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Prudential Guarantee and Assurance Inc.: Client Information Sheet - For Individual Client

This 3 sentence summary provides the key details about the client information sheet document: The document is a client information sheet for Prudential Guarantee and Assurance Inc. that collects personal details such as name, address, contact information, identification numbers, employment details, source of funds, and beneficiary names for individual clients. Upon completion, the client signs and dates the form which is then filled out by Prudential Guarantee with the client's assured code and intermediary.

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Ryan Redoble Delmo
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Download as PDF, TXT or read online on Scribd
255 views

Prudential Guarantee and Assurance Inc.: Client Information Sheet - For Individual Client

This 3 sentence summary provides the key details about the client information sheet document: The document is a client information sheet for Prudential Guarantee and Assurance Inc. that collects personal details such as name, address, contact information, identification numbers, employment details, source of funds, and beneficiary names for individual clients. Upon completion, the client signs and dates the form which is then filled out by Prudential Guarantee with the client's assured code and intermediary.

Uploaded by

Ryan Redoble Delmo
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Prudential Guarantee and Assurance Inc.

Coyiuto House 119 C. Palanca St. Telephone Number: 810-4916


Legaspi Village, Makati City Website: www.prudentialguarantee.com
CLIENT INFORMATION SHEET – For Individual Client*

Complete Name (Last, First, Middle): ________________________________________________________________________


Present Address: _______________________________________________________________________________________
Permanent Address: _____________________________________________________________________________________
Contact Numbers: ___________________________________ Nationality: _________________________________________
Date of Birth: _______________________________________ Place of Birth: _______________________________________
TIN: ____________________ SSS / GSIS No.:________________ ID No. & Issuer**_________________________________
Nature of Work: _____________________________________ Name of Employer: ___________________________________
Nature of Self-employment / Business: ______________________________________________________________________
Source of Funds: _______________________________________________________________________________________
Names of Beneficiaries, if applicable: ________________________________________________________________________
______________________________________________________________________________________________________
Client’s Signature: _______________________________________ Date Signed: ____________________________________
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------
This portion is to be filled up by Prudential Guarantee:

Assured Code/s: ______________________________________________ Intermediary: _____________________________


*As mandated by Philippine Anti-Money Laundering Act, as amended, and Its Implementing Rules and Regulations

Important: Attach photocopy of valid ID**


PGA-KYC-Form-01.03
01-29-2014

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