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Attention: Agency Administration
Level 10, Menara Prudential
Transfer of Servicing Request Form
I (policyholder/participant) hereby request to transfer the policy/certificate (s) as stated below to _______________________________
(New Servicing Agent name) ____________________ (New Servicing Agent code)
Policy No. / Certificate No. Name of Assured/Participant Contact No.
Reason for Change of Servicing Agent: - ______________________________________________________________________________
___________________________________________________________________ (Compulsory)
___________________________ _________
Signature of Policyholder / Participant Date
I (New servicing Agent) _____________________________________hereby agree to service the above-named policyholder/participant.
__________________________ __________
Signature of Agent Date
Code No.
Note: Only in-force policies are allowed to transfer
Seven (7) policies and above required RDM/SRDM’s recommendation
---------------------------------------------------------------------------------------------------------------------------------------------------------
For Transfer of Servicing and commission (Applicable under same agency only)
I (existing agent) ____________________________________________ hereby agree to transfer servicing and commission to the above-
named agent.
___________________________ __________________________
Signature of Agent Endorsed by QL
Code No: Name:
Code No.
---------------------------------------------------------------------------------------------------------------------------------------------------------
RDM/SRDM’s recommendation for transfer for seven (7) policies and above
Justification: ________________________________________________________________________________________
__________________________
RDM/SRDM
Name:
Region
Appendix 1 : Transfer of Servicing Form
For Office Use Only
Date : _____/_____/_____
To : _________________________________
Agency Code : _________________________________
Branch : _________________________________
Dear Sir / Madam,
We regret to inform you that we are unable to process your request for servicing due to:-
You are not licensed to service Life/Takaful customers unless you have passed the said examination.
Signature of policyholder/participant is different from our record.
Request for Transfer of Servicing form is incomplete.
QL / Existing agent’s signature is different from our record.
Policyholder withdraws the request for change of servicing agent.
No signature/justification from RDM/SRDM. (For Seven (7) policies and above)
Others: __________________________________________________________________
___________________________________________________________________
Checked By: __________________ Approved By: __________________
Name: Name:
Date: Date:
Note: Please refer to the next page

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Transfer policy

  • 1. Attention: Agency Administration Level 10, Menara Prudential Transfer of Servicing Request Form I (policyholder/participant) hereby request to transfer the policy/certificate (s) as stated below to _______________________________ (New Servicing Agent name) ____________________ (New Servicing Agent code) Policy No. / Certificate No. Name of Assured/Participant Contact No. Reason for Change of Servicing Agent: - ______________________________________________________________________________ ___________________________________________________________________ (Compulsory) ___________________________ _________ Signature of Policyholder / Participant Date I (New servicing Agent) _____________________________________hereby agree to service the above-named policyholder/participant. __________________________ __________ Signature of Agent Date Code No. Note: Only in-force policies are allowed to transfer Seven (7) policies and above required RDM/SRDM’s recommendation --------------------------------------------------------------------------------------------------------------------------------------------------------- For Transfer of Servicing and commission (Applicable under same agency only) I (existing agent) ____________________________________________ hereby agree to transfer servicing and commission to the above- named agent. ___________________________ __________________________ Signature of Agent Endorsed by QL Code No: Name: Code No. --------------------------------------------------------------------------------------------------------------------------------------------------------- RDM/SRDM’s recommendation for transfer for seven (7) policies and above Justification: ________________________________________________________________________________________ __________________________ RDM/SRDM Name: Region Appendix 1 : Transfer of Servicing Form
  • 2. For Office Use Only Date : _____/_____/_____ To : _________________________________ Agency Code : _________________________________ Branch : _________________________________ Dear Sir / Madam, We regret to inform you that we are unable to process your request for servicing due to:- You are not licensed to service Life/Takaful customers unless you have passed the said examination. Signature of policyholder/participant is different from our record. Request for Transfer of Servicing form is incomplete. QL / Existing agent’s signature is different from our record. Policyholder withdraws the request for change of servicing agent. No signature/justification from RDM/SRDM. (For Seven (7) policies and above) Others: __________________________________________________________________ ___________________________________________________________________ Checked By: __________________ Approved By: __________________ Name: Name: Date: Date: Note: Please refer to the next page