Consumer Insurance Contract
Paragraph 5 of Schedule 9 of the Financial Services Act 2013 requires You:
(a) to take reasonable care not to make any misrepresentation when answering any questions in this application form; and
(b) to take reasonable care to disclose to Us any other matter which may be relevant to Our decision on whether to accept the risk and the rates and terms to be applied.
You are also required to continue to disclose any changes or additional material facts in respect of Your health, occupation, financial status etc. which may arise between the time of submission of the application form and the time the contract of insurance is entered into, varied or renewed. If You are in doubt whether or not a matter is relevant to Our decision, You should disclose that matter. Your duty of disclosure above continues until the time the contract is entered into, varied or renewed. You also understand and agree that this application may be re-underwritten based on such changes or additional material facts.
You are advised that You should not sign this application form unless it has been completed to Your full satisfaction as You are solely responsible for the answers given in this application form once it has been signed by You.
In accordance with the laws and guidelines on anti-money laundering and anti-terrorism financing governing Malaysia, We are required to verify the identity of Our customers. If We do not receive sufficient proof of identification, We may not be able to consider Your application.
If you do not understand Your obligation / duty as stated above or if You need further explanation, kindly contact Our customer service officer.
I/We, hereby in my/our capacity as the Life to be Assured hereby declare that:
1. I/We am aware that it is my/our pre-contractual duty of disclosure that I/we must exercise reasonable care not to give false answers/information when answering any questions asked by the Company and that I/we am/are to answer the questions fully and accurately/correctly.
2. I/We have read and understood the contents of the application form including all warnings and notices therein and I/we have fully and accurately answered all the questions in the application form and the other questions asked by the Company, if any, after having fully read and understood the questions.
3. I/We am/are aware that I/we must inform the Company of any change to the answers given in the application form if the change occurred after I/we have submitted the application form but before the Contract is entered into.
4. I/We fully understand that my/our answers and/or statements given in respect of the questions asked by the Company, and any other relevant documents completed by me/us in connection with the application and in my/our medical report or amendments (collectively referred to as “the information”) are relevant to the Company in deciding whether to accept my/our application or not and the rates and terms to be applied.
5. I/We am/are aware that if any of my/our answers or statements or information given by me/us is not accurate/correct, the Policy may be avoided, my/our claim denied or reduced, the terms of the Policy changed or varied, or the Policy terminated.
6. I/We understand that the Company has the discretion to accept or decline this application notwithstanding payment of premium or part thereof (if any) has been made by me/us. The risk under the insurance applied herein shall only commence after all the following conditions have been fulfilled during my/our lifetime and provided always that there have been no change in my/our state of health as declared up to the commencement date:
(a) the Company has given written acceptance of this application;
(b) all the conditions specified in the Company’s written acceptance have been fulfilled; and;
(c) the first premium payable has been received in full and accepted by the Company.;
Consent to use, collect, hold, process or disclose Personal Data/Sensitive Personal Data under Personal Data Protection Act 2010 (PDPA), Foreign Account Tax Compliance Act (FATCA) & Common Reporting Standard (CRS).
i. I/We hereby give consent to the Company to use, collect, hold, process or disclose my/our *Personal Data/Sensitive Personal Data as defined in the Malaysian Personal Data Protection Act 2010 (PDPA 2010), pursuant to this policy contract, which shallamong , others, include the application form, counter-offer form, policy contract, endorsement etc. (“Policy Contract”), to its group of companies (within or outside Malaysia), respective employees, professional advisers or bodies including Life Insurance Association of Malaysia, Ombudsman for Financial Services, ISM Insurance Services Malaysia Berhad, intermediary or representatives, any third party, insurance or reinsurance companies, regulatory authorities whether or not relating to an intergovernmental agreement between the governments or regulatory authorities of two or more jurisdictions, external service providers who provide support or professional services to the Company (within or outside Malaysia) and/or to another country or jurisdictions in which I/we may be a tax resident, for purposes of (a) processing my/our application and verifying my/our eligibility for insurance and financial products and services, (b) provision and design of insurance, financial services or related products, (c) processing of any credit, medical, security and underwriting checks and insurance claims, (d) processing payment instructions (e) responding to my/our queries, (f) any other purpose in connection with the provision of any product or service to me/us, and/or (g) any other purpose that may be deemed necessary or expedient by the Company in accordance with applicable laws and regulations. I/We further confirm that I/we understand that both the Company and I/we am/are bound by the provisions of PDPA, FATCA and CRS.
ii. I/We hereby give consent to the Company and/or its authorised representatives to access my/our Personal Data/Sensitive Personal Data used, collected, held, or processed by any hospital, clinic, physician, specialist, insurance or reinsurance companies, professional adviser or bodies, Life Insurance Association of Malaysia, Ombudsman for Financial Services, ISM Insurance Services Malaysia Berhad, organisation, institution or person(s) and authorised intermediary or representatives for the purpose of processing this Policy Contract.
iii. I/We hereby /give consent to the Company to use, collect, hold, process or disclose my/our *Personal Data/ Sensitive Personal Data to Company’s own use or any third party for the purpose of (a) marketing and promotional services, (b) informing me/us about the Company’s products and services, (c) informing me/us about the Company’s promotional campaigns relating to the Company’s products, (d) statistics and research, (e) direct marketing or study of consumer behaviour or (f) performing policy review and customer’s needs analysis for purposes of processing this Policy Contract.