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Allianz Life Insurance Malaysia Berhad (198301008983)
(Licensed under the Financial Services Act 2013 and regulated by Bank Negara Malaysia)
14 January 2022
CHIA SWEE YEE

NO.6F,
LORONG OLD OYA 8M,
96000 SIBU SARAWAK.
CASB - SBU_D - 100442-3
Welcome to Allianz Life.
We are delighted you have taken an important step to protect yourself and the well-being of your loved ones. Attached is a
copy of your policy document for your retention.
Everything you need to know about your insurance plan is in this document. If you see any information that is incorrect
or should any of the information you have provided change, please do let us know for us to make necessary updates. If
you need any clarification or if we can be of any assistance, please call us at 1 300 22 5542 (8.45am to 5.45pm, Monday
to Friday) or connect with us via Facebook Messenger (https://m.me/AllianzMalaysia). Alternatively, you can email us at
customer.service@allianz.com.my.
We are continuously striving to serve you better so that you can live our dreams. Thank you for your support and trust in us.
Yours sincerely
Joseph Gross
Chief Executive Officer
ALLIANZ CUSTOMER SERVICE CENTER

Allianz Arena
Ground Floor, Block 2A, Plaza Sentral
Jalan Stesen Sentral 5, Kuala Lumpur Sentral
50470 Kuala Lumpur
Allianz Contact Center : 1 300 22 5542 / 1 300 88 2229 (HSBC Bancassurance Customer Only)
Email : customer.service@allianz.com.my / HSBC.customercare@allianz.com.my (HSBC Bancassurance Customer Only)
Website : www.allianz.com.my
POLICY SCHEDULE STAMP DUTY PAID
POLICY OWNER POLICY NO. ISSUE DATE

CHIA SWEE YEE 8005767424 13/01/2022
NRIC NO. BASIC PLAN POLICY DATE
820516-05-5218 Allianz PowerLink 13/01/2022
TYPE OF POLICY INSURED AMOUNT
NON-PARTICIPATING MYR 50,000.00
ASSURED NAME NRIC NO. AGE SEX ADMITTED RELATIONSHIP TO

POLICY OWNER
LIFE ASSURED SIEW EUNG YUE 200831-13-0030 1 Female Yes Daughter
CHIA SWEE YEE 820516-05-5218 40 Female Yes
JOINT LIFE ASSURED NOT APPLICABLE
SPOUSE NOT APPLICABLE
DEPENDENT NOT APPLICABLE
SCHEDULE OF BENEFITS AND PREMIUMS
TYPE OF COVERAGE AMOUNT OF BENEFITS/ MODAL PREMIUM** LAST PAYMENT DATE PREMIUM PAYABLE MATURITY/
PLAN TYPE* (RM) (RM) TERM (YEAR) EXPIRY DATE***
Allianz PowerLink 50,000.00 2,592.00 13/01/2120 99 13/01/2121

Insurance Premium 2,592.00
Investment Premium 0.00
Total and Permanent Disability 50,000.00 0.00 13/01/2091 70 13/01/2092
MediSafe Infinite+ (Base Plan) 150.00 0.00 13/01/2120 99 13/01/2121
Hospital Assistance Fee 0.00 0.00 13/01/2120 99 13/01/2121
HealthCover Plus 50,000.00 0.00 13/01/2120 99 13/01/2121
SecureCover 2,592.00 0.00 13/01/2051 30 13/01/2052
SecureCover (ETPD) 2,592.00 0.00 13/01/2051 30 13/01/2052
TOTAL ANNUAL PREMIUM (MYR): 2,592.00

