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Important Note:

If the Applicant is not the Primary Insured/Insured Participant, Consent Form MUST be completed before enrolment:

1. If Primary Insured/Insured Participant is 21 years old and above and Applicant is not Primary Insured/Insured Participant, Consent Form must be filled by the Primary Insured/Insured Participant.
2. If Primary Insured/Insured Participant is under 21 years old but married, Consent Form must be filled by the Primary Insured/Insured Participant.
3. If Primary Insured/Insured Participant is under 21 years old and Applicant is not the parent / legal guardian or Primary Insured/Insured Participant, Consent Form must be filled by the parent or legal guardian.

Enrolment cannot proceed without the completed Consent Form. Download Consent Form here:

Consent Form for
Prudential Indonesia’s Primary Insured

Consent Form for
Prudential Syariah’s Participant