KYC for Beneficial Owner and Third Party Payor
A requirement pursuant to the AMLC Regulatory Issuance PRU LIFE INSURANCE CORPORATION OF U.K.
(ARI) A,B, C No.3 - Guidelines on Identifying Beneficial 9/F Uptown Place Tower 1, 1 East 11th Drive, Uptown Bonifacio,
Ownership and an Addendum to the following 1634 Taguig City, Philippines
Customer helpdesk: (632) 8683 9000, (632) 8884 8484, (632) 8887 LIFE
Application for Life Insurance forms:
within Metro Manila, 1 800 10 PRULINK for domestic toll-free
• Individual Insurance • Simplified Issue • Entity Insurance Email: [Link]@[Link] Website: [Link]
REMINDERS:
Please use CAPITAL LETTERS and black ink. POLICY NUMBER APPLICATION NUMBER
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.
BENEFICIAL
BENEFICIAL OWNER
OWNER THIRD PARTY
BENEFICIAL
✔ PAYOR
OWNER BOTH (BO AND
BENEFICIAL TPP)
OWNER
Please see Page 2 for reference.
FOR OFFICIAL USE ONLY
BRANCH TIME AM/PM RECEIVED BY/DEPARTMENT
PERSONAL INFORMATION OF BENEFICIAL OWNER/ THIRD PARTY PAYOR
SURNAME
DOMINGO
GIVEN NAME
VIZT MARK
MIDDLE NAME OTHER LEGAL NAME/ALIAS
SABIO
GENDER CIVIL STATUS SALUTATION
✔ Male Female Single ✔ Married Others MR.
DATE OF BIRTH (mm/dd/yyyy) AGE PLACE OF BIRTH (city/province, country) NATIONALITY
1 0 0 7 1 9 8 6 36 QUEZON CITY FILIPINO
IDENTIFICATION INFORMATION MOBILE NUMBER TELEPHONE NUMBER EMAIL ADDRESS
SSS/GSIS TIN
267314771000
viztmarkdomingo@[Link]
OTHERS ID NUMBER
OCCUPATION (State exact duties; if member of AFP/PNP, state rank.) EMPLOYER
HR OFFICER QATAR INTERNATIONAL AUTOMOBILES
NATURE OF WORK OR NATURE OF BUSINESS (if self-employed) NATURE OF BUSINESS OF EMPLOYER
GROSS ANNUAL INCOME (in PhP) NET WORTH (in PhP) SOURCES OF FUNDS
1,475,595.00 1,475,595.00 ✔ Salary Business Others
Tick if same as
PRESENT ADDRESS (number, street, municipality/city, province) PERMANENT ADDRESS (number, street, municipality/city, province) present address
FLAT 17 BUILDING 8 STREET 827 ZONE 39 4B MARIA CORAZON ST. CONGRESS PARK SUBD.
COMMONWEALTH, QUEZON CITY,
COUNTRY ZIP CODE COUNTRY ZIP CODE
QATAR PHILIPPINES 1121
BUSINESS/EMPLOYER ADDRESS (number, street, municipality/city, province) Tick if same as
present address POLICY DETAILS
NAME OF POLICYOWNER
LORAINE MARJORIE CO DOMINGO
RELATIONSHIP OF BENEFICIAL OWNER/ THIRD PARTY PAYOR TO POLICYOWNER
WIFE
REASON FOR THIRD-PARTY PAYMENT
COUNTRY ZIP CODE
FAMILY PAYMENT
IMPORTANT: This supplemental form should be attached to the main Application for Life Insurance.
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 ([Link] 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@[Link]
EXECUTED AT
DOHA, QATAR THIS 0 2 1 2 2 0 2 3 VIZT MARK DOMINGO
PLACE DATE COMPLETED
Signature over printed name
of BENEFICIAL OWNER/ THIRD PARTY PAYOR
Know Your Customer (KYC) requirements for Beneficial Owners and eligible Third-Party Payors
Any natural person who ultimately owns or controls the customer, and/or on whose behalf a transaction
What is a Beneficial Owner? 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.
What is a Third-Party Payment? This is a payment made to Pru Life UK by any person other than the Policyowner.
1. Persons named in the Life Insurance Application Form either as
Life Insured or Beneficiary
2. The following family members of the Policyowner:
- Parent - Sibling
- Child
Who are the eligible Third-Party Payors (TPP)? - Spouse - Grandparent
3. Pru Life UK insurance agents provided that they are any of those mentioned in items 1 and 2
(with satisfactory proof or declaration provided by the life insurance agent)
Only the following categories will be accepted as Corporate or Entity TPP:
A. Sole proprietorship provided that the Policyowner is the sole proprietor
Who are allowed to be Corporate/Entity TPP?
B. Worksite/Group accounts where an employee-employer relationship is duly established
(subject to the submission of Certifications of Employment)
- Duly accomplished and signed KYC Form for TPP
What are the requirements for a first-time TPP? - Copy of one (1) valid government-issued ID or two (2) valid non-government IDs.
The KYC Form for TPP shall remain valid for twenty-four (24) months provided that the TPP was able
How long will the KYC Form for TPP remain valid? to pay continuously as TPP for a period of twenty-four (24) months. Otherwise, the validity of the
KYC form will only be for a period of one (1) year from the date of execution of the KYC Form.
As TPP documents are handled on a per-Policyowner basis:
If I am an existing TPP, do I have to fill out and submit another - Yes, if you have not yet applied as a TPP for that particular Policyowner.
set of requirements if I intend to become a TPP of another policy?
- No, if both the policies you are applying and have previously applied for have the
same Policyowner.
A. If the policies have the same Policyowner, you will need to submit only one (1) KYC Form for TPP.
If I am simultaneously applying as a first-time TPP
B. If the policies have different Policyowners, you will need to submit the same number
for multiple policies, how many KYC Forms do
of KYC Form for TPPs as there are Policyowners to individually establish your relationship
I need to fill out and submit?
with each.
Yes, because the KYC for TPP requires the essential details on employment and source of funds which
I am a first-time TPP and one of the Beneficiaries of were not asked from you (being the Beneficiary) in the New Business Application Form or
the policy. Do I still need to submit a KYC Form? Policy Amendment Request Form.
- No need to submit a new one if the previously submitted TPP requirements are still within
Do I have to re-submit the TPP requirements for
a new set of Auto Debit Arrangement (ADA) the 24-month validity period.
enrolment/credit card enrolment for the same policy? - Yes, you will have to submit a new set of requirements if it is already beyond the validity period.