The total ANNUAL premium displayed is inclusive of Service Tax, if any
PREMIUMS ARE PAYABLE ON THE POLICY DATE AND EVERY SUBSEQUENT 12 MONTH(S) THEREAFTER UNTIL THE LAST PAYMENT DATE AS PROVIDED ABOVE, SUBJECT TO THE
TERMS AND CONDITIONS STATED IN THE POLICY CONTRACT.
FOR INVESTMENT-LINKED POLICY, THE SELECTED MODAL PREMIUM** MAY BE INSUFFICIENT TO SUSTAIN UP TO THE MATURITY/EXPIRY DATE***. YOU MAY NEED TO INCREASE
YOUR MODAL PREMIUM OR PAY A TOP UP PREMIUM IN LATER YEARS TO MAINTAIN YOUR POLICY BENEFITS.
ANNEXURE ATTACHED: PLK_10V6 / UTPD_06V1 / UMI+_01V2 / UHCPR_03V1 / USCRT_03V8 / EUSCRT_03V6
MAY DENOTE LIMITATIONS OF THE BENEFITS OR AMOUNT OF COVERAGE.
1. THE MAXIMUM TOTAL AND PERMANENT DISABILITY BENEFIT PAID OR PAYABLE ON ANY ONE LIFE ASSURED FROM ALL POLICIES AND SUPPLEMENTARY CONTRACTS / RIDERS (SUBJECT TO
THE RESPECTIVE MAXIMUM LIMITS INDICATED THEREIN) ISSUED BY ALLIANZ LIFE INSURANCE MALAYSIA BERHAD PROVIDING THE SIMILAR TOTAL AND PERMANENT DISABILITY BENEFIT
COLLECTIVELY SHALL NOT EXCEED THE MAXIMUM AMOUNT AS SPECIFIED IN THE POLICY CONTRACT.
2. AMOUNT OF BENEFITS/PLAN TYPE* FOR THE HOSPITALISATION AND SURGICAL RIDER REFERS TO THE CHOSEN PLAN TYPE.
3. IN ORDINARY CASES WHERE THE POLICY DATE AND ISSUE DATE ARE THE SAME DATE, THE INSURANCE COVERAGE COMMENCEMENT DATE FOR THIS POLICY IS AS DEFINED IN THE DEFINITIONS
SECTION IN THE POLICY CONTRACT. HOWEVER, IF THE POLICY DATE AND ISSUE DATE ARE DIFFERENT DATES, THE INSURANCE COVERAGE COMMENCEMENT DATE FOR THIS POLICY SHALL
ALWAYS BE THE LATER DATE.
CHANNEL: AGI
ALLIANZ CUSTOMER SERVICE CENTER

Allianz Arena
Ground Floor, Block 2A, Plaza Sentral
Jalan Stesen Sentral 5, Kuala Lumpur Sentral
50470 Kuala Lumpur
Allianz Contact Center : 1 300 22 5542 / 1 300 88 2229 (HSBC Bancassurance Customer Only)
Email : customer.service@allianz.com.my / HSBC.customercare@allianz.com.my (HSBC Bancassurance Customer Only)
Website : www.allianz.com.my
ALLIANZ POWERLINK
THE CONTRACT
This Policy is issued in consideration of the payment of the Premium as specified in the Policy Schedule and pursuant to
Your Application w hich is material information that shall form part of this contract of insurance betw een You and Us. If
any of Your answ ers or statements or information is not fully and accurately given, this Policy may be avoided, a claim
may be denied or reduced or the terms of this Policy may be changed or varied, or Policy terminated.
PART A
DEFINITIONS
When used in this Policy,
“ACCOUNT VALUE” means the number of Units under this Policy multiplied by the Bid Price on the relevant Valuation
Day.
“APPLICATION” means the answ ers and disclosures in Your Application Form, medical reports, questionnaires and all
relevant documentary declaration and/or statements made by You betw een the time of submission of Your Application
Form and the time this Policy contract is entered into.
“BID PRICE” is the value at w hich a Unit shall be debited from and credited to this Policy, rounded up to three (3)
decimal places.
“CONTINGENT OWNER” means the person named in the Proposal or appointed by You, if any. On default of such
appointment, Your legal representative shall be the Contingent Ow ner.
“DEFERRED POLICY CHARGES” means the Policy Charges as specified in the Provision for Policy Charges contained
in Part G Clause 9 in this Policy that is due but unpaid due to insufficient Units in the Account Value during In Force
Guarantee.
“DIVISIBLE SURPLUS” means any surplus from the life insurance fund to be distributed from time to time as bonus
and/or dividends.
“DUE DATE” means the date for payment of premium as stated on the Policy Schedule or the Endorsement, if any.
“ENDORSEM ENT” means variation to this Policy.
“HEAD OFFICE” refers to Our principal place of business.
“INDEBT EDNESS” means any amount due and ow ing to Us.
“INSURANCE PREMIUM” means the portion of the Premium as specified in the Policy Schedule or Endorsement.
“INSURED AMOUNT/AMOUNT OF BENEFITS” means the amount payable by Us as specified in the Policy Schedule
or Endorsement upon the occurrence of the event indicated in this Policy.
“INVESTMENT PREMIUM ” means the portion of the Premium as specified in the Policy Schedule or Endorsement.
“ISSUE DATE” means the date Your Policy is issued.
“LIFE ASSURED” means the person, as specified in the Policy Schedule, w hose life is insured under this Policy.
“MATURITY/EXPIRY DATE” means the date, as specified in the Policy Schedule or Endorsement, w hen this Policy and
the Unit Cancellation Supplementary Contract(s) attached to it shall mature/expire.
“NON-PARTICIPATING” means Your Policy does not participate in the Divisible Surplus of Our life insurance business.
“POLICY OWNER” means the person w ho ow ns this Policy and can exercise all rights, privileges and options available
under this Policy.
“POLICY” means the legal contract betw een You and Us. We agree to give You the benefits set out in the Policy
Schedule/Endorsement for the premiums paid by You.
“POLICY ANNIVERSARY” means the same date each year as the Policy Date.
“POLICY DATE OR COMMENCEMENT DATE” means the date the insurance coverage under this Policy commences.
The Policy Date is show n in the Policy Schedule and the Commencement Date is indicated in the relevant Endorsement
and shall include the Reinstatement Date.
PLK_10V6 / Sept 2021 Page 1 of 13

