In consideration of the Company accepting this Direct Credit request, I agree to and accept the following terms and conditions:

1. I am the holder of the bank account specified above ("Account") and the details thereof are correct, true and complete. I further confirm that I have full power and authority to operate the Account.
2. I hereby request and authorise the Company to credit any moneys that are due to me under my above-captioned Policy directly into this Account and I accept full responsibility for all transactions arising from the use of this Direct Credit payment facility.
3. The Direct Credit payment facility is only applicable to existing active individual savings or individual current account which must be maintained with one of the financial institutions offering MEPS INTERBANK GIRO (IBG) service. A list of IBG members can be found at http://www.myclear.org.my.
4. Any use of correction fluid on documents required for the purposes of this request will not be accepted.
5. The Company shall not be held responsible for any claims, loss, damage and/or expenses arising from the successful or unsuccessful processing of the debit due to exceeding credit limits, insufficient funds in my account, malfunction of system, electricity failure and any other factors beyond the Company's control.
6. I acknowledge and agree that the Direct Credit payment facility provided by the Company is solely for my/ our convenience and benefit.
7. I will notify the Company in writing of any changes to my Account or the discontinuance of this facility. Any change or cancellation will only be effective after the Company has duly acknowledged receipt of such notice.
8. Unless and until the Company receives written notification of my death, incapacity or revocation of this authorisation, this authorisation will remain in force and effective.
9. The Company may at its absolute discretion at any time terminate this facility without assigning any reason by giving me or the Policy Owner one day written notice or change the Terms and Conditions herein without prior notice to me or the Policy Owner.
10. I shall immediately refund to the Company in full any moneys paid into this Account which I am not entitled to receive.
11. I hereby agree to keep the Company indemnified against any claims, loss, damage and/or expenses which the Company may suffer or incur as a result of the Company acting on my instruction.
12. I understand that any payment into the Account shall be a valid discharge of the Company's liability under the Policy.

In consideration of the Company accepting this Direct Credit request, I agree to and accept the following terms and conditions:

1. The Company shall not be held responsible for any claims, loss, damage and/or expenses arising from the successful or unsuccessful processing of the debit due to exceeding credit limits, insufficient funds in my account, malfunction of system, electricity failure and any other factors beyond the Company's control. I am, therefore, responsible to resolve all problems or dispute with my Card Company arising from the processing or debiting of my card.
2. The Company shall not be required to enquire whether my signature in this application is the same as that in in my Card Company's record.
3. I will notify the Company in writing of any changes to my card or cancellation of this authorization at least one month before the next premium is due. Any change will only be effective after the Company has duly acknowledged receipt of such notice.
4. The Company may at its absolute discretion at any time terminate this arrangement without assigning any reason by giving me or the Policy Owner one month's written notice or change the Terms and Conditions herein without prior notice to me or the Policy Owner.
5. I hereby agree to keep the Company indemnified against any claims, loss, damage and/or expenses which the Company may suffer or incur as a result of the Company acting on my authorization.
6. In the event that any moneys are refunded by the Company for any reason, the Company is authorized to refund the moneys to me or the Policy Owner by crediting the said sum into my card account and shall thereafter be fully discharged from all obligations pertaining to the same. Should any dispute arise, both the Policy Owner and I shall refer only to each other for remedies and resolutions.
7. The Policy Owner or I shall settle any outstanding premium until this authorisation is effective.
8. Receipts will not be issued for premium payments made through this arrangement. I shall refer to my account statements or annual confirmation letter (statement for Income Tax) from the Company for confirmation of payments.
9. Unless and until the Company receives written notification of my death, incapacity or revocation of this authorisation, this authorisation will remain in force and effective.
10. The Company is under no obligation to honour any direct debit instruction unless there is sufficient available credit limit in my card account at the time the payment is due. I am solely responsibly to ensure that there is sufficient credit available at all times in my card account.
11. Insurance coverage will only commence from the date of approval of the application subject to full premium being paid.

