Certificate of Insurance / Sijil Insurans This is to certify that / Dengan ini disahkan bahawa

NRIC / No. KP :

is a Life Assured under the / ialah Hayat yang Diinsuranskan di bawah

TOKIOMARINE – STARTERPACK

issued to the Policy Owner / yang dikeluarkan kepada Pemilik Polisi

Tokio Marine Life Insurance Malaysia Bhd.

This policy does not participate in the profits of Tokio Marine Life Insurance Malaysia Bhd. / Polisi ini tidak menyertai dalam pengagihan untung Tokio Marine Life Insurance Malaysia Bhd.

GROUP POLICY NO./

NO.POLISI BERKUMPULAN : 70000000

CERTIFICATE NO./

NO. SIJIL :

AGE / UMUR : YEARS/ TAHUN EFFECTIVE DATE OF INSURANCE/

TARIKH KUAT KUASA INSURANS :

SUM ASSURED (RM)/

JUMLAH YANG

DIINSURANSKAN (RM) :

EXPIRY DATE OF INSURANCE/

TARIKH TAMAT TEMPOH

INSURANS :

PAYMENT MODE/

MOD BAYARAN :

PREMIUM (RM)/

PREMIUM (RM) :

BENEFITS/

MANFAAT-MANFAAT :

Death Benefit/ Manfaat Kematian 100% of the Sum Assured is payable upon the death of the Life Assured. 100% daripada Jumlah yang Diinsuranskan akan dibayar apabila kematian Hayat yang Diinsuranskan berlaku.

This Certificate is issued in respect of the Life Assured named above as evidence of his insurance provided under the group policy number specified above.

Sijil ini dikeluarkan kepada Hayat yang Diinsuranskan yang namanya dinyatakan di atas sebagai bukti insuransnya yang diberikan di bawah nombor polisi

berkumpulan seperti yang dinyatakan di atas.

This Certificate shall commence on the Effective Date of Insurance as stated above. Sijil ini akan bermula pada Tarikh Kuat Kuasa Insurans seperti yang dinyatakan di atas.

IMPORTANT: Please keep Your Certificate of Insurance properly for future references.

PENTING: Sila simpan Sijil Insurans anda untuk rujukan masa depan.

Authorised Signature / Tandatangan Yang Dibenarkan

___________________________

Issue Date / Tarikh Dikeluarkan: Chief Executive Officer

Exclusion and Limitation:

1. The Death Benefit will not be payable for death resulting from suicide within one (1) year after the Effective Date of

Insurance or the reinstatement date of the insurance cover, whichever is later.

Termination of Coverage:

The coverage shall terminate on the earlier of any of the following events:

1. the date of the Life Assured’s death;

2. the Expiry Date of Insurance;

3. the date on which the Life Assured’s insurance cover is terminated;

4. the date on which the Life Assured’s insurance cover lapses due to non-payment of premium; or

5. any other date on which the Life Assured ceases to be eligible for insurance.

Cooling Off Period:

The Life Assured may request to cancel his/her insurance cover by returning the Certificate of Insurance to the Policy Owner

within fifteen (15) days after the delivery of the Certificate of Insurance. The Company shall refund to the Life Assured the

premium paid less medical fee incurred, if any.

The Certificate of Insurance shall be deemed delivered to the Life Assured on the date of transmission.

Grace Period:

The Life Assured will have a grace period of thirty (30) days from the premium due date to pay the premium due. During the

grace period, the insurance cover will remain in force and any eligible claim will be honored subject to the appropriate

deductions for unpaid premium. If any premium due remains unpaid after the grace period, the coverage will lapse.

Premium Deduction at Death:

In the event of the Life Assured’s death during a Policy Year, any unpaid premium for the Policy Year will first be deducted from

the proceeds payable under the Certificate of Insurance.

Reinstatement:

If the insurance cover on the Life Assured lapses due to non-payment of premium, the Life Assured may apply to reinstate the

insurance cover within sixty (60) days from the date of lapse subject to the Life Assured submitting a health declaration and

repay all outstanding premium due.

Claims Procedure:

To make a claim under the insurance cover, the following documents must be submitted to Us:

1. Completed claim form (which can be downloaded from our website);

2. Certified true copy of the Death Certificate; and

3. Proof of identity of both the Life Assured and the claimant.

Notification of claim must be given to Us in writing within sixty (60) days of the Life Assured’s death. The documents can be

submitted to Us at any of Our branches or by emailing Us at customercare@tokiomarinelife.com.my.

