• 1
  • 2
  • 3
  • 4
  • 5
  • 6

Enter your details

  • Name
  • {{CustomerDetail.CustomerName}}
  • NRIC no.
  • {{CustomerDetail.NRIC}}

Please enter your address below:

Address (Line 1):

Address (Line 2):

Address (Line 3):

Post code

State

Country

Malaysia


Please select your preferred language for your e-policy:

QUOTE 

Premium

RM 0.00

premium cycle

{{cylce}}

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

QUOTE 

PREMIUM

RM 0.00

Add-on cost

RM 0.00

Total cost

RM 0.00

PREMIUM cycle

{{cylce}}

Please tick the box below to proceed:

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

Declaration

I declare and agree on behalf of myself and any person or persons, firm or corporation, who may have or claim any interest in this insurance application, that:

  1. I have read the Product Disclosure Sheet and I fully understood the contents of the Product Disclosure Sheet and my particular attention has been drawn to the essential information of the major features and limitations of which has been satisfactory explained to me.
  2. I declare that:
    1. I am aware that it is my pre-contractual duty of disclosure that I must exercise reasonable care not to misrepresent i.e. to give false answers/information when answering any questions asked by AIA and that I am to answer the questions fully and accurately/correctly;
    2. I have read and understood the contents of my application including all warnings and notices therein and I have fully and accurately answered all the questions in this application and the other questions asked by AIA, if any, after having fully read and understood the questions.
    3. I am aware that I must inform AIA of any change to the answers given in this application if the change occurred after I have submitted the application but before the contract is entered into.
    4. I fully understand that my answers and/or statements given in respect of the question asked by AIA, and any other relevant documents completed by me in connection with this application and in any medical report or amendments (collectively referred to as “the information”) are relevant to AIA in deciding whether to accept my application or not and the rates and terms to be applied
    5. I am aware that if any of my answers or statements or information given by me is not accurate/correct, the policy may be avoided, my claim denied or reduced, the terms of the policy changed or varied, or the policy terminated.
  3. I will keep AIA updated of any change to such personal information as soon as practicable.
  4. I agree that neither AIA nor its employees shall be liable for any direct or indirect loss or damage due to my inaccuracy or incompleteness in the personal information provided to AIA and shall include but shall not be limited to personal details of transactions with or through AIA whether within or outside Malaysia involving any party.
  5. I understand that the coverage will only be effective upon receipt of the appropriate premium payment and approval by AIA of this application and relevant e-policy is issued and delivered to me pursuant to this application during my lifetime and in good health.
  6. I understand and agree that upon receipt of the e-policy document from AIA, I am obliged to check and confirm and/or ensure the accuracy and completeness of all information declared and submitted to AIA in relation to my application. I also understand that, I will have a 15-day free look period from the date of receipt of the e-policy from AIA to evaluate the suitability of the plan purchased. In the event that I wish to cancel the said policy during this period, I may do so by giving AIA written notice of my intention to AIA for cancellation.
  7. I understand and agree that any personal information collected or held by AIA (whether contained in this purchase or otherwise obtained) may be held, used, and disclosed by AIA to individuals/organization related to and associated with AIA or any selected third party (within or outside of Malaysia, including reinsurance and claims investigation companies and industry associations/federations) for the purpose of processing this purchase and providing subsequent service for this and other financial products and service 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 AIA concerning me. Such request can be made to any of AIA’s Customer Centre.

QUOTE 

PREMIUM

RM 0.00

Add-on cost

RM 0.00

Total cost

RM 0.00

PREMIUM cycle

{{cylce}}

Please tick the boxes below to proceed:

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

Confirm your purchase

quote details
  • Name
  • {{CustomerDetail.CustomerName}}
  • Gender
  • {{#GENDER}}{{Gender}}{{/GENDER}}
  • Age
  • {{Age}}
  • Height
  • {{Height}} cm
  • Weight
  • {{Weight}} kg
  • NRIC no.
  • {{CustomerDetail.NRIC}}
  • Address
  • {{Address1}}
  • {{Address2}}
  • {{Address3}}
  • {{Postcode}} {{State}}
  • {{Country}}
  • Payment Frequency
  • {{PaymentMode}}
  • What industry do you work in?
  • {{Industry}}
  • What is your occupation?
  • {{Occupation}}
  • How many years are you covered for?
  • {{CoverYearsText}}
  • How much do you want to be covered for?
  • RM {{SumInsured}}
  • Have you smoked cigarettes in the last 12 months?
  • {{CigaretteDesc}}
  • e-Policy language
  • {{PreferredLanguage}}
  • Mobile no.
  • {{MobTel}}
  • Email Address
  • {{Email}}

question 1:

{{UnderWriteQuestion}}

Answer: No

question 2:

{{UnderWriteQuestion}}

Answer: No

question 3:

{{UnderWriteQuestion}}

Answer: No

question 4:

{{UnderWriteQuestion}}

Answer: No

question 5:

{{UnderWriteQuestion}}

Answer: No


Nominee details

Nominee 1
  • Name
  • {{CustomerName}}
  • NRIC no.
  • {{Nric}}
  • Relationship to owner
  • {{RelationshipText}}
  • Date of birth
  • {{DateOfBirth}}
  • % allocation of share
  • {{ShareAllocation}}
  • Address
  • {{Address1}}
  • {{Address2}}
  • {{Address3}}
  • {{Postcode}} {{State}}
  • Malaysia

Trustee details

trustee 1
  • Name
  • {{CustomerName}}
  • NRIC no.
  • {{Nric}}
  • Address
  • {{Address1}}
  • {{Address2}}
  • {{Address3}}
  • {{Postcode}} {{State}}
  • Malaysia

QUOTE 

PREMIUM

RM 0.00

Add-on cost

RM 0.00

Total cost

RM 0.00

PREMIUM cycle

{{cylce}}

Ensure that your pop-up is enabled on your browser so that your transaction goes smoothly.

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

PAYMENT IN PROGRESS

You are being redirected to the payment gateway, so please disable your pop up blocker.

Please do not close this window until you have finalised your payment. Once your payment is complete, you will be automatically redirected to the confirmation page.


QUOTE 

PREMIUM

RM0.00

Add-on cost

RM0.00

Total cost

RM0.00

PREMIUM cycle

{{cylce}}

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

Thank you for choosing AIA!

Thank you for Choosing AIA!

Your purchase is confirmed and your insurance coverage starts today.

Policy number: {{PolicyNo}}

We will send you an email confirmation once your policy document is available for you to view and download in your My AIA account.

It is advisable for you to appoint a nominee(s) to receive the benefits to be paid from your life insurance policy should you pass away, and to ensure that the person(s) nominated is aware of this. Without a nomination, policy moneys may be paid to the lawful executor or administrator of your estate, subject to the Financial Services Act 2013. Click here to find out how.

If you have any questions, feel free to contact us.