RELEASE, WAIVER, QUITCLAIM FROM ANY LIABILITY

AND WAIVER OF INTELLECTUAL PROPERTY

Know All Men By These Presents:

I, ________________________, Filipino, of legal age, single/married, and a resident of _________________________________

City, Philippines, under oath, depose and state that:

1. I am an Insurance Agent of Pru Life Insurance Corporation of U.K. (“Pru Life UK”), a
corporation duly organized and existing under and by virtue of the laws of the Republic of the Philippines with principal
office at the 8th floor Uptown Place Tower 1, East 11th Drive, Uptown Bonifacio, 1634 Taguig City, Philippines.

2. I have qualified for / was invited to and will participate in the 2022 Protection Drive:
Switzerland activity (the “Activity”), which partakes of the nature of an incentive trip. I fully understand that
participation in this Activity is purely voluntary and that I can validly opt out of the Activity, as may be applicable. I am
aware of the risks associated with participating in the Activity, which include but are not limited to physical injury or
loss of property. I hereby assume all such risks on my behalf and on behalf of companion(s) I may bring with me to the
Activity.

3. I assume full responsibility for the actions and omissions of my companion(s) at all times and
regardless of any ongoing Activity.

4. I hereby completely, absolutely, and unconditionally discharge, release, and hold Pru Life UK,
its successors, assigns, parent companies, affiliates, subsidiaries, shareholders, directors, officers, employees, agents,
and representatives (together “Relevant Parties”) free and harmless from any and all damages, claims, liabilities, losses,
costs, fines, penalties, demands, suits, actions, proceedings, and causes of actions of whatever kind or nature, in law or
in equity (whether actual or potential, prospective or contingent, known or unknown and whether or not existing in law
at the date of this document) including indirect or consequential losses or loss of opportunities or future profits
(“Liabilities”) which I or my companion(s) and our successors and assigns may have by reason of any matter, cause,
thing, incident, or whatsoever arising from or with respect to the Activity.

5. I and my companion(s) agree that Pru Life UK has the absolute and irrevocable right to take
photos on, videos of, and do any form of recording of the Activity which may feature or include me and/or my
companion(s). I and my companion(s) also agree and acknowledge that Pru Life UK is the copyright, trademark, and
intellectual property owner of and shall have the exclusive title, interest, and intellectual property and legal rights to all
photo, video and sound recording, film, footage, audio-visual work and any materials taken/created with respect to the
Activity (“Intellectual Property”). I and my companion(s) will not make any claim against Pru Life UK with respect to and
waive any rights, title, and interests in the Intellectual Property in favor of Pru Life UK or its nominees. If requested by
Pru Life UK, and at no further expense to Pru Life UK, I and my companion(s) will execute in writing any
acknowledgments or assignments of Intellectual Property ownership in favor of Pru Life UK or its nominees.

6. I and my companion(s) also agree that Pru Life UK shall have the full and absolute right to
use, edit, fixate, air, publish, broadcast and release any and all Intellectual Property without limit as to time, venue of
airing and exhibit, and number of releases and versions in any medium anywhere within the Philippines and
internationally. I and my companion(s) agree and acknowledge that Pru Life UK is entitled to exploit in whatever form
and extent any and all Intellectual Property and that no award of compensation shall be paid to undersigned for any
such exploitation.

7. I and my companion(s) unconditionally, irrevocably and absolutely forever release and

discharge, and hold free and harmless Pru Life UK and the Relevant Parties from any and all Liabilities of whatsoever
nature with respect to the Intellectual Property and the use, fixation, and public performance and display thereof.

8. If at any time any provision hereof is or becomes illegal, invalid or unenforceable in any
respect under the laws of any jurisdiction, the legality, validity, or enforceability of the remaining provisions hereof shall
not in any way be affected or impaired thereby.

9. No provision hereunder shall be considered waived except when such waiver is made in
writing. No failure or delay on the part of Pru Life UK in exercising any right, power, or privilege hereunder shall impair
any such right, power, or privilege or operate as a waiver thereof. The rights, powers, and remedies herein expressly

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 provided are cumulative and not exclusive of any right or remedies that Pru Life UK would otherwise have under
applicable law.

10. The validity, interpretation, construction and performance of this Release, Waiver, and
Quitclaim from any Liability and Waiver of Intellectual Property shall be governed by the laws of the Republic of the
Philippines. The proper court in Taguig City shall have exclusive jurisdiction and shall be the venue of any action or
dispute arising out of this Release, Waiver, and Quitclaim from any Liability and Waiver of Intellectual Property.

I and my companion(s) have carefully read this Release, Waiver, and Quitclaim from any Liability and Waiver of Intellectual
Property and the same has been completely explained to us in the language(s)/dialect(s) we understand. As such, I and my
companion(s) clearly understand the complete meaning thereof in accordance with applicable laws, rules, and regulations and
agree to abide and be bound by the same. I and my companion(s) have executed this Release, Waiver, and Quitclaim from any
Liability and Waiver of Intellectual Property voluntarily and of free will.

ATTESTING TO THE TRUTH OF THE FOREGOING, I and my companion(s) hereunto execute this Release, Waiver, and Quitclaim
from any Liability and Waiver of Intellectual Property on the ___ day of _________ 20__ in ______________ City, Philippines.

_________________________________
Signature over Printed Name of Agent
With my/our Conformity:
______________________________
______________________________
______________________________
______________________________
Signature over Printed Name of the Companion(s)
of Legal Age and Signature of over Printed Name of
the Parent(s)/Legal Guardian(s) for Minor
Companion(s)

Signed in the presence of:

______________________________ _________________________________
Signature over Printed Name of Witness Signature over Printed Name of Witness

This Release, Waiver, and Quitclaim from any Liability and Waiver of Intellectual Property was personally subscribed and sworn
to by the affiant/s before me this ___ day of ______________, in __________ City, Philippines, with affiant/s exhibiting to me
the following:

NAME GOV’T ISSUED ID NO. ISSUED AT/ON/EXPIRY DATE

[insert name of agent]

[insert name of companion of
agents of legal age]
[insert name of parent/legal
guardian of companion of agents
who is a minor]

IN WITNESS WHEREOF I have hereunto set my hand and affixed my Notarial Seal on the date and place first above written.

Notary Public
Doc. No.: _____
Page No.: _____
Book No.: _____
Series of _____
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