Revival Application Form – Fillable PDF

Looking for a quick way to bring a lapsed Prudential policy back to life? The Revival Application Form is a fillable PDF that lets you request the restoration of loyalty‑related benefits such as Milestone Booster, Loyalty Booster, and Loyalty Bonus.

What Is the Revival Application Form?

This form is used by policyholders who want to revive a lapsed policy and re‑activate any associated loyalty features. It captures essential information about the policy, the reason for lapse, and the applicant’s consent to the terms and conditions.

How to Complete the Form Online

Instead of downloading the PDF and opening it in a separate editor, simply click the "Fill out this form" button on the page. The Formize PDF Filler app will load instantly, allowing you to type directly into each field, add signatures, and save your completed form.

• Step 1: Click the "Fill out this form" button.
• Step 2: Wait for the Formize PDF Filler to load (usually a few seconds).
• Step 3: Complete every required field, upload any supporting documents, and sign where indicated.
• Step 4: Review the form for accuracy, then click "Submit" to download a copy for your records.
• Step 5: Email the completed PDF to Prudential’s policy‑servicing department as instructed.

Common Mistakes to Avoid

Even a small error can delay the revival process. Make sure you:

• Enter your policy number exactly as it appears on your policy document.
• Provide a current mailing address and contact number.
• Read and acknowledge every clause in the "Terms and Conditions" section.
• Sign the form using the PDF filler’s built‑in signature tool.
• Attach any required supporting documents (e.g., proof of payment, identification).

Where to Submit Your Revival Request

After filling out the form, send the completed PDF to the email address listed on the last page of the document or upload it through your Prudential online portal. Keep a copy for your records in case follow‑up is needed.

Need more help? Review the FAQs below or contact Prudential’s customer service for assistance.