“PREMIUM” means the total of the Insurance Premium, Investment Premium and any premium required to maintain
Policy Sustainability payable as stated in the Policy Schedule or Endorsement.
“PROPOSAL” means Your request for an insurance under this Policy.
“REINSTATEM ENT DATE” means the date Your application for reinstatement is approved by Us.
“FUND” means a separately identifiable investment-linked fund set up by Us for the purpose of ascertaining the benefits
payable under this Policy. The Funds w hich are currently maintained by Us are listed in the Schedule of Investment
Funds. Any fund created or closed w ill be added to or removed from the Schedule of Investment Funds accordingly.
“AD HOC TOP-UP PREMIUM” means the unscheduled premium amount of w hich is specified by You but is subject to a
minimum amount determined by Us, w hich may be paid to Us at any time subject to Our approval w hile the Policy is in
force. We reserve the right to revise the minimum and maximum amount of any Ad Hoc Top-up Premium by giving You
at least three (3) months prior w ritten notice.
“UNITS” mean units of the respective Fund. The Fund shall be converted into Units of equal value.
“UNIT CANCELLATION SUPPLEMENTARY CONTRACT” means the respective supplementary contracts(s) attached
to this Policy w here the Cost of Insurance for the benefits offered by the supplementary contract(s) is levied by w ay of
cancellation of units from Your Account Value.
“VALUATION DAY” means every business day of the w eek or such date as We may determine at w hich the underlying
assets of each Fund shall be valued subject to the provisions of this Policy.
“COMPANY/WE/US/OUR” means Allianz Life Insurance Malaysia Berhad.
“YOU/YOUR” means the Policy Ow ner. The Policy Ow ner may be the Life Assured or someone other than the Life
Assured.
PART B
PAYMENT OF PREMIUMS
1. PAYMENT OF PREMIUMS
All Premiums payable under this Policy are to be paid to Us on or before their Due Dates either at the issuin g
office or to an authorised agent or cashier, w here applicable, in exchange for an official receipt.
2. CHANGE OF FREQUENCY OF PREMIUM PAYMENT

Subject to Our approval and the minimum premium requirements, You may change the frequency of Your
premium payment by giving Us w ritten notice. Premium may be paid annually, semi-annually, quarterly or monthly
at the premium rates applicable on the Policy Date.
3. PREMIUM HOLIDAY
Subject to the In Force Guarantee Provision contained in Part D in this Policy, if any Premium remains unpaid on
the Due Date, this Policy shall be kept in force by effecting a Premium Holiday for so long as this Policy has
sufficient Units to be utilised to pay for all the Policy Charges w hen due. The value of the Units to be utilised shall
be calculated in the same manner as if the Units are to be cancelled.
PART C
BENEFIT S PROVISIONS
While this Policy is in force, We shall, subject to the provisions contained in this Policy, pay any one (1) of the follow ing
benefits less any Indebtedness due and ow ing to Us:-
1. AMOUNT PAYABLE ON MATURITY/EXPIRY DATE

If the Life Assured survives on the Maturity/Expiry Date, the amount payable shall be one hundred percent
(100%) of the Account Value. The relevant Valuation Day shall be the Valuation Day immedia tely after the
Maturity/Expiry Date. Subsequently, this Policy shall terminate.
2. AMOUNT PAYABLE IN THE EVENT OF DEATH

