PROTECTOR PLUS APPLICATION AND PRODUCT SUMMARY

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STAR PROTECTOR PLUS

APPLICATION AND PRODUCT SUMMARY

November 2020

AIA Singapore Private Limited

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SUBMISSION CHECKLIST

Application Form

Product Summary Cover Page

Interbank Giro

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PART0008 (04/2019 09/2020 10/2020)

AIA Singapore Private Limited (Reg. No. 201106386R) AIA Customer Service Centre, 1 Finlayson Green, Singapore 049246 Monday – Friday: 8.45am – 5.30pm AIA Customer Care Hotline: 1800 248 8000 AIA.COM.SG

1

DETAILS OF APPLICANT/OWNER (Please tick the circles as appropriate)

Name (shown on NRIC/FIN/Passport):

Date of Birth: dd mm yyyy

Gender: Male Female

Place of Birth: United States of America Others (Country): _________________

Marital Status:

Single Married Widowed / Divorced / Separated

Residency Status:

Singapore Singapore PR Pass Holders Others

NRIC/FIN/Passport No.:

For Singapore PRs and Pass holders, please use Singapore NRIC or FIN No.

Country of Residence:

Contact Details:

Home: Country Code - Phone No. 2IÀFHCountry Code - Phone No.

Mobile: Country Code - Phone No. Email:

Current Residence Address

Please submit the following document(s) to show proof of this address.

(i) For Singaporeans and PRs residing in Singapore- Copy of NRIC (ii) For Singaporeans and PRs residing overseas and Pass holders-

Letters from government or banks, or utility or telephone bills (dated within the last 6 months)

Citizenship:

if not Singaporean

Foreign Permanent Residence Address - Please provide the full address in English. (Compulsory for non-Singaporeans)

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shows proof of this address.

If the address on the document(s) differs from this address, please explain the reason(s) in writing.

Postal Code:

Mailing Address (Use of P.O. Box is not allowed):

For Singaporeans, PRs and Pass holders - if different from Current Residence Address.Only Singapore Mailing address is allowed.

For Passers-by - if different from Foreign Permanent Residence Address.

Postal Code:

Please provide the reason if:

1. Your “Current Residence Address” is different from your identity documents and/or 2. Your Foreign Permanent Address is different from your identity documents and/or 3. Your “Mailing Address” is different from your “Current Residence Address”

Note: Please provide separate reasons if all the addresses do not match.

Relationship of Applicant/Owner to Proposed Insured: Parent Legal Guardian

AIA SINGAPORE

WARNING: In accordance with Section 25(5) of the Insurance Act Cap.142, as may be amended from time to time, you are to fully and faithfully disclose in this Application Form all facts which you know, or ought to know, failing which you may receive nothing from the policy and/or the policy issued may be void.

Corporate ID: WM

Master Policy No. (For Worksite Marketing Only) Policy 1

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Policy 2

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AIA STAR PROTECTOR PLUS APPLICATION (PARTNERSHIP DISTRIBUTION)

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A381020010206

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AIA STAR PROTECTOR PLUS

(Policy 1)

AIA STAR PROTECTOR PLUS (Policy 2)

Plan: Plan 1 Plan 2 Plan 3 Plan: Plan 1 Plan 2 Plan 3

2SWLRQDO%HQHÀW Option 1: S$30,000 Critical Illnesses Option 2: S$50,000

Option 3: S$100,000

2SWLRQDO%HQHÀW Option 1: S$30,000 Critical Illnesses Option 2: S$50,000

Option 3: S$100,000 Regular Premium Payment Frequency:

Monthly Semi-annually Annually

Regular Premium Payment Frequency:

Monthly Semi-annually Annually

Policy 1

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Policy 2

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DETAILS OF CONTINGENT OWNER

Name (shown on NRIC/FIN/Passport): NRIC/FIN/Passport No.:

For Singapore PRs and Pass holders, please use Singapore NRIC or FIN No.

