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Note: This Special Power of Attorney (“SPA”) can only be used for One (1) Pru Life UK Insurance

Policy. If you want to execute an SPA for


another Pru Life UK Insurance Policy, you must execute another SPA.

(Republic of the Philippines )


(______________________) SS.

SP E CI A L PO W ER O F A TT ORN E Y

KNOW ALL MEN BY THESE PRESENTS:

I, JULIETA T. FRANCISCO, of legal age, Filipino, with resident address at [insert address] am the policyowner of an insurance
policy with Pru Life Insurance Corporation of U.K. (“Pru Life UK”), which is more particularly described below:

[insert the name of the plan] with Policy Number [insert the policy number] (“Insurance Policy”)

As policyowner of the Insurance Policy, I do hereby name, appoint, and constitute, my son, JAN KENNETH T. FRANCISCO of legal
age, Filipino, with resident address at [insert address], as my true and lawful Attorney-in-Fact, for me and in my name, place,
and stead, and for my own use and benefit, to do and perform with respect to my Insurance Policy the transaction(s) below as
confirmed by my complete signature in the right column below:

SIGNATURE OF POLICYOWNER
TRANSACTION AUTHORIZING THE TRANSACTION
Note: Please sign only the chosen Transaction.
Full Withdrawal (applies to PruLink Insurance Policy); or
1. to effect the full withdrawal on and termination of my Insurance
Policy (“Full Withdrawal”);
2. to answer, accomplish, sign, execute, submit, transact, and process
the PruLink Application for Withdrawal, the Receipt and Release
Form, and any and all other documents necessary to effect the Full
Withdrawal, and I, hereby, bind myself to all the terms and
conditions of the aforementioned documents; and
Cash Surrender (applies to Traditional Insurance Policy)
1. to effect the cash surrender on and termination of my Insurance
Policy (“Cash Surrender”);
2. to answer, accomplish, sign, execute, submit, transact, and process
the Request for Cash Surrender Form, the Receipt and Release
Form, and any and all other documents necessary to effect the
Cash Surrender, and I, hereby, bind myself to all the terms and
conditions of the aforementioned documents; and

SIGNATURE OF POLICYOWNER
TRANSACTION AUTHORIZING THE TRANSACTION
Note: Please sign only the chosen Transaction(s).
Partial Withdrawal (applies to PruLink Insurance Policy)
1. to effect only one (1) time the partial withdrawal on my Insurance
Policy in the amount of [indicate the amount in words] (indicate
the amount in figures) (“Partial Withdrawal”);
2. to answer, accomplish, sign, execute, submit, transact, and process
the PruLink Application for Withdrawal, the Receipt and Release
Form, and any and all other documents necessary to effect the
Partial Withdrawal, and I, hereby, bind myself to all the terms and
conditions of the aforementioned documents; and

Dividend Withdrawal (applies to Traditional Insurance Policy)

1
Note: This Special Power of Attorney (“SPA”) can only be used for One (1) Pru Life UK Insurance Policy. If you want to execute an SPA for
another Pru Life UK Insurance Policy, you must execute another SPA.

1. to effect only one (1) time the dividend withdrawal on my


Insurance Policy in the amount of [indicate the amount in words]
(indicate the amount in figures) (“Dividend Withdrawal”);
2. to answer, accomplish, sign, execute, submit, transact, and process
the Request for Dividend Withdrawal, the Receipt and Release
Form, and any and all other documents necessary to effect the
Dividend Withdrawal, and I, hereby, bind myself to all the terms
and conditions of the aforementioned documents; and
Premium Deposit Fund Withdrawal
(applies to Traditional Insurance Policy)
1. to effect only one (1) time the Premium Deposit Fund withdrawal
on my Insurance Policy in the amount of [indicate the amount in
words] (indicate the amount in figures) (“PDF Withdrawal”);
2. to answer, accomplish, sign, execute, submit, transact, and process
the Request for PDF Withdrawal, the Receipt and Release Form,
and any and all other documents necessary to effect the PDF
Withdrawal, and I, hereby, bind myself to all the terms and
conditions of the aforementioned documents; and
Policy Loan (applies to Traditional Insurance Policy)
1. to effect only one (1) time the Policy Loan on my Insurance Policy
in the amount of [indicate the amount in words] (indicate the
amount in figures) (“Policy Loan”);
2. to answer, accomplish, sign, execute, submit, transact, and process
the Policy Loan Agreement Form, the Receipt and Release Form,
and any and all other documents necessary to effect the Policy
Loan, and I, hereby, bind myself to all the terms and conditions of
the aforementioned documents; and
Refund (applies to both PruLink Insurance Policy and Traditional
Insurance Policy)
1. to effect only one (1) time the refund on payment on my Insurance
Policy in the amount of [indicate the amount in words] (indicate
the amount in figures) (“Refund”);
2. to answer, accomplish, sign, execute, submit, transact, and process
the Letter Request for Refund, the Receipt and Release Form, and
any and all other documents necessary to effect the Refund, and I,
hereby, bind myself to all the terms and conditions of the
aforementioned documents; and

SIGNATURE OF POLICYOWNER
AUTHORIZING THE MODE OF RELEASE
MODE OF RELEASE
Note: Please sign only the chosen Mode of
Release
Release through Bank Transfer of the proceeds of the [insert the
transaction(s)]; or
3.a to authorize Pru Life UK only one (1) time to release the proceeds
from the abovementioned transaction(s) in [insert currency]
currency through bank transfer to the account of [insert the
complete legal name of the bank account holder(s)] in [insert the
legal name of the bank] with bank account number [insert the bank
account number] and to sign such documents necessary to effect
such authority; OR

Release through Check [insert the transaction(s)];

2
Note: This Special Power of Attorney (“SPA”) can only be used for One (1) Pru Life UK Insurance Policy. If you want to execute an SPA for
another Pru Life UK Insurance Policy, you must execute another SPA.