Subject to the Suicide Clause below and the Provisions for Juveniles – Lien Rule contained in this Policy, the
amount payable on the death of the Life Assured before the Maturity/Expiry Date shall be as follow s:-
(i) Insured Amount/Benefits; and
(ii) One hundred percent (100%) of the Account Value. The relevant Valuation Day shall be the Valuation Day
on or after the claim approval date.
Subsequently, this Policy shall terminate.
3. AMOUNT PAYABLE IN THE EVENT OF DEATH FROM SUICIDE (SUICIDE CLAUSE)

The amount payable in the event of death of the Life Assured resulting from suicide w ithin tw elve (12) months
from the Issue Date or Reinstatement Date w hichever is later, w hile the Life Assured is sane or insane, shall be
one hundred percent (100%) of the Account Value together w ith the total Cost of Insurance charged from the
Issue Date or Reinstatement Date, w hichever is later. The relevant Valuation Day shall be the Valuation Day on
or after the claim approval date. Subsequently, this Policy shall terminate.
PART D
IN FORCE GUARANT EE PROVISION
IN FORCE GUARANT EE
The Policy Charges for the first three (3) policy years w ill be deferred (subsequently called the “Deferred Policy
Charges”) so that this Policy w ill not lapse in the event the value of balance of Units in this Policy is insufficient to pay the
Policy Charges w hen due provided all Premiums due under this Policy are paid no later than thirty -one (31) days from
the Premium Due Date and no Units are w ithdraw n from this Policy for this duration (subsequently called “the In Force
Guarantee feature”). The In Force Guarantee feature w ill be forfeited if the total Premium due under this Policy is not
paid or paid after the expiry of thirty-one (31) days from the Premium Due Date.
The Deferred Policy Charges w ill be deducted from the Account Value w hen the Account Value becomes sufficient or
from the Insured Amount/Benefits payable under the Basic Policy and Supplementary Contract (if any).
PART E
OWNERSHIP PROVISIONS
1. OWNERSHIP OF POLICY
You are the Policy Ow ner named on the Policy Schedule or the Endorsement, if any. During the lifetime of the
Life Assured only You have the right to exercise all rights and privileges available under this Policy unless
ow nership of this Policy has been changed under the Change of Ow nership provision.
2. CHANGE OF OWNERSHIP / ASSIGNMENT

During the lifetime of the Life Assured, You may change the ow nership of this Policy by an assignment by filing
w ritten notice satisfactory to Us. We shall not be considered to have know ledge of any assignment unless the
above w ritten notice is received by Us. The change shall be effective only after We receive the w ritten notice of
the assignment. We assume no responsibility for the validity or sufficiency of any assignment. We may require
proof of the assignment.
3. TRANSFER OF OWNERSHIP (FOR JUVENILE POLICIES ONLY)

