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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-certificate:

QUOTE 

contribution

RM0.00

contribution cycle

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QUOTE 

contribution

RM0.00

Add-on cost

RM0.00

Total cost

RM0.00

contribution cycle

{{cylce}}

Please tick the box below to proceed:

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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 Takaful 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 featured 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 and/or information when answering any questions asked by AIA PUBLIC and that I am to answer the questions fully and accurately and/or 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 asked by AIA PUBLIC after having fully read and understood the questions;
    3. I fully understand that my answers and/or statements given in respect of the questions asked by AIA PUBLIC, and any other relevant documents completed by me in connection with the application and in any medical report or amendments are relevant to AIA PUBLIC in deciding whether to accept my application or not and the rates and terms to be applied;
    4. I am aware that if the information given by me is not accurate or correct, the certificate may be avoided, my claim denied or reduced, the terms of the certificate changed or varied, or the certificate terminated.
  3. I will keep AIA PUBLIC updated of any change to such personal information as soon as practicable.
  4. I agree that neither AIA PUBLIC 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 PUBLIC and shall include but shall not be limited to personal details of transactions with or through AIA PUBLIC whether within or outside Malaysia involving any party.
  5. I hereby agree that my Contribution, as billed by AIA PUBLIC, shall be debited from my credit card or my bank account (where applicable) as stated in this application.
  6. I understand that I will have a 15-day free look period from the date I received the e-certificate from AIA PUBLIC to evaluate the suitability of the plan participated. In the event that I wish to cancel the said certificate during this period, I may do so by giving AIA PUBLIC written notice of my intention to AIA PUBLIC for cancellation.
  7. I understand that the coverage will only be effective upon receipt of the appropriate Contribution payment and approval by AIA PUBLIC of this application and relevant e-certificate is issued and delivered to me pursuant to this application during my lifetime and in good health.
  8. I hereby agree:
    1. To participate in the Takaful plan pursuant to this application based on the principle of Takaful and pay the required Contribution which will be credited in the Participant’s Risk Fund (PRF).
    2. To allocate a portion of my Contribution in PRF as a Tabarru’ (donation) to be used for the Takaful coverage and for mutual financial aid and assistance to other participants in time of misfortune as prescribed in the Takaful Certificate. I understand that I am also entitled to receive the unutilised portion of the Contribution allocated in the PRF, provided that no claim has been made, in the event of surrender.
    3. To appoint AIA PUBLIC on the basis of Wakalah (agency) principle to manage the Takaful scheme, including managing the PRF in accordance with Shariah principles.
    4. To allow AIA PUBLIC to deduct a certain percentage (%) of Contribution as a Wakalah (agency) fee to AIA PUBLIC for the services rendered and any other chargers as stipulated in the Product Disclosure Sheet.
    5. That AIA PUBLIC is entitled to any surplus arising from the PRF of up to 50% as a performance fee.
    6. If the PRF becomes deficit, AIA PUBLIC will arrange for a al-Qard al-Hasan (interest free loan) to enable the PRF to fulfil its obligation and the al-Qard al-Hasan will be repaid from future surplus of the PRF.
  9. I hereby agree that any sum payable to either me, jointly or equal in value to RM10.00 or less in total shall be credited into overage account, which will be utilized as charity on behalf of the participants.
  10. I understand and agree that any personal information collected or held by AIA PUBLIC (whether contained in this application or otherwise obtained) may be held, used and disclosed by AIA PUBLIC to individuals/organization related to and associated with AIA PUBLIC or any selected third party (within or outside of Malaysia, including retakaful and claims investigation companies and industry associations/federations) for the purpose of processing this application and providing subsequent service for this and other financial products and service 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 PUBLIC concerning me. Such request can be made to any of AIA Customer Centres.

QUOTE 

contribution

RM0.00

Add-on cost

RM0.00

Total cost

RM0.00

contribution cycle

{{cylce}}

Please tick the boxes below to proceed:

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Confirm your participation

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?
  • Your coverage for this plan is {{CoverYears}} year only
  • How much do you want to be covered for?
  • RM {{SumInsured}}
  • Have you smoked cigarettes in the last 12 months?
  • {{CigaretteDesc}}
  • e-Certificate 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


Nominee details

Type of nomination

{{TypeOfNomination}}

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

QUOTE 

contribution

RM 0.00

Add-on cost

RM 0.00

Total cost

RM 0.00

contribution cycle

{{cylce}}

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

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PAYMENT IN PROGRESS

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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 

contribution

RM0.00

Add-on cost

RM0.00

Total cost

RM0.00

contribution cycle

{{cylce}}

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Thank you for choosing AIA Public!

Thank you for Choosing AIA PUBLIC!

Your participation is confirmed and your Takaful coverage starts today.

Certificate number: {{PolicyNo}}

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

You will also receive a Welcome Email from AIA Vitality Malaysia to activate your membership account.

It is advisable for you to appoint a nominee(s), either as an executor or as a beneficiary under a Conditional Hibah (Gift), to receive the benefits to be paid from your Takaful certificate should you pass away. Click here to find out how.

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