- All information contained in this application is true and correct and I understand and agree that any inaccurate declaration or non-disclosure herein may result in withdrawal of this application or termination of my Agent Contract with the Company.
- I understand and agree that any personal information collected or held by the Company (whether contained in this application or otherwise obtained) may be held, used and disclosed by the Company to individuals/organisation related to and associated with the Company or any selected third party (within or outside of Malaysia) for the purpose of processing this application and to communicate with me for such purposes. I understand that I have a right to obtain access to and to request correction of any personal information held by the Company concerning me. Such request can be made to the Company’s Agency Administration and Support Department.
- Pursuant to the requirement under the Anti-Money Laundering, Anti-Terrorism Financing and Proceeds of Unlawful Activities Act 2001 (AMLATFPUAA), Bank Negara Malaysia’s Guidelines on Anti-Money Laundering and Counter Financing of Terrorism (AML/CFT) – Insurance and Takaful (Sector 2) and the Company’s AML/CFT Policy, I undertake to conduct a proper verification on the customer by sighting the identification document of the customer whereby,
|For individual customer, the original NRIC / passport / birth certificate; and|
|For corporation / club / society / charity, the original / certified true copy of its certificate of incorporation / registration and identification documents of its director / shareholders / partners / authorised persons.|
Note: For the purpose of this Declaration, the Company refers to AIA Bhd. (Company No. 790895-D) and/or AIA PUBLIC Takaful Bhd. (Company No. 935955-M), whichever is applicable.
Signature of applicant*
Jessica Tan Mei Wei
Applicant Identification No.
Applicant Signature Date & Time
01 Mar 2018, 00:45
No. 7, Jalan Indah, Taman Raya 56100, Kuala Lumpur, W.P. Kuala Lumpur
Signature of WITNESS*
Witness Identification No.*
witness Signature Date & Time
01 Mar 2018, 00:45