Tokio Marine Life Insurance Malaysia Bhd’s Rights:

1. Payment of the benefit under this Certificate of Insurance shall be a valid discharge of Our responsibilities and liabilities.

2. In the event of non-disclosure or fraud, We reserve the right to reject a claim or to avoid the cover granted to the Life

Assured.

3. Except for fraud, the insurance cover shall be incontestable after it has been in force for two (2) years from the Effective

Date of Insurance.

4. The Policy, the Proposal and any declaration or questionnaire submitted together with this Certificate of Insurance shall

constitute the entire contract between Us and the Policy Owner.

5. The premium payable under this plan is NOT guaranteed and is subject to actual claims experience and other relevant

factors. We reserve the right to revise the renewal premium by giving the Life Assured ninety (90) days’ notice in advance.

Contact us at customercare@tokiomarinelife.com.my or call us on 603-26033999 or find out more about us at

www.tokomarine.com.my

Pengecualian dan Batasan:

1. Manfaat Kematian tidak akan dibayar untuk kematian yang disebabkan oleh membunuh diri dalam tempoh satu (1) tahun

dari Tarikh Kuat Kuasa Insurans atau tarikh pengembalian semula perlindungan insurans, mana-mana yang kemudian.

Penamatan Perlindungan:

Perlindungan akan ditamatkan dalam mana-mana keadaan yang lebih awal berikut: 1. Tarikh kematian yang Diinsuranskan;2. Tarikh Tamat Tempoh Insurans;3. tarikh di mana insurans Hayat yang Diinsuranskan ditamatkan4. tarikh perlindungan insurans Hayat yang Diinsuranskan diluputkan kerana tidak membayar premium; atau5. mana-mana tarikh di mana Hayat yang Diinsuranskan tidak lagi layak untuk mendapatkan insurans.

Tempoh Bertenang:

Hayat yang Diinsuranskan boleh membuat permintaan untuk membatalkan Sijil Insurans dalam tempoh lima belas (15) hari

selepas Sijil Insurans telah dikirim oleh Kami. Hayat yang Diinsuranskan boleh mengembalikan Sijil Insurans kepada Kami dan

Kami akan mengembalikan premium yang dibayar tolak elaun perubatan yang ditanggung, jika ada, kepada Hayat yang

Diinsuranskan.

Tempoh Tangguh:

Hayat Yang Diinsuranskan akan mempunyai tempoh tangguh tiga puluh (30) hari dari tarikh terakhir premium untuk membayar

premium yang perlu dibayar. Semasa tempoh tangguh, perlindungan insurans akan terus berkuatkuasa dan sebarang tuntutan

yang layak akan diproseskan tertakluk kepada potongan yang sesuai untuk premium yang belum dibayar. Jika sebarang premium

yang belum dibayar masih belum dibayar selepas tempoh tangguh, perlindungan akan luput.

Penolakan Premium semasa Kematian:

Sekiranya kematian Hayat yang Diinsuranskan semasa Tahun Polisi, sebarang premium yang belum dibayar untuk Tahun Polisi

akan ditolak dulu dari pembayaran manfaat di bawah Sijil Insurans ini.

Pengembalian semula:

Jika ketamatan perlindungan insurans terhadap Hayat yang Diinsuranskan disebabkan oleh tidak membayar premium, Hayat

yang Diinsuranskan boleh memohon untuk mengembalikan perlindungan insurans dalam tempoh enam puluh (60) hari dari tarikh

luput tertakluk kepada Hayat yang diinsuranskan mengemukakan perisytiharan kesihatan dan membayar balik semua premium

tertunggak.

Prosedur Tuntutan:

Untuk membuat tuntutan di bawah perlindungan insurans, dokumen-dokumen berikut mesti dikemukakan kepada Kami:

1. Borang tuntutan yang lengkap (yang boleh dimuat turun dari laman web kami);

2. Salinan Sijil Kematian yang disahkan; dan

3. Bukti identiti kedua-dua Hayat Yang Diinsuranskan dan pihak menuntut.

Pemberitahuan tuntutan mesti diberikan kepada Kami secara bertulis dalam tempoh enam puluh (60) hari kematian Hayat yang

Diinsuranskan. Dokumen tersebut boleh dikemukakan kepada Kami di mana-mana cawangan kami atau dengan menghantar e-

mel kepada kami di customercare@tokiomarinelife.com.my.

