Declaration

I/We have read and fully understand the product benefits, key terms and conditions, exclusions, premium, fees and charges that I/we have to pay

I/We to the best of my/our knowledge hereby confirm that the statements contained in this proposal form are true and correct and I/we have not concealed, misrepresented or misstated any material fact.

I/We agree to accept insurance subject to the terms and conditionsof the Company’s policy and that the insurance will not be in force until the proposal has been accepted by the company, except to the extent of any official cover note which may be issued.

I/We hereby declare that any of my/our personal information collected or held by the Company is provided with my/our consent for it to be used, processed and disclosed to individuals or organisations related or associated with MS&AD Insurance Group (in and outside of Malaysia) including inter-departments within the Company or any selected third party service providers such as insurance or reinsurance companies, broking firms, loss adjusting companies, claims or forensic investigations companies, law firms, credit reference companies, any service provider appointed by governing authority/association/federation of insurance companies,association or federation of insurance companies or any corporate entities or governmental and judicial bodies or regulators to whom the Company is obliged to disclose under the requirement of any law relating to the Company or any of its affiliates or partners.

I/We further declare and confirm that I/We have obtained the consent of the person(s) named herein and that he/she/they has/have authorised me/us to disclose his/her/their personal information on his/her/their behalf.

I/We understand that I am/we are entitled to obtain access to and to request correction of my/our personal information held by the Company. I/We also understand that I am/we are entitled to inform the Company to cease processing my/our personal information concerning me/us for the purpose of future cross marketing exercises and that such request can be made to the Company.