Sic insurance singapore Pre MSIG mm MaidPlus Application Form ewes er (A) Particulars of Applicant None sities nine TIEN SUNY HOK Gender Ovaie BFerate Residential Addess BIDE ALEXANDRA ROAD #15-10 Postal ote 154958 yarn ses ce your ening pices withthe new malig hess! Yes No vis $ 2900049 T anus OD single EA ttanies Ooi 6476329, (8) Particulars of Maid Mdm BORIAH w 0 00918970 Gender O mate Bremate (©) Cover Required Basie Plan | ptionat covers (rene Period of insurance (25 ments) Fon (0) Premium Payment A enclose my Plea ee Xe ity INDONESIAN option HOUSE WIFE se OO Malay Cine 58 Transmission, 5832655, B osos04é INGA , INDONESIA Place of Birth PURE evn 0/0/1461 stionainy INDONESIAN Manta Siow MARRIED Suan nsirediiimit |” Premium As per picy $26750 Os5:000 Osa Qs15.000 Bisse $300,000 “ oOOou ojooU Cate(€) Preference For Receiving Updates ene n2rmen) Dyes. | agree to receive updates from MSIG on insurance products and promotions vis SMS and/or phone calls, Ho, do not wish to receive updates from SIG on insurance products and promotions via SMS andlor phone calls (F) Declaration eZ ‘want to effec the insurance specified hee and decay that |) watrane hat the informacion given and answers to questions inthis Application ate tue and cocrect to the best of my knowledge ang have not uwithbela any facts ely to fluence MBC Insurance (Singapore) te Lids (MIG assessment ofthis Application, Uarrant that the maid is i9 ged Mealth and foe from pnyscal detects, infirmity a lines oF recuing ness Understand mat all Pre-existing corctions before the effective date of iis Policy af not covered Understand thatthe personal acdent benefits of tis insucance well only be payable upon an accent accuting apres to accept the terms, conditions ard excisions contained i the Polty and as modified of extended and agree that his Appkation, [Desaration aed ani other information provide shal form she bass of the contract Understand that any guarantee sued by MIG pursuant to the Pokcy is subject fo the Counter Idemity as attached and agtee to the terms fd coneitions there vii) ndertand this App cation vl be subject to the approval and acceptance by MSIG and the orm fly paid and received by MSIG before cover can bestfected. it) Understand and accept that my persona particulars wl be collected, used ard dsclosed by MSIC in accoreance withthe Personal Data Protection fet 2012 an MSG Pivaey & Laokies Pole, for hs provsin oF al services related fe, and protection under. this insurance policy, including for proper spiveing under ting ard clos admnstation MSIe may ciscose my personal paraculars ta is business partners ane third party service proicers for trese purposes. SIG may alsa Send me marketing aller: by post or emas. where there afe re than ane inddual insured perfons. | confirm tney have consented to MSIGs colecton, use and dscosure af ther personal particulars. The full MSIGs Privacy & Cokes Pry can be found at wove msigcomse ‘Signature of Appiant rv) Date ‘AgertiBroker Stamp Ths ply spotted ur the Ply Owes Potecton Sthame which sans by the Singspre Dept surance Corperatin. Far mare information onthe Scheme lease WS wn Bese ee ots 1 of neue Ful tas of the es. condos ad escetons of his nance ae provided the pay nd wb san te you wo MSE naan Sungapar) Be : ive document is nt con scepter pc Counter indemnity To: MSIG insurance (Singspore) Pte Lid In consideration of MIG Insurance (Soporte Le Qereter refered oa MSI) agreeing at my recwesst prove (0) eter of Guaante ore sum of Singapore Do’ Five Tausand Ory (S$5.000) tothe Mushy of Marpowe. Segaote. a cut fr the de nd Seistctry ‘tzenance and partsmance ot condone the Security Bond conoeton wth my empiymant cra fae somestic wore, nde (0 @ epoicble) 9 Letter of Guarantee fr the sm of Siogopoce Doar Twa Sever Treiman ony (8520007557000) tothe Prope Oversens Labour OMe Shgapre Eassy of Puppies sect fr comple of te Eneasy ol Pipe Sanaa rproment Cntac Yt Pipe Housed Woes Snaapore hereby evecaby ad uncon age a undertake fle ‘Vtoindenty MSI en mandi ul aga all clans payers ceands acne sts proceedings loses abies cons interests ad eapenges whatsoever which may Beaten oade agaist Mic orn el Decor payatie by MSG under eet on of ton he saovemettared Lees of Guarantee (Caatateesy 2 tat Stary a table cretion crema cams payment deans atom ute poceccng ses abies costs teresa and expenses which may be {Bren or nade spat Mle under ete: cnz sth he Casares, 2 toaccept al rece vouchers another even fal payments made by MSI oa bite or tigation incur by MSIbyeacan a thr ce bath of he Euantos as conduve eine agate y estate ofthe fat ahd enon of My aby hei 4 tay MSIE meres based an pa aural sms pad by MIG unr ote ofthat he Cantante called rom the date when payment was made Mig um the te when ‘ul payments eveby We rhe, Yo pay ofan tery oss. a Coss an expenses MSR Ted oF May HEMET Fenner bv Counter Infcty sue atc: te ta ay acon algal proceeangs tat aye conmencea by MSE 5 Mat his unt inemnty shale acer nerty ane MS raya ary neo ins a is den wat ving any nae tre extn the vali ofa Feo ether tear buth oe Cast tows ot fant any mulgese otmaee any aongoment of omparise maa ether one Bethe the Casati NOU discharging or imoating my laity snd te Courter ndeONNy, ‘6. that no ey er oman oy he prt #0 cvercing ay en aM Flee or amy in espet a his Counter ney Salmo Suc Ns, Owes Betas ee eats nas = nee ove Corr Co cama OT Px ta EME ts ed 7 ny eit res tm as nn ea ott nt hay of MSG under eae te spect urine as hey Sedo Irdoenty stl te gove ed sn consid by the bs of he Repco Signore and wrevacably sob to the jraction of he Courts the inwiries signed is Counts aderatyon.__dayat_20 ‘Sarature oF Anoicant (Empey ‘Signature ot witness ane nae RIC NUParpert No NRIGFINPSisport No ess oe ess {Copy of npncle Approval ets” Retons Hse 5 Poca of he mato MFA Pascort pt ine yon crs len Fo