EASY WAY TO PAY YOUR PREMUIM

Contact Us : 1-300-88-1616 ( 8.30 -5.30 pm ) Friday 5.00 pm Webpage : www.axa.com.my

1 Additional Information
Biller Code : 2006 - Please retain the Transaction Slip for reference
Ref-1: Your AXA AFFIN Life Policy Number - You will receive an official receipt from us for this payment.

JomPAY online at Internet and Mobile Banking with your Current, Savings
or Credit Card account
2 Credit Card Arrangement 5 Bank Auto Debit Arrangement
Automatically charge your premium to your VISA or MASTER credit card You may opt to enroll your premium payment through your savings or
by filling up the form below. current account maintained in any of the banks below:
Send this form back to us via: Please call us for the requirement form.
- Email at customer.care@axa-life.com.my or - BSN
- Fax at 03-2117 6768 - Alliance Bank
- FPX (Direct Debit)
Bank Islam Malaysia Berhad
3 Electronic Payment ( INTERNET ) Bank Kerjasama Rakyat Malaysia Berhad
Pay your renewal premium online anytime. Bank of America Merrill Lynch
- click on Maybank Internet Portal-www.maybank2U.com.my CIMB Bank Berhad
- REFERENCE - Indicate your AXA AFFIN Life Policy Number Citibank Berhad
Deutsche Bank Malaysia Berhad
Hong Leong Bank Berhad
4 Over the Counter - MAYBANK or BSN HSBC Bank Malaysia Berhad
Visit any of Maybank or BSN Branches nearest to you. Malayan Banking Berhad
Fill out the bank-in slip with the following details: OCBC Bank Malaysia Berhad
- PAYEE : AXA AFFIN LIFE INSURANCE BERHAD Public Bank Berhad
- MBB ACCOUNT NO : 514356721583 Standard Chartered Bank Malaysia Berhad
- BSN ACCOUNT NO : 1410029898651859
- REFERENCE - Indicate your AXA AFFIN Life Policy Number 7 Mail
- Do Not pay through the Self Service Terminals such as - Cheques must be payable to AXA AFFIN Life Insurance Berhad
ATM / Cash & Cheque Deposit Machine and mail to:
Address : AXA AFFIN Life Insurance Berhad
8th Floor , Chulan Tower
6 Branch Office Counter No 3 , Jalan Conlay
- Walk in to any of our branches near to you to pay your 50450 Kuala Lumpur
premuim by Cash , Cheque or Credit Card (VISA / MASTER CARD ) - Indicate the Policy No. / Insured's IC number on the reverse side
- Policy Number or IC number of the Insured is required of the cheque
- Do not send Cash by mail

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Owner's Name: ______________________________________ Policy Number: ______________________________________

q CREDIT CARD AUTHORIZATION FORM

I authorize AXA AFFIN Life Insurance Berhad (723739W) to charge my credit card with the amount of premium due as advised by AXA AFFIN Life from
time to time for this insurance policy. I understand that all renewal premiums will be automatically charged to my credit card until further notice from
me.

Cardholder’s Name:

Issuing Bank:

Credit Card Number:

Expiry Date (MM/YYYY):

q I want to change my Correspondence Address / Contact Details

Post code : _________________________________________ E-mail : ___________________________________

Mobile No.: _________________________________________ House Tel. No. __________________________________________

Owner's Signature: ___________________________________ Date: ___________________________________