Hak Tokio Marine Life Insurance Malaysia Bhd:

1. Pembayaran apa-apa manfaat di bawah Sijil Insurans ini merupakan suatu pelepasan tanggungjawab sah untuk Kami.

2. Sekiranya berlaku ketidakdedahan maklumat penting atau penipuan, Kami berhak untuk menolak tuntutan atau

mengelakkan perlindungan yang diberikan kepada Hayat Yang Diinsuranskan.

3. Kecuali penipuan, perlindungan insurans tidak boleh ditolak selepas ia telah berkuat kuasa selama dua (2) tahun dari Tarikh

Berkuatkuasa.

4. Polisi, Cadangan dan apa-apa perisytiharan atau soalan yang dikemukakan bersama-sama dengan Sijil Insurans ini akan

membentuk seluruh kontrak di antara Kami dengan Hayat yang Diinsuranskan.

5. Premium yang perlu dibayar di bawah pelan ini TIDAK dijamin dan tertakluk kepada pengalaman tuntutan sebenar dan

faktor lain yang berkaitan. Kami berhak untuk menyelaraskan premium pembaharuan dengan memberi notis sembilan puluh

(90) hari terlebih dahulu.

Hubungi kami di customercare@tokiomarinelife.com.my atau hubungi kami di 603-26033999 atau ketahui lebih lanjut mengenai kami

di www.tokomarine.com.my

PROPOSAL FOR TOKIOMARINE-STARTERPACK

Certificate No. :

Life Assured’s Details

Name

NRIC No.

Life Assured’s Personal Statement and Declaration

1. I confirm that I have never been diagnosed with or sought medical advice or treatment for any form of high blood pressure, diabetes, heart disease, stroke, cancer, liver or kidney disease, AIDS, HIV or any other serious illness / physical impairment.

Yes

2. I confirm that I have NOT had any application for insurance on My life ever been declined, withdrawn, postponed, rated or modified in any way.

Yes

3. I agree and authorise TMLM to use my personal data provided or release my personal data to any personor organisation for marketing and promotion purposes. I understand that I can choose to unsubscribe atany time if I no longer wish to receive any marketing or promotional materials from TMLM by notifyingTMLM in writing.

Acknowledgement: 1. I have read and understood the Terms and Conditions and agree to be bound by them.

Terms and Conditions: a) I have read and understood the Product Disclosure Sheet, sales illustration (if any) and other marketing materials

(if any) provided to me in respect of the insurance coverage plan proposed for in this application, including butnot limited to the terms, description, benefits and limitations that apply to this plan and my duties under theinsurance cover and I agree to be bound by them.

b) I have read and understood my Duty of Disclosure and I declare that all details I have entered in this applicationare true, correct and complete and I have not withheld any important or relevant information to this application.

c) I understand that any incorrect or incomplete information provided will entitle Tokio Marine Life InsuranceMalaysia Bhd ("TMLM") to void the insurance cover issued, my claim being denied or reduced, or the termsgoverning the cover being changed or varied.

d) I agree and authorise TMLM to collect, record, hold, use, store and disclose my personal data including anysensitive personal data in accordance with TMLM's Privacy Policy and Data Protection Policy athttps://www.tokiomarine.com/my/en/about-us/corporate-policies/privacy-policy.html

e) I have read and understood TMLM's Privacy Policy and Data Protection Policy and agree to provide my consentfor my personal data to be used for the purposes stated therein.

Duty of Disclosure You should answer the questions asked by Us honestly, fully, and accurately. Failure to give answers that are full and accurate may result in Your policy being voided, a claim not being paid or reduced, or the terms of the policy being changed. You are advised to take reasonable care not to make any misrepresentation when answering any questions asked by Us. In addition to answering the questions in this Application, You are also required to take reasonable care to tell us any matter which You know to be relevant to Our decision on whether to accept the risk or not and the rates and terms to be applied. You must inform us if there is any change to the information given in this proposal after You have submitted this proposal but before the contract is entered into or varied. If You do not understand Your duty as stated above or if You need any further explanation, You can contact Us.

2. In the event of non-disclosure during underwriting stage:a) Tokio Marine Life Insurance Malaysia Bhd. (TMLM) reserves the full rights to reject the application, after system

validation at TMLM; andb) TMLM reserves the right to reject the claims.