Date of Birth: dd mm yyyy Relationship:

Place of Birth: United States of America Others (Country): _________________

2

DETAILS OF PROPOSED INSURED

Name (shown on NRIC/FIN/Passport):

Date of Birth: dd mm yyyy Gender: Male Female

Place of Birth: United States of America Others (Country): _________________ Country of Residence:

NRIC/FIN/Passport No.:

For Singapore PRs and Pass holders, please use Singapore NRIC or FIN No.

Residency Status: Singapore Singapore PR Pass Holders Others

Name of School / College attending: Citizenship:

if not Singaporean

5

CREDIT CARD AUTHORISATION

I authorise AIA Singapore to charge to my credit card and issuer of the card the initial premium and all subsequent premiums including additional premiums levied (if any) payable to AIA Singapore. Should payment not be successfully effected pursuant to this authorisation for any reason, AIA Singapore shall under no circumstances be held responsible or liable for any non-inception, lapse or termination of the policy due to late or non-payment of premiums. This authorisation shall be binding and remain valid, notwithstanding death of the cardholder, irrespective of whether or not this application is accepted by AIA Singapore.

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&DUGKROGHU·V6LJQDWXUHDVSHU&UHGLW&DUG Date (DD/MM/YYYY)

Important Notes

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2. Recurring arrangement is only available for MasterCard on premiums starting 2^nd anniversary 3. Credit Card payment is NOT allowed for Single Premium policies

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5. Credit Card deduction will be processed upon receipt of this authorization by AIA Singapore. The deduction does not constitute approval of the application

Name of Cardholder (as shown on Credit Card): Contact No.(HP): Credit Card No.: S Visa S Mastercard S Amex

Card Expiry Date (MM/YY): Relationship of Cardholder to the Policyowner Name of Issuing Bank: Country of Issuing Bank:

/ If you have provided a Singapore-issued MasterCard above, please select ONE of the following option

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7.1 a. Height (metres): c. Was there any weight change in the past year?

If yes, how much and state the reason: Yes No b. Weight (kilograms):

G 1DPHDQG$GGUHVVRIWKH3URSRVHG,QVXUHG·VGRFWRU Give date, reason and result of last consultation:

7.2 Has the child received medical advice, counselling or treatment in connection with AIDS, AIDS Related Complex or any other AIDS related condition, been told the child has any of these; or that the child had HIV testing done OR in the last 3 months had any of the following symptoms for more than one week continuously: fatigue, weight loss, diarrhoea, enlarged nodes or unusual skin lesions?

Yes No

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diabetes, cancer, cardiomyopathy, polycystic disease, mental disease or any AIDS related condition? Yes No Relationship Age at Onset Current Age Illness/Age at Death (if deceased)

A381020030406

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DETAILS OF PREVIOUS & CONCURRENT INSURANCE APPLICATIONS AND PURSUITS OF PROPOSED INSURED

6.1 Do the Applicant/ Owner and the Proposed Insured(s) have any in-force insurance policy(ies) or pending insurance application(s)?

If yes, please give details. Yes No

Applicant/Owner Proposed Insured

Insurance Company Death

Total & Permanent Disability Critical Illness

Personal Accident Disability Income Others

Important Note:

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FKDUJHVRUGLVDGYDQWDJHVWKDWPD\DULVHIURPDUHSODFHPHQWZLOORXWZHLJKDQ\SRWHQWLDOEHQHÀWV6RPHRIWKHVHGLVDGYDQWDJHVPD\LQFOXGH

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may be less or not suitable for you as you may not be insurable at standard terms and the new policy terms may be different.

6.2 Is this proposal to replace or intended to replace in full or in part any insurance policy or investment products with AIA Singapore or any other ÀQDQFLDODGYLVHURULQVWLWXWLRQ"

No Yes – Please give details:

6.3 Is any application for or reinstatement of your life, critical illness, accidental, medical, disability or health-related insurance policy pending RUKDVLWHYHUEHHQGHFOLQHGSRVWSRQHGUDWHGRUPRGLÀHGLQDQ\ZD\",I\HVSOHDVHLQGLFDWH&RPSDQ\DQGSURYLGHGHWDLOV

No Yes – Please indicate company:

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DECLARATION

1. RESIDENCY – Please answer according to your Citizenship/Residency that you are holding.

Applicant/Owner Proposed Insured

Yes No Yes No

A. For Singapore Citizen

A.1 Have you resided outside of Singapore continuously for at least 5 years preceding the date of application?

