Lima, September 6, 2017

INSURANCE COMPANY
PACIFICO LIFE INSURANCE
Av. Juan de Arona 830, San Isidro

Present.-

CARMEN DEL PILAR MONTEZA PARRA, identified by DNI No. 41996021,

with address for these purposes in Jr. Ramón Castilla Nº 219-A, Dept. 502,
Engineering Urbanization, San Martin de Porres District, I hereby state the
following:

That, for purely personal reasons and in accordance with the provisions of
Clause Twenty-Eighth of the General Conditions of the INDIVIDUAL LIFE
INSURANCE POLICY Gold Investment Life Insurance, I request the Resolution
of the Policy and the Surrender Value of the POLICY. No. 17-036775/8, with
application number 20846184, request that will extinguish the rights and
obligations of this policy except for the obligation of the Company to pay the
surrender value, for which I attach the documents p ertinent

Without further ado, and in advance, thank you for responding to this request.

Sincerely

___________________________________ CARMEN DEL PILAR MONTEZA

PARRA
ID 41996021

Annexes

1-A. Copy of ID
1-B. Copy of the Individual Life Insurance Policy - Gold Investment Life Insurance.