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August 2, 2016

Prudential Guarantee and Assurance Inc.


Coyiuto House, 119 C. Palanca St., Legapi Village
Makati City, Philippines
Attn: CANCELLATION
Re: Medical Cash Assistance Policy No. ___________.
Please consider this letter as a formal request to cancel the referenced Medical
Cash Assistance Policy. In line with this, kindly stop all debits and/or charges for
my premium payments. The effectivity date of the policy cancellation shall be on
_____________.
Kindly send a written confirmation letter to me within 30 days after the
cancellation takes effect. Please refund any and/or unused portions of my premium.

Looking forward for your immediate response.


Sincerely,
Xarifa Lao Sanguila
Policy Holder

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