A.2 Are you currently residing in Singapore?

B. For Singapore Permanent Resident & employment pass, work permit, dependant pass or other work pass holders

Have you resided in Singapore for a total of less than 183 days in the 12 months preceding the date of application?

C. For student pass or long term visit pass holders C.1 Does your pass have a duration of less than 90 days?

C.2 Have you resided in Singapore continuously for less than 90 days during the 12 months preceding the date of application?

D. If you do not belong to any of the above categories, please tick here

For Applicant/Owner application, both the Proposed Insured and Applicant need to answer; where the Applicant is not an individual, only the Proposed Insured needs to answer.

I/We acknowledge and agree that the Policy to be issued in relation to this application shall be deemed to be a Singapore Policy.

2. YOUR GUIDE TO HEALTH INSURANCE - Tick as appropriate

I have been informed and directed to view or download a copy of “Your Guide to Health Insurance” (applicable only to accident and health business) from www.aia.com.sg, or www.lia.org.sg

I have been informed and I request to be given a hardcopy of “Your Guide to Health Insurance” (applicable only to accident and health business).

7.4 Has the child ever had, or have been told or been treated for:

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affecting the nervous system? Yes No

b. any heart disorder, blood disorder, diabetes, endocrine disorder, liver disease or any gastrointestinal disorder,

kidney problems, nephritis or abnormality of the genitourinary system? Yes No

c. condition affecting the sight, hearing or speech, physical or developmental defects, abnormal or premature

birth or any cancer, growth, tumor? Yes No

7.5 In the past 5 years, has the child had any (other than for immunisation or vaccination)

a. of the following tests done? If yes, please give details as indicated below Yes No

Test Date Reason Results Test Date Reason Results

a. Blood Test g. Liver Function Tests

b. Biopsy h. PAP Smear

c. Chest X-Ray i. Ultrasound

d. CT Scan j. Urine

e. ECGs k. Others. Please specify

f. Cholesterol __________________

b. illness, operation, medical advice, investigations or hospital treatment not mentioned above? Yes No

8

REMARKS In connection with insurance applied for, if any answer to question 7 is “Yes”, give details below, quoting the relevant question number(s).

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ADDITIONAL DECLARATION

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insurance on this application that:

1. No statement, information or agreement made by/to or given by/to the person soliciting/taking this application or any other persons, shall be binding on AIA Singapore Private Limited (“AIA Singapore”), unless presented in writing.

2. The statements and answers in this application together with any required questionnaire or amendments (the “Information) are full, complete, true and correct and that no information or material has been withheld. I/We understand that AIA Singapore, believing the Information to be such, will rely and act on the Information accordingly. I/We further agree that the Information shall form the basis of the contract between the parties hereto. I/We understand that if any of the Information is not full or complete or true or correct, the Policy issued hereunder may EHYRLGDQG,ZHZLOOUHFHLYHRQO\DUHIXQGRIWKHSUHPLXPVZLWKRXWLQWHUHVWOHVVDQ\DQGDOOPHGLFDOH[SHQVHVLQFXUUHGLQ$,$6LQJDSRUH·V

consideration of my/our application.

3. AIA Singapore shall assume no liability whatsoever, and that my/our Policy/Policies will only be effective after this application is accepted E\$,$6LQJDSRUHDQGWKHÀUVWSUHPLXPGXO\SDLGLQIXOOWRDQGDFFHSWHGE\$,$6LQJDSRUHGXULQJWKH,QVXUHG·VOLIHWLPHDQGJRRGKHDOWK

4. All my/our declarations made and my/our statements or answers in this application and in any required questionnaire or amendments together with the relevant Policy shall constitute the entire contract between the parties in so far as it may be relevant to the Policy or Policies I/we have requested.

5. I ( the Applicant/Owner if other than the Proposed Insured) am not an undischarged bankrupt and no bankruptcy application (including any statutory demand) or order has been made against me/us within the last twelve months.