3.b to authorize Pru Life UK only one (1) time to issue a check for the
abovementioned transaction(s) in [insert currency] currency in the
name of [insert the complete legal name of the payee in the check]
(“Payee”) and to sign such documents necessary to effect such
authority and to physically receive or to authorize the Payee to
receive the aforementioned check and the proceeds pertaining
thereto.

HEREBY GIVING AND GRANTING unto my Attorney-in-Fact full power and authority, without right of substitution, to do and
perform all acts, deeds, and things necessary to carry into effect and render effective the foregoing authority, as fully to all
intents and purposes, as I could lawfully do if personally present and HEREBY APPROVING, CONFIRMING, AND RATIFYING ALL
that my Attorney-in-Fact shall lawfully do or cause to be done by virtue of these presents.

I acknowledge and understand that Pru Life UK shall only process the above chosen/authorized transaction(s) if all the
requirements thereof, which include the written consent of the Life Insured, the Irrevocable Beneficiary(ies), and the
Assignee(s), as may be applicable, have been satisfactorily submitted by my Attorney-in-Fact to Pru Life UK.

In consideration of the payment of the proceeds of the above chosen/authorized transaction(s), I fully, completely, and
absolutely release and discharge Pru Life UK and any of its affiliates, shareholders, directors, officers, employees, or
representatives from any and all claims, demands, and liabilities, in law or in equity, with respect to the above
chosen/authorized transaction(s), including its resulting effect(s)/consequence(s) and payment(s) made pursuant thereto, and
forever warrant and defend the above chosen/authorized transaction(s) against, and save harmless Pru Life UK and any of its
affiliates, shareholders, directors, officers, employees, or representatives in connection therewith.

IN WITNESS WHEREOF, I HAVE HEREUNTO SET MY HAND THIS ___ DAY OF ___________ 20__, IN ______________.

_________________________________
[INSERT THE COMPLETE LEGAL NAME OF THE POLICYOWNER]
Policyowner/Principal1

Accepted, Acknowledged and Agreed:

_________________________________
[INSERT THE COMPLETE LEGAL NAME OF THE ATTORNEY-IN-FACT]
Attorney-in-Fact2

_____________________________

1If the Policyowner/Principal executed/signed this SPA in the Philippines, the Policyowner/Principal must have this SPA notarized before a Philippine
Notary Public.

If the Policyowner/Principal executed/signed this SPA outside the Philippines, the Policyowner/Principal must have this SPA notarized before a foreign
Notary Public and authenticated before the Philippine Embassy/Consulate General.

2If the Attorney-in-Fact executed/signed this SPA in the Philippines, the Attorney-in-Fact must also have this SPA notarized before a Philippine Notary
Public.

If the Attorney-in-Fact executed/signed this SPA outside the Philippines, the Attorney-in-Fact must also have this SPA notarized before a foreign Notary
Public and authenticated before the Philippine Embassy/Consulate General.

3
Note: This Special Power of Attorney (“SPA”) can only be used for One (1) Pru Life UK Insurance Policy. If you want to execute an SPA for
another Pru Life UK Insurance Policy, you must execute another SPA.

_________________________________
[INSERT THE COMPLETE LEGAL NAME OF THE BANK ACCOUNT HOLDER(S), IF OTHER THAN THE ATTORNEY-IN-FACT, OR IN
CASE OF JOINT BANK ACCOUNT] 3

_________________________________
[INSERT THE COMPLETE LEGAL NAME OF THE PAYEE IN THE CHECK, IF OTHER THAN THE ATTORNEY-IN-FACT] 4

ACKNOWLEDGMENT

BEFORE ME, personally appeared the following:

Name Government ID No. Date Issued Place Issued Expiry Date


[insert the details of
the Policyowner /
Principal]
[insert the details of
the Attorney-in-Fact]
[insert the details of
Bank Account
Holder(s)]
[insert the details of
the Payee]

known to me to be the same persons who executed the Special Power of Attorney and acknowledged to me that the same is
their free and voluntary act and deed.

Witness my hand and seal this ____ day of __________ 20__ in _____________.

NOTARY PUBLIC

Doc. No. ___;


Page No. ___;
Book No. ___;
Series of 20__.

3If the Bank Account Holder(s) executed/signed this SPA in the Philippines, the Bank Account Holder(s) must also have this SPA notarized before a
Philippine Notary Public.

If the Bank Account Holder(s) executed/signed this SPA outside the Philippines, the Bank Account Holder(s) must also have this SPA notarized before
a foreign Notary Public and authenticated before the Philippine Embassy/Consulate General.

4 If the Payee executed/signed this SPA in the Philippines, the Payee must also have this SPA notarized before a Philippine Notary Public.

If the Payee executed/signed this SPA outside the Philippines, the Payee must also have this SPA notarized before a foreign Notary Public and
authenticated before the Philippine Embassy/Consulate General.

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