Professional Documents
Culture Documents
AGENT'S DECLARATION
I hereby declare that I have sighted the original NRIC/Passport/Birth Certificate of the Person to be Covered and the Proposer and verified the
identity(ies) of the Person to be Covered and the Proposer through the use of such NRIC/Passport/Birth Certificate. In case of the Proposer
being a corporate customer (including company and business), I have sighted the original/verified true copy of its certificate of
incorporation/registration, identification document of its directors/shareholders/partners and of person authorised to represent the corporate
customer, and verified their identities through the use of such documents.
I further declare that I have adhered to the requirements of the Proper Financial Advice Checklist and have disclosed all required information
and advice to the Proposer. I have also explained and given the Proposer the full set of Takaful Operator's approved Benefit Illustration and
Product Disclosure Sheet relevant to the proposed products. I hereby confirm that I had clicked on the agent's confirmation box in the
electronic "Confirmation Note From the Soliciting Agent". By so doing I understand that I had confirmed that the party/parties to the proposed
certificate had/have fully understood the contents of the E-Form(s) together with the statements made and answers given by him/them to the
questions therein and that he/they had duly indicated his/their agreement to submit the duly completed E-Forms to the Takaful Operator for
processing.
I agree to preserve the confidentiality of information disclosed to me in the Prospective Certificate Owner Fact Find Form by the Prospective
Certificate Owner and not to release such information to third parties, and to restrict the use of such information only for the purpose of
recommending Family Takaful products.
The analysis/advice in Prospective Certificate Owner Fact Find Form is based on the facts furnished in the Form and other relevant facts
which are made available to me. I have taken reasonable steps to ensure that the advice is suitable for the Prospective Certificate Owner,
having regard to the facts disclosed in this Form. I have also explained to the Prospective Certificate Owner about the features of the product
recommended and have given sufficient information to enable the Prospective Certificate Owner to make an informed decision.
I hereby certify and witness the following signature(s) was/were made in my presence and that to my own personal knowledge it is the
signature(s) of the Person to be Covered/Proposer/Credit Card Holder.
X X
Signature of Proposer (Owner - if other than Person to be Covered) Signature of Person to be Covered
Name Name
X X X
Signature of Credit Card Holder Signature of Agent/Financial Advisor Signature of Agency Leader
(For electronic Easy Pay Form) (For year ONE Agent ONLY)
Rank
Date / /
Day Month Year
* For applications of the Agent's own takaful or his immediate family members, the Agent's immediate Officer or GM or the Takaful Operator's Executive or Head
of Business Development/Administration Manager/Head should countersign,verify and confirm the information to be correct at Signature of Leader.
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