In consideration of the Company accepting this banking card/account request, I agree to and accept the following terms and conditions:

1. The Company shall not be held responsible for any claims, loss, damage and/or expenses arising from the successful or unsuccessful processing of the debit due to exceeding credit limits, insufficient funds in my account, malfunction of system, electricity failure and any other factors beyond the Company's control. I am, therefore, responsible to resolve all problems or disputes with my card/account Bank arising from the processing or debiting of my card/account.
2. The Company shall not be required to enquire whether my signature in this application is the same as that in my bank's record.
3. I will notify the Company in writing of any changes to my card/bank account or cancellation of this authorization at least one month before the next premium is due. Any change will only be effective after the Company has duly acknowledged the receipt of such notice.
4. The Company may at its absolute discretion at any time terminate this arrangement without assigning any reason by giving me or the Policy Owner one month's written notice or change the Terms and Conditions herein without prior notice to me or the Policy Owner.
5. I hereby agree to keep the Company indemnified against any claims, loss, damage and/or expenses which the Company may suffer or incur as a result of the Company acting on my authorization. 
6. In the event that any money are refunded by the Company for any reason, the Company is authorized to refund the money to me or the Policy Owner by crediting the said sum into my bank account and shall thereafter be fully discharged from all obligations pertaining to the same. Should any dispute arise, both the Policy Owner and I shall refer only to each other for remedies and resolutions.
7. The Policy Owner or I shall settle any outstanding premium until this authorisation is effective.
8. Receipts will not be issued for premium payments made through this arrangement. I shall refer to my account statements or annual confirmation letter (statement for Income Tax) from the Company for confirmation of payments.
9. Unless and until the Company receives written notification of my death, incapacity or revocation of this authorisation, this authorisation will remain in force and effective.
10. The Company is under no obligation to honour any direct debit instruction unless there is sufficient available credit limit/fund in my card/account at the time the payment is due. I am solely responsible to ensure that there is sufficient credit/fund available at all times in my card/account. 
11. The insurance coverage will only commence from the date of approval of the application subject to full premium being paid.

I/We, the Policy Owner in the title of the above mentioned policy, hereby authorize and request that the above policy be changed in accordance with the above particulars. I/We further agree that any alteration or variation shall not take effect until the request is approved by the Company.

I understand and agree that the information I supply will be collected, used and processed by the Company, its agents and its authorised parties (within or outside of Malaysia) for the purposes of processing this application and to facilitate the Company's function as an insurance company. I understand that I have a right to obtain access to and to request correction of my personal information held by the Company by contacting the Company's Customer Service Representative

1. I/We, the Policy Owner in the title of the above mentioned policy, hereby authorize and request that the above policy be changed in accordance with the above particulars. I/We further agree that any alteration or variation shall not take effect until the request is approved by the Company.
2. I understand and agree that the information I supply will be collected, used and processed by the Company, its agents and its authorised parties (within or outside of Malaysia) for the purposes of processing this application and to facilitate the Company’s function as an insurance company. I understand that I have a right to obtain access to and to request correction of my personal information held by the Company by contacting the Company’s Customer Service Representatives.

1. If you are a US person
   1. Please download Personal Particulars Update Form
   2. Please download W-9 Form http://www.irs.gov/pub/irs-pdf/fw9.pdf
   3. Please refer instructions http://www.irs.gov/pub/irs-pdf/iw9.pdf


2. If you are a US Indicia
   1. Please download Particulars Update Form
   2. Please download W-8BEN Form http://www.irs.gov/pub/irs-pdf/fw8ben.pdf
   3. Please refer Instructions http://www.irs.gov/pub/irs-pdf/iw8ben.pdf

2. Please download Personal Particulars Update Form
3. Please download Tax Residency Self-Certification Form
4. Please refer informationhttp://www.oecd.org/tax/automatic-exchange/crs-implementation-and-assistance/tax-residency/