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Submitted Cases (NB, AS, CL)
Congratulations on your submitted NB cases! To help you with issuance, kindly fill out this form.
For Amendments and Claims, log details for timely follow ups and resolution.
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* Indicates required question
Team
*
Thrixia
Charish
Hazel
Ruffa
Sara
Charli
Transaction Type (e.g. NB, Reinstatement, Amendment, etc.)
*
Your answer
Date Submitted
*
MM
/
DD
/
YYYY
Agent’s Code (e.g. 70012345)
*
Your answer
Agent’s Name (e.g. Carl Benson Olivar)
*
Your answer
Application or Policy Number (e.g. RF1234567, Editable Form)
*
Your answer
Product (e.g. PAA, Elite 5, PruMil)
*
Your answer
Initial Payment Method if NB (e.g. Cash, Credit Card, Online Transfer, OTC)
Your answer
Recurring Payment Method if NB (e.g. Cash, Credit Card, ADA)
Your answer
APE if NB (put NA if not applicable)
*
Your answer
Policyowner (e.g. Hazel Manuel)
*
Your answer
Life Insured (e.g. Ruffa May Lomat)
*
Your answer
Remarks
Your answer
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