6. I/We hereby authorise, agree and consent to:

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time, irrespective of whether the proposal is accepted by AIA Singapore; and

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of whether the proposal is accepted by AIA Singapore; and

c. AIA Singapore or any of its approved medical examiners or laboratories to perform the necessary medical assessment and tests to underwrite and evaluate my/our health status in relation to this application and any resulting claim; and

d. AIA Singapore Private Limited (“AIA Singapore”), its associated persons/organisations, its and their third party service providers and its and their representatives, whether within or outside Singapore (collectively “AIA Persons”) to collect, use, disclose, store, retain and/or process (collectively, “Use”) all personal data and information (“Personal Data”) that had/has been provided to AIA Persons and/or that AIA Persons possess about me/us (whether from me/us or a third party), in the manner and for the purposes described in the AIA Personal Data Policy (“PD PolicyµZKLFKLVDYDLODEOHRQ$,$6LQJDSRUH·VZHEVLWHLQFOXGLQJEXWQRWOLPLWHGWRSURFHVVLQJRI

this Application/form and/or to provide subsequent advice or services to me/us in relation to this Application/Policy/form/AIA Vitality Programme and/or any other existing or future policy/policies/programmes that I/we may hold/participate with AIA Singapore. Without prejudice to the foregoing, I/we agree to comply with the terms of the PD Policy, including where such PD Policy is amended from time to time by AIA Singapore in accordance with its terms. Where Personal Data of another person is disclosed by me/us, I/we represent and warrant that I/we have obtained the consent of the individual concerned, except to the extent such consent is not required under relevant laws: (i) to collect such Personal Data; (ii) to disclose such Personal Data to the AIA Persons; and (iii) for the AIA Persons to 8VHVXFK3HUVRQDO'DWDLQWKHPDQQHUDQGIRUWKHSXUSRVHVGHVFULEHGLQWKH3'3ROLF\,:HKHUHE\VSHFLÀFDOO\ZDLYHRQRXURZQ

behalf and on behalf of each such other person, and I/we represent and warrant that such other person has granted me/us authority to so waive) any right to bring a claim of any nature against any of the AIA Persons in respect of any above-mentioned Use and/or any Use of Personal Data in the nature of or for any of the purposes described above or in the PD Policy. I/We hereby agree to indemnify AIA Persons for all losses and damages that AIA Persons may suffer in the event that I/we are in breach of any representation and warranty provided by me/us herein.

This authorisation shall bind my/our successors and assignees, and remains valid, notwithstanding death, irrespective whether or not my/

our application is accepted by AIA Singapore. A photocopy of this authorisation shall be effective and valid as the original.

7. Deemed Delivered

I/We understand that the policy document and all other documents from AIA Singapore are considered delivered and received (i) if made DYDLODEOHHOHFWURQLFDOO\YLD0\$,$XSRQUHFHLSWRIWKHUHOHYDQW606DQGRUHPDLOQRWLÀFDWLRQLQIRUPLQJPHWKDWWKHGRFXPHQWLVDFFHVVLEOH

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8. Electronic Receipt of Policy Documents and Correspondences

I/We acknowledge and accept that if I/we had opted to receive my/our Policy Document and/or correspondences relating to my/our Policy (“Correspondences”) electronically, my/our Policy Documents and/or Correspondences will be made available in my/our My AIA. My AIA is

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been explained to me/us and I/we agree to be bound by them.

I/We understand that not all of the Correspondences are currently available via electronic statements.

I/We consent to AIA Singapore providing me/us with hard copies of Correspondences that are currently unavailable electronically. I also understand and accept that AIA Singapore may cease providing hardcopies when the electronic copies become available in future.

I/We agree and accept that AIA (Singapore) will not be responsible for any consequences arising from my/our failure to (i) provide AIA Singapore with a true, complete and accurate email address and mobile number and/or (ii) notify AIA Singapore of any change(s) to my/

our email address and mobile number. I/We acknowledge and accept that my/our Policy Document and/or Correspondences will be delivered via post if my/our email address and mobile number are not provided in this proposal.

