By transacting with Prudential Guarantee and Assurance, Inc. (PGAI), I hereby allow and authorize PGAI to collect, use and process my personal data provided in this form and its attachments in accordance with PGAI’s Privacy Notice and all applicable laws.  I agree to be bound by the Data Privacy Act of 2012 and related laws, rules and regulations. I understand that my personal data may be made available to  PGAI’s agents, affiliates, brokers, service providers, third-party companies and government bodies whenever necessary.  By freely and voluntarily providing personal data to PGAI, I am confirming that they are true and correct.  I understand that PGAI reserves the right to revise any decision made on the basis of the data provided should the same be found untrue or incorrect.  I hold PGAI, its agents and affiliates,  brokers, service providers and, where applicable, third-party companies free and harmless from any liability which may arise as a result of the authorization herein given.

PGAI shall collect, process, use, store, record and update my personal data necessary for securing an insurance contract and other related purposes.  The same may be shared, disclosed, or transferred to agents, affiliates, brokers, service providers of PGAI and government bodies authorized by law to receive such information.  PGAI shall retain all information provided for a period necessary to fulfill the aforesaid purposes, unless a longer retention period is required or permitted by law.  Such personal data shall be treated with utmost confidentiality and shall be accessed by authorized personnel only.  In  accordance with the Data Privacy Act of 2012, data subjects shall have the right to access their personal data to correct, update or supplement any false, inaccurate or incomplete information.  Should there be any question, please contact the Data Protection Officer of PGAI through 8 878-3000 loc. 7284 or email us at dpo@prudentialguarantee.com.