TOKIOMARINE

INSURANCE GROUP

BENEFIT PAYMENT FORM

Policy No 00267191

WELLNESS BENEFIT
Type of Payment

Please select ONE option:

UPayNow registered with Singapore NRIC/FIN

Please note that PayNow account registered with mobile number is not acceptable.

YOu may register for PayNow account using your Singapore NRIC/FIN via "Manage Paynow"
in your internet banking or mobile banking application.
cheque to your mailing address.
f the PayNow transaction is unsuccessful, we will
send you a

Electronic Fund Transferto your Singapore Bank Account

and bank
Please attach a copy of your bank statement/passbook showing your name
account no.

Name of Singapore Bank DBS BANK LTD

Account NNo 404 O6135-4
Bank Account Holder's Name CHEAH HON KEONG

Bank Swift Code DB S9SGSG

Declaration &Authorisation
We hereby authorise Tokio Marine Life Insurance Singapore Ltd to take this onetime instruction to

credit the current and all future due amounts to Me/Us under the selected type of payment to the
above requested Paynow/Bank Account, Where Applicable. Amounts so credited would constitute
valid discharge of above payment due to me/us.

This will be treated as the latest Policy Preferred Payment Method instruction to be registered in TMLS
records.

wWe authorize Tokio Marine Life Insurance Singapore Ltd to update my/our Email Address and/or
Mobile No. to the information provided by me/us in this form.

Page 1 of 2 (wef 01112020)

Tokio Marine Life Insurance Singapore Ltd. Company Reg. No: 194200055D)
20 McCallum Street #07-01 Tokio Marine Centre Singapore O69046 T: (65 6592 6100 F: (65) 5223 9120 W tokiomarine.com A member of the
Tokio Marine Group
 TOKIOMARINE
INSURANCE GROUP

BENEFIT PAYMENT FORM

DHO Policy No 00267191

Type of Payment WELLNESS BENEFIT

Please select ONE option:

PayNow registered with Singapore NRIC/FINN
Please note that PayNow account registered with mobile number is not acceptable.

You may register for PayNow account using your Singapore NRIC/FIN via "Manage Paynow
in your internet banking or mobile banking application.

I f the PayNow transaction is unsuccessful, we will send you a cheque to your mailing address.

Electronic Fund Transfer to your Singapore Bank Account

Please attach a copy of your bank statement/passbook showing your name and bank
account no.

Name of Singapore Bank DBS BANK LTD

Account No 404 06135-4+
Bank Account Holder's Name CHEAH HONN KEONG
Bank Swift Code DeS9eGSG

Declaration & Authorisation

wwe hereby authorise Tokio Marine Life Insurance Singapore Ltd to take this onetime instruction to
credit the current and all future due amounts to Me/Us under the selected type of payment to the
above requested Paynow/Bank Account, Where Applicable. Amounts so credited would constitute
valid discharge of above payment due to me/us.

This will be treated as the latest Policy Preferred Payment Method instruction to be registered in TMLS
records.

We authorize Tokio Marine Life Insurance Singapore Ltd to update my/our Email Address and/or
Mobile No. to the information provided by me/us in this form.

Page 1 of 2 (wef 01112020)

Tokio Marine Life Insurance Singapore Ltd. (company Reg No: 1948000550)
20 McCallium Street #07-01 TOkio Marine Centre Singapore 069046 T. (65) 6592 6100 F (65) 6223 9120 W tokiomarine com A member of the
Tokio Marine Group