Document Delivery Preference

Policy Contract

(Hardcopy version is only available for applicant/Owner age 60 and above)

All other correspondences

(Hardcopy version is only available for applicant/Owner age 60 and above)

Policy 1

Receive my contract in electronic version Receive my contract in hardcopy version

Receive future correspondences electronically Receive future correspondences in hardcopy Policy 2

Receive future correspondences electronically Receive future correspondences in hardcopy Note: Only one option to be selected (either electronic OR hardcopy).

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Policy 2

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10. I am/We are aware that the Policy Contract and all other documents are considered to be received by me/us within 7 days of posting to the address which I/we have instructed AIA Singapore to send correspondence to. I/We agree to inform AIA Singapore immediately of any change in my/our correspondence address.

11. I/We have received a copy of (1)Your Guide to Health Insurance and (2) the Product Summary, (3) “Your Guide to Life Insurance” and (4) “Your Guide to Health Insurance” (applicable only to accident and health business), the contents of which have been explained to me/

us to my/our satisfaction.

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13. I/We understand and agree that AIA Singapore is entitled not to accept or process this application should a person connected with the relevant Policy be found to be a Prohibited Person, meaning a person or entity (including any director or direct / indirect shareholder or SHUVRQ KDYLQJ H[HFXWLYH DXWKRULW\ RU QDWXUDO SHUVRQV DSSRLQWHG WR DFW RQ P\RXU EHKDOI EHQHÀFLDULHV RU P\RXU EHQHÀFLDO RZQHUV RU

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any country, which have the effect of prohibiting AIA Singapore from providing insurance coverage, transacting business with or otherwise RIIHULQJDQ\HFRQRPLFEHQHÀWVWRPHXVRUDQ\RWKHUEHQHÀFLDULHVRUDVVLJQHHVXQGHUWKHUHOHYDQW3ROLF\DQGWKHGHFLVLRQRI$,$6LQJDSRUH

VKDOOEHÀQDO,:HIXUWKHUDJUHHWKDWLQWKHHYHQWWKDW$,$6LQJDSRUHEHFRPHVDZDUHVXEVHTXHQWO\WKDWDSHUVRQFRQQHFWHGZLWKWKH

relevant Policy has become a Prohibited Person, AIA Singapore may block and/or terminate the relevant Policy, including but not limited to, making or receiving any payments under the relevant Policy. As an ongoing obligation, I/we will immediately inform AIA Singapore if WKHUHDUHDQ\FKDQJHVWRWKHLGHQWLWLHVVWDWXVFRQVWLWXWLRQHVWDEOLVKPHQWSDUWLFXODUVDQGLGHQWLÀFDWLRQGRFXPHQWVRIWKHVHSHUVRQV,IDQ

application is accepted or processed by AIA Singapore despite a person connected with the relevant Policy being a Prohibited Person, AIA Singapore shall be entitled to block and/or terminate the relevant Policy at any time, whether with effect from inception of the relevant Policy or otherwise.

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me/us in the Republic of Singapore and that the signing of this application has taken place in the Republic of Singapore.

Declared in SINGAPORE on Day: Month: Year:

WITNESSED BY

SIGNATURE OF APPLICANT/OWNER NAME & SIGNATURE OF AIA

INSURANCE ADVISER(S)

Please note: copies of the terms and conditions on which the insurance will be made, and this completed application form, will be available on your request.

PLEASE NOTE: You are discouraged to switch between an existing accident and/or health insurance Policy without considering whether the switch is detrimental, as there may be potential disadvantages with switching. A penalty may be imposed for early Policy termination and the QHZ3ROLF\PD\FRVWPRUHRUKDYHIHZHUEHQHÀWVDWWKHVDPHFRVW

WARNING: 3OHDVH QRWH WKDW ZLWK HIIHFW IURP 0D\ DOO 3ROLFLHV 5HQHZDO &HUWLÀFDWHV &RYHU 1RWHV (QGRUVHPHQWV IRU 3ROLFLHV ZLWK

commencement date on or after 1 May 2005 carry a Payment Before Cover Warranty Clause which requires the premium to be paid in full on RUEHIRUHWKHGDWHRILQFHSWLRQRIWKH3ROLF\)DLOLQJZKLFKWKHUHZRXOGEHQROLDELOLW\XQGHUWKH3ROLF\5HQHZDO&HUWLÀFDWHV&RYHU1RWHVDQG

Endorsements.

