EX Ale Customer Due Diligence Form (for Individual only) / Borang Usaha Wajar Pelanggan (untuk Perseorangan sahaja) This frm i forthe se of / Barong in adalah unl kegunaan [AIA Bhd. 200701032867 (790896-0), AIA PUBLIC Takaful Bhd. 201101007816 (258564 and AIA General Berhad 20:00:040438 asa) PolcyiGertieate Number Nonor Pale have aubmiied @ copy of NRIG (or Malaysian cizan ony) or Passport (fr Nor-Malaylan eilzen aly) Saya telah menghantar sal Polcyicortscate Owner Yee 4 copy of NRICIPasepet) ayrconaaor LL Yes LIN (please subret copy af RICIPasspot) 1. POLICYIGERTIFICATE OWNER DETAILS / BUTIR-BUTIR PEMILIK POLISUSIJIL All sections are ragired tobe completed Sms bahagien pol llengkapken [NRIC No. Fo Msn tan ot omen — Gander Date Female cto) Nationality Name of Employer Nature of Business ‘occupation Exact Duties Telephone No. weoe offee Lye No. wa complete th PayeriGonttutar formation section below |. PAYORICONTRIBUTOR DETAILS / BUTIR-BUTIR PEMBAYAR/PENCARUM All sections are required to be competed Servs bahagian porl lengkaphan Name [NRIC No. Foran ano Date of Bint (wannernn Gender Livete L Female Passport No. For Nanas ton ct) Nationality Name of Employer Nature of Busi ‘occupation ‘Exact DutiesTelephone No Mobile Residence ‘oe a Tacaipam nee See Hasse ane Blame Came” yee ewes — ebramtn ences PayoriContrbutor's Correspondence Address DECLARATION / PENGISYTIARAN "De understand and agoe thal any personal information cllcted o el by AIR Bs. AIA PUBLIC Tekafl Bnd, /AIA General Berhad (erin rated o a8 AIA) {whet eantaine ints fom or oberwse obtained, inching Pwough cei eporing agercios) may be Pel. vend, and csclosed by AA to naviuasorganisations Folate to and assocated wih AA 0 any selected tha pry (wahin or oulise of Maloy, ieuding bul no! Unites lo regualosauthottes, enaurance companies! retseall operators clams Investgaon compensa, industry Serccstonaacratons and ced poring agence) forthe purpose ot) proceeeng th form, (0) proving subsequent sonic ors (for AIA data ateing (fo rviow an aden on myo” coverage wih AI and (ef: rgultny andi stakory compliance Purposes. IWe understand that we have te ight ocean acess to andl eaves carecon of any personal information held by AIA coicering mals. Such reques Ean be made o any of AKs Customer Sanica Genes. Sayaka amar dan bersci Bahawa vebarang makumat penbad yang diumpukan atau Jpegang och ‘AIA Bha. AIA PUBLIC Talat! Bha./ AIA General Berhad (selepas ii djuk sebaga “AIA same ada trkardurg dalam Darang in ateu doerloh dengan car lan, formasuk retail agen’ pelaporan kre) boloh dpogang,cigunakan dan eberkan ol AIA kepad incntvorgansas! yang beehabung dan berkaian dengan ‘etahat,"syantatpenyasatentuttan,gerstuanpereeutuan Indust! dan agers! pelaporenkredt) bag! han (a) Memeroses pormohoran in (2) Member {mat stersanya () unt orsadanen data Ao) menyemak dan member ranganalperingenesyaiamy dengan Ala dan (o ogi taanpamatanann indlang-undang dana stator Sayaka fahorbahawa sayalkam brbak memporeieh akseskepade, dan memoton pombotuansebarang mau pono yang Important Note: 1 Nora Pent ‘NA may review andor upto th Privacy Statsment fom timo to tie to rfc th chargesin hw andlor AA somal poly. Fr mor information on how AIA doa wth porenalinformato, plone latte tls Privacy Salmon on our wabste al yew acon. J A mungkin maryora sora danas orga hi Kenyataa Piven dar masa ke semaea brdasarkan peroanan dalam undang undeng detvaau pots dalaman MA, Unt lca AIA merguruskan Imakumat parted ork Kenyataan Priva tertan Taman web kay wa com Executed on DONT wae WITT ‘Signature of Poucyiereata Own: INRICTPasspan WoT KP aps