Prudential Assurance Company Singapore (Pte) Limited (Reg. No.: 199002477Z) Postal Address: Robinson Road P.O. Box 492, Singapore 900942 Website: www.prudential.com.sg Part of Prudential Corporation plc

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I understand that the alteration will not be effective until an official letter is sent by Prudential Assurance Company Singapore (Pte) Limited (“Prudential”) confirming acceptance of the change.

Change of Payment Frequency

PruCustomer Line: 1800 333 0333 (Local) +65 6333 0333 (Overseas)

CHANGE OF PAYMENT FREQUENCY FORM Policy Number NRIC/Passport number of Policyowner Name of Policyowner

Change of payment frequency from Monthly to Non-Monthly can only be effected on the next policy anniversary date.

Otherwise, advance premium payment is required for immediate processing. For example, from monthly to annual mode, the policyholder will have to pay the balance monthly premiums up to the next policy anniversary before the change to the annual premium can be effected. If the current payment method of your policy is by credit card, this advance premium payment will be charged to the same credit card. If the current payment method of your policy is via GIRO or cash, please make a payment to us for the advance premium.

Name:

Date (dd/mm/yyyy):

Signature of Policyowner(s) / Trustee(s) / Assignee(s)

Tick the required boxes, fill in the details and sign and date the application. If you made any amendments, sign next to the amendments made.

Annually

Half-Yearly

Quarterly

Monthly *

Declaration (Please read carefully before signing this application)

* For change of payment frequency to monthly, your payment method has to be via Credit Card or GIRO.

For application for regular premium payment by Credit Card, please login to PRUaccess to apply online, or submit theApplication for Regular Premium Payment by Credit Card form.

For application for regular premium payment by GIRO, please submit the Application for Premium Payment by Interbank GIROapplication form.

Signature of Joint Policyowner / Trustee (if applicable)

Name:

Date (dd/mm/yyyy):

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