authority to give the required consents of the other data subjects with respect to the disclosure and processing of their personal information and/or sensitive personal information for the legitimate purposes set out in this application or in the policy issued by Pru Life UK. • You agree to indemnify Pru Life UK and hold it free and harmless from any damages incurred by Pru Life UK as a result of any claim filed by any of the data subjects in relation to a breach of any of the warranties above, or for any damages arising from any misrepresentation made in this application or from any material breach of its provisions.

Signature over printed name of LIFE INSURED

Please answer all questions in full.

1) a. How long have you known the Life Insured or Policyowner?

b. Are you related to the Life Insured or Policyowner? (If yes, please state relationship)

2) Is the Life Insured or Policyowner a fellow active agent or a spouse/child of a fellow agent? (If yes, please state relationship)

3) If the Life Insured or Policyowner is a married person, what amount of life insurance is now in force on his/her spouse in all companies? State "None" if none.

4) Describe any distinct or visible mark on the Life Insured or Policyowner.

I hereby represent that all of the above statements and answers to all the above questions are complete and true.