Prudential policy tracing questionnaire

Transcription

1 WMS Prudential policy tracing questionnaire This questionnaire should be completed if you think you or a family member have an unclaimed policy for a Prudential life insurance or endowment policy which started before We will use this information to track the policy. Note the following before completing the form: 1. You will only need to complete some sections, use the table below to check which sections 2. Send it back to us using our freepost address at the end of the questionnaire 3. Please make sure you send copies (not originals) of any policy documentation you have mentioned in the questionnaire 4. Make sure you sign the declaration at the end. 5. Complete this form in black ink using CAPITAL LETTERS I am completing the questionnaire because: I know the policy number (sections to fill in, complete in the following order) I don t know the policy number (sections to fill in, complete in the following order) I have a policy in my name Section one Sections one and three A relative I know has/may have a policy Section two Sections two and three Is this policy in your name? Yes Complete section one No Complete section two Section one details about you and your policy Policy number (eight or nine digits if known) Preferred telephone number Full name (mandatory) Maiden name(s) and dates of marriage (if applicable) Date of birth (mandatory) Contact address (mandatory) Other names you have been known by, please include dates (if applicable) Address where last premium was paid (if known) Have you supplied a policy number? Yes Thank you, we have everything we need to get started. You should hear back from us within 12 weeks. Please post the questionnaire to us using the freepost address at the end of the questionnaire. No Complete section three Prudential policy tracing questionnaire ZORQ /2017 Page 1 of 6

2 Section two a) Your details Name (mandatory) Date of birth (mandatory) Please tell us your relationship to the person who the policy is linked to and why you are contacting us on their behalf? (Note for data protection we can only communicate with you about this policy if you have permission from the policy owner, if they are alive. Please provide details of information held and we will be in touch if needed.) Contact address (mandatory) Preferred telephone number (mandatory) Section two b) details of the person who has the policy in their name Policy number (eight or nine digits if known) Other names they have been known by, please include dates (if applicable) Their full name (mandatory) Their date of birth (mandatory) Their maiden name(s) and dates of marriage (if applicable) Address where last premium was paid (if known) Any other addresses and dates lived here (if applicable) Have you supplied a policy number? Yes Go to question below No Complete section three Is the person who had the policy in their name alive? Yes Thank you, we have everything we need for now and will use this information to find the policy. You should hear back from us within 12 weeks. Please post the questionnaire to us using the freepost address at the end. No Complete section four Prudential policy tracing questionnaire ZORQ /2017 Page 2 of 6

3 Section three as the policy number is not known we will try and find it. The more information you can give us, the easier it will be. Type of policy taken out (tick all that apply) Fixed Term Saving (Endowment) Whole of Life cover Other (please state) How was the premium paid? (tick all that apply) Weekly Direct debit 4 weekly At a post office At the door Other (please state) Policy taken out by (this is the full name of the person who took out the policy if this is different to the name on the policy) Sum assured (if known) Amount paid as a premium (if known) Relationship with person who took out the policy (if applicable) Date policy taken out (if known or approximate date) Date last premium was paid (if known) Are you possession of any policy related documents? (Where yes, please supply copies) Yes (please state details of documents held) No Address when policy was taken out (if known) Include any other addresses where premiums may have been collected (if applicable) Details of other Prudential policies you, the person who has the policy in their name or immediate family members may hold (if applicable please provide policy number(s) Prudential collector/agent s name (if known) and any dates of collection Is the policy in your name? Yes Thank you, we have everything we need for now and will use this information to find the policy. You should hear back from us within 12 weeks. Please post the questionnaire to us using the freepost address at the end. No Complete section four if the person who had the policy is deceased. Otherwise please post the questionnaire to us using the freepost address at the end. Prudential policy tracing questionnaire ZORQ /2017 Page 3 of 6

4 Section four Information on the deceased (the person who had a policy in their name) If we can find the policy and a claim is payable, completing this information will speed up the process. Date of death (as stated on the death certificate) Notification of death date (as stated on the death certificate) Registration/district/office (as stated on the death certificate) Death certificate reference (as stated on the death certificate) Was there a will? Yes No If yes, are you the executor of the will? Yes No Are you the Next of kin? Yes No If no, please state your relationship to the deceased Please supply details of any spouse and children who are still alive (if applicable) Any additional information which you feel is relevant Thank you. Prudential policy tracing questionnaire ZORQ /2017 Page 4 of 6

5 Next steps Before you send the application check you have completed all sections which apply. The policy is Policy number supplied Policy number not supplied In my name Section one Sections one and three A relatives Section two Sections two and three 1. Make sure you sign the declaration below. 2. Please make sure you send copies (not originals) of any policy documentation you have mentioned in the questionnaire. 3. Send it back to us using our freepost address Freepost IB SERVICING PRUDENTIAL. 4. We will now use this information to trace the policy. We may need more information but will be in touch if that is the case. We will write to you to confirm the outcome of our search. 5. Please bear with us as it can take up to 12 weeks to trace a policy. If you do need to get in touch with us, contact us for free on Declaration I understand it is a criminal offence to knowingly provide false, misleading information and/or forged documents, signatures for the purpose/intention of committing fraud and this may result in prosecution. I declare that, to the best of my knowledge, the information I have given is correct and truthful. Print name Signature Date Financial Crime (verifying your identity to prevent Fraud & Money Laundering) To verify your identity and prevent financial crime we may use and share your information with any company within the Prudential Group, with companies who work for us and with other appropriate organisations. We may also search, send your details to, and use information from third party verification service providers and financial crime and credit reference agencies (Third Parties). This involves checking your details against databases that these Third Parties use. Prudential Assurance Company Limited and these Third Parties may keep a record of the search, the results of the search, any suspicions of financial crime and the details may be used to assist other companies for verification and identification purposes. This search is not a credit check and your credit rating should be unaffected. By signing this form you are giving your consent to these activities which will make it easier for you to do business with us and help prevent financial crime. For more information, please write to Financial Crime Prevention Team, Prudential, Lancing BN15 8GB. Prudential* will use your details to search for the policy. We may contact you for further information or to see whether you have any questions. It may be necessary, for the above purposes, to transfer your information to countries that provide a different level of data protection from the UK. Where this is the case we will ensure your data is kept secure. Prudential policy tracing questionnaire ZORQ /2017 Page 5 of 6

6 *Prudential is a trading name of the Prudential Assurance Company Limited, which is registered in England and Wales. This name is also used by other companies within the Prudential Group. Registered office at Laurence Pountney Hill, London EC4R 0HH. Registered number Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. ZORQ /2017