POLICY INFORMATION REPORT

POLICY NUMBER: 03917851

GENERAL INFORMATION

POLICY OWNER : DE LA CRUZ, JOSE BANDIOLA CONTRACT STATUS : IN FORCE

INSURED NAME : DE LA CRUZ, JOSE BANDIOLA PLAN DESCRIPTION : PIA 3 Reg PESO

AGENT NAME : GARIN, KRISEL ANNE MEDINA BRANCH NAME : JASPER BRANCH

POLICY EFFECTIVE DATE : 08/13/2012 PLAN CURRENCY : PHP

FIRST ISSUE DATE : 08/13/2012 PREMIUM STATUS : SINGLE PREMIUM

NON-FORFEITURE STATUS : N/A SUM ASSURED : 29,224.38

DIVIDEND OPTION : N/A

MAILING ADDRESS : B18 L23 SAVANNAH TRAILS B OTON, ILOILO PHILIPPINES

RESIDENCE ADDRESS : B18 L23 SAVANNAH TRAILS B OTON, ILOILO PHILIPPINES

PAYMENT INFORMATION

PAYMENT METHOD : NO BILLING BILLING FREQUENCY :

PAID TO DATE : 08/13/2013 MODAL PREMIUM : 0.00

SINGLE PREMIUM : 23,379.50

PLAN DETAILS

PLAN / RIDER DESCRIPTION SUM ASSURED CONTRACT STATUS PREMIUM STATUS

P3RP PIA 3 Reg PESO 29,224.38 IN FORCE SINGLE PREMIUM

FUND DETAILS

FUND TYPE UNIT BALANCE UNIT PRICE PRICE DATE FUND VALUE
PRUlink Growth Fund 42,614.25 4.00 12/03/2019 170,654.29

BENEFICIARY DETAILS

NAME RELATIONSHIP BIRTHDATE PERCENTAGE DESIGNATION

DE LA CRUZ, MARY CHRIST B. SISTER 25-DEC-1981 50.00% P-RE
DE LA CRUZ, VICTOR BANDIOLA BROTHER 12-MAY-1978 50.00% P-RE

BENEFICIARY DESIGNATION LEGEND: P-Primary S-Secondary RE-Revocable IR-Irrevocable

-------------------------------------------------------- Nothing Follows --------------------------------------------------------

Displayed data are as of December 3, 2019

Note: The Disclaimer and Copyright provisions can be viewed in the PRISM About page. Moreover, please be advised that PRISM
Information is for internal use only and not intended for dissemination to policy holders and/or clients. For purposes of
obtaining official data to be released to clients, please contact Customer Contact Management (CCM) through the Contact Us page of PRISM. Page 1 of 1