WARNING: If a material fact is not disclosed in this proposal, any policy issued may not be valid. If you are in doubt as to whether a fact is material, you are advised to disclose it. This includes any information that you may have provided to the Insurance Adviser(s) but was not included in the SURSRVDO3OHDVHFKHFNWRHQVXUH\RXDUHIXOO\VDWLVÀHGZLWKWKHLQIRUPDWLRQGHFODUHGLQWKLVSURSRVDO$GGLWLRQDOO\DQGZLWKRXWSUHMXGLFHWRWKH

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all material facts that may arise or which have changed from the information you had provided.

Please sign Policy Illustration / Product Summary and Financial Health Review together with this application form.

Marketing Consent

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and the conducting of consumer, marketing-related and other similar research and analysis by, AIA Persons^[1] and to each of them collecting, using, disclosing, storing, retaining and processing all my personal data in accordance with the terms in this form and the AIA Personal Data Policy (Singapore). I also consent to AIA Persons disclosing my personal data to independent third parties and their representatives and for them to process my personal data, for such purposes.

Contact me by^[2]: Post

Electronic transmission to or through my email addresses and social media accounts Voice call

Text message (e.g. SMS/MMS)

I understand that the consent provided by me in this form is in addition to and does not supersede any consent that given previously for the above purposes.

I may withdraw one or more consents that I have given, at any time via AIA Customer Care Hotline at 1800-248-8000, My AIA SG or by completing and submitting the relevant forms.

1 “AIA Persons” refers to AIA Singapore Private Limited, its associated persons/organisations, its and their third party service providers and its and their representatives, whether within or outside Singapore.

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AIA Singapore Private Limited (Reg. No. 201106386R)

1 Robinson Road, AIA Tower, Singapore 048542 AIA Customer Care Hotline: 1800 248 8000 AIA.COM.SG Product Summary ver2. 

E. & O. E. Page 1 of 1

Product Summary Cover Page

Applicant / Policy

Owner / Policyholder: Signature of Applicant /

Policy Owner / Policyholder:

Proposed Assured / Insured:

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Gender / Occupation:

Modal Premium:

Plan Name: AIA Star Protector Plus Maximum Coverage Age: 75 years old

Name of AIA Financial

Services Consultant / Insurance

Representative:

Signature of AIA Financial Services Consultant / Insurance Representative:

Date:

Name of AIA Financial

Services Consultant / Insurance

Representative:

Signature of AIA Financial Services Consultant / Insurance Representative:

Date:

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Corporation (SDIC). Coverage for your policy is automatic and no further action is required from you. For more information on the types of benefits that are covered under the scheme as well as the limits of coverage, where applicable, please contact your insurer or visit the GIA/LIA or SDIC web-sites (www.gia.org.sg or www.lia.org.sg or www.sdic.org.sg).

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Basic AIA Star Protector Plus Optional Benefit Child Critical Illnesses Benefit

$UH\RXD$,$6ROLWDLUH3$,, 3ODQ DERYH3ROLF\KROGHU"

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G010220010202

Page 1

AIA SINGAPORE

APPLICATION FOR INTERBANK GIRO

PART 1 : To Be Completed By Bank Account Holder

Important notes:

1. All ¿ elds are mandatory. Amendments made must be countersigned by the bank account holders. Use of correction À uid/tape is not allowed.

2. The approval process for GIRO application using this application form is approximately 2 months. Alternatively, for Non-Corporate Solutions policies, POSB/DBS Account Holders can apply for GIRO at any AXS kiosks and you will be noti¿ ed within 7 days if the GIRO application is successful. Until your GIRO application is approved, kindly remit premium payments directly to AIA Singapore Private Limited.

3. For Non-Corporate Solutions Policies, please mail to Life Operations Dept at 03 Tampines Grande, #09-00, AIA Tampines Singapore 528799.

4. For Corporate Solutions Policies, please mail to Corporate Solutions Dept at 03 Tampines Grande, #07-00, AIA Tampines Singapore 528799.

