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Attention : Agency Administration Date : _____________
Level 10, Menara Prudential
APPOINTMENT OF NEW SERVICING AGENT
Section I is to be completed by policyholder / certificateowner:
Policy / Certificate No. :
Name of Assured / Participant :
Contact No :
Signature of Assured / Participant : :
Section II is to be completed by new servicing Agent :
Agent's Code :
Agent's Name :
Signature of Agent :
Section III is to be completed by existing agent & QL(Please tick whichever applicable) :
I am agreeable to the transfer of servicing only.
I am agreeable to the transfer of commission only.
I am agreeable to the transfer of servicing and commission.
Agent's Code :
Agent's Name :
Signature of Agent :
Signature of QL :
FOR OFFICE USE ONLY
Dear Mr / Ms ______________________________
Please complete section __________________ and return to us before _________________ for further action.
Remarks : Checked by :
________________

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Transfer Agent PAMB to PBTB Agent

  • 1. Attention : Agency Administration Date : _____________ Level 10, Menara Prudential APPOINTMENT OF NEW SERVICING AGENT Section I is to be completed by policyholder / certificateowner: Policy / Certificate No. : Name of Assured / Participant : Contact No : Signature of Assured / Participant : : Section II is to be completed by new servicing Agent : Agent's Code : Agent's Name : Signature of Agent : Section III is to be completed by existing agent & QL(Please tick whichever applicable) : I am agreeable to the transfer of servicing only. I am agreeable to the transfer of commission only. I am agreeable to the transfer of servicing and commission. Agent's Code : Agent's Name : Signature of Agent : Signature of QL : FOR OFFICE USE ONLY Dear Mr / Ms ______________________________ Please complete section __________________ and return to us before _________________ for further action. Remarks : Checked by : ________________