5. AIA Financial Services Consultants (AIA FSC) and their Family Members are not allowed to use their personal bank account (via GIRO) to pay premiums of Policy Owners, other than their own. Disciplinary action will be imposed accordingly.

a. I/We, hereby instruct you to process AIA Singapore Private Limited’s instructions to debit my/our account.

b. You are entitled to reject AIA Singapore Private Limited’s debit instruction if my/our account does not have suf¿ cient funds and charge me/us a fee for this. You may also at your discretion allow the debit even if this results in an overdraft on the account and impose charges accordingly.

c. This authorization will remain in force until terminated by your written notice sent to my/our address last known to you or upon receipt of my/our written revocation through AIA Singapore Private Limited.

Date:

D D M M Y Y Y Y

Billing Organisation: AIA Singapore Private Limited

Name of Bank (Please tick only one): Bank Account Holder’s Name(s):

^POSB/DBS ^OCBC ^UOB

Standard Chartered Maybank HSBC

^Citibank Others : ______________________

Bank Account Number (Please omit dash): Signature(s) / Thumbprint(s)* / Company Stamp (as in Bank’s record):

For OCBC Bank, please write full 10 or 12 digits account numbers

* Your thumbprint(s) need to be witnessed and veri¿ ed by the Bank’s staff. For signature(s), you have an option to approach your respective Bank for veri¿ cation.

Bank Account Holder’s Contact No. (Home/ Mobile):

AIA Insurance Adviser Name & Agency / Distributor Name:

For Non-HealthShield Policy Numbers:

• For loan repayment policy number pre¿ x must be “R”.

• Please ensure that policy numbers are written clearly.

1) 2) 3) 4) 5)

For AIA HealthShield & AIA HSG Max Rider ONLY:

• For GIRO application of AIA HSG Max Rider, please apply under basic HealthShield pre¿ x “H”, e.g. to apply GIRO for E123456789 policy, indicate as H123456789 on the form.

1) H

2) H

3) H

4) H

5) H

PART 2 : To Be Completed By AIA Singapore Private Limited

For POSB/DBS Accounts, please use the following account number: For Other Bank Accounts, please use the following account number:

BANK SWIFT BIC AIA Singapore Bank A/C No. BANK BRANCH AIA Singapore Bank A/C No.

DBSSSGSGXXX 0060126499 7232 141 010876001

PART 3: To Be Completed By Bank

To: AIA Singapore Private Limited

This application is hereby REJECTED (please tick for the following reason(s)):

Signature / Thumbprint^# differs from bank’s records Wrong account number

Signature / Thumbprint^# is incomplete / unclear^# Amendments not countersigned by customer

Account operated by Signature / Thumbprint^# Others: ___________________________________________

________________________________ ________________________________ ________________________________

Name of Approving Of¿ cer Authorised Signature Date

#Delete where applicable

PT0011063 (06/2016 10/2018A 02/2020)

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AIA Singapore Private Limited (Reg. No. 201106386R)

1 Robinson Road, AIA Tower, Singapore 048542 Monday - Friday: 8.45am - 5.30pm AIA Customer Care Hotline: 1800 248 8000 AIA.COM.SG

(07/2020 09/2020 11/2020)

PROTECTOR PLUS APPLICATION AND PRODUCT SUMMARY

STAR PROTECTOR PLUS

APPLICATION AND PRODUCT SUMMARY

November 2020

AIA Singapore Private Limited

SUBMISSION CHECKLIST

Application Form

Product Summary Cover Page

Interbank Giro

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AIA SINGAPORE

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AIA STAR PROTECTOR PLUS APPLICATION (PARTNERSHIP DISTRIBUTION)

*A381020010206*

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*A381020030406*

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*G010220010202*

AIA SINGAPORE

APPLICATION FOR INTERBANK GIRO

PART 1 : To Be Completed By Bank Account Holder

D D M M Y Y Y Y

PART 2 : To Be Completed By AIA Singapore Private Limited

PART 3: To Be Completed By Bank

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A381020010206

A381020030406

A381020050606

G010220010202