This clause provides for the transfer of Policy’s ow nership upon Your death w hile the Life Assured is still a minor.
You may, during Your lifetime, appoint a natural person to be the Contingent Ow ner w ho shall replace You as the
legal ow ner of the Policy and shall hold the Policy in trust for the Life Assured, subject to the condition that You
die w hile the Life Assured is still a minor. You shall use Our prescribed form for appointing the Contingent Ow ner.
If no Contingent Ow ner is appointed, upon Your death w hile the Life Assured is still a minor, Your personal
representative(s) as appointed by the Grant of Probate or Letters of Administration, as the case may be, shall be
the Contingent Ow ner(s).
In the event of Your death w hile the Life Assured is still a minor, the ow nership of this Policy and all rights,
interests, privileges and benefits of the Policy shall be vested in and exercisable by the Contingent Ow ner(s) as
the legal ow ner and trustee(s) for the benefit of the Life Assured. Subsequently, upon the Life Assured attaining
the age of sixteen (16) years old, the Contingent Ow ner(s) shall cease to be the legal ow ner and trustee(s) and
the ow nership of this Policy and all rights, interests, privileges and benefits of the Policy shall automatically be
transferred from the Contingent Ow ner to and be vested in the Life Assured w ho shall then be entitled to deal w ith
this Policy w ith full rights as the legal ow ner replacing the Contingent Ow ner.
The appointment of the Contingent Ow ner shall automatically lapse and shall have no legal effect w hen the
Contingent Ow ner predeceases You or the Life Assured has attained age of sixteen (16) years old w hile You are
still alive, w hichever is earlier. You may appoint a new Contingent Ow ner replacing the one that predeceases
You.
Notw ithstanding the above, the Contingent Ow ner cannot assign the Policy for w hatsoever reasons. You shall
reserve the right to remove or replace or revoke the appointment of Contingent Ow ner w ithout his/her consent at
any time.
If Your death occurs w hen the Life Assured has attained age of sixteen (16) years old, the ow nership of the Policy
shall be automatically vested in the Life Assured as the legal ow ner of the Policy.
4. NOMINATION
If You are the Life Assured under this Policy, You may on the Issue Date and upon attaining sixteen (16) years of
age nominate a natural person to receive the policy moneys payable upon Your death by notifying Us in w riting in
Our prescribed form giving particulars of the name, date of birth, identity card number or birth certificate number
and the address of the nominee. If You make a nomination after this Policy has been issued, You may be
required to submit Your Policy to Us for Our Endorsement on Your Policy.
Your nominee shall receive the policy moneys as executor or executrix and not as beneficiary unless You assign
Your Policy to Your nominee. The assignment to Your nominee must be received and endorsed by Us during
Your lifetime for it to be effective. How ever, You need not assign this Policy to Your nominee if the nominee is
Your spouse or child or, if You do not have a spouse or child at the time You make Your nomination, Your parent.
If You are a Muslim Policy Ow ner, Your nominee shall receive the policy moneys only as executor or executrix,
w ho shall distribute the policy moneys in accordance w ith the Islamic law .
5. REVOCATION OF NOMINATION
Subject to the provisions of the Financial Services Act 2013 (w hich shall include any subsequent amendments or
enactments to it), Your nomination shall be revoked upon:-
(i) the death of Your nominee, or if there is more than one (1) nominee, upon the death of all the nominees,
during Your lifetime; or
(ii) Our receipt of Your w ritten notice of such revocation to Us; or
(iii) Our receipt of Your w ritten notice of any subsequent nomination made by You to Us.
If You have appointed a trustee for Your Policy, You are required to obtain the consent of the trustee before You
revoke a nomination under this Policy. The rights of any assignee under an assignment or encumbrance on or
attached to this Policy shall have a priority over the interest or claim of Your nominee.
PART F
GENERAL PROVISIONS
1. ALTERATION
No alteration, variation or w aiver of any provision of this Policy shall be valid unless such alteration, variation or
w aiver is made by an Endorsement and signed by Our authorised person. We may request for Y our Policy to be
sent to Us to effect the Endorsement. We w ill notify You of any amendments, variations, changes, alterations or
modifications required by law or regulatory authorities to be made to this Policy. Once the Endorsement is
effected, the terms and conditions of this Policy shall be read subject to such Endorsement.
No agent has the authority to make any alteration to or to w aive any of the terms and conditions in Your Policy.
2. APPLICABLE LAW
Your Policy is governed and shall be construed in acc ordance w ith law s of Malaysia and the parties to this Policy
agree to submit to the jurisdiction of the Malaysian courts.
3. CHANGE OF PLAN / CONVERSION

Change of plan or Policy conversion is not allow ed.
4. CURRENCY AND PLACE OF PAYMENT

All amounts payable by You or by Us pursuant to this Policy shall be payable in Malaysia and in the Malaysian
currency.
5. FREEDOM FROM RESTRICTIONS

This Policy contains no restriction upon the Life Assured in respect of travel, residence or occupation.
6. FREE LOOK PERIOD

The Policy may be cancelled by Your w ritten request and by returning this Policy to Us w ithin fifteen (15) days or
such longer period as may be specified by Bank Negara Malaysia, from the date of receipt of this Policy by You.
The amount refunded shall be the Account Value calculated in the same manner as if the Units are to be
cancelled together w ith the unallocated Premium, Policy Charges and any revision of it, if any, of the premium
less the percentage of the premium granted as bonus unit and any expenses incur red for medical examination.
7. INDISPUTABILITY
We shall not dispute the validity of Your Policy if it has been in force during the lifetime of the Life Assured for tw o
(2) years from the Issue Date or Reinstatement Date, w hichever is later unless a statement of material fact or
matter w as fraudulently made or there w as a fraudulent suppression or omission of material fact or matter in Your
Proposal and/or Application.
8. MISSTATEMENT OF AGE AND SEX

The age and sex of the Life Assured is stated on the Policy Sc hedule. The age is the age nearest birthday of the
Life Assured. This age is based on the date of birth stated in the Application Form.
If the age and/or sex of the Life Assured has been misstated, We may vary the term of coverage or any benefits
that may become payable based on the Cost of Insurance that w ould have become payable if this Policy had
been based on the true age and/or sex.
Where the Life Assured w as not eligible for the insurance at the true age and/or sex, We shall refund the Account
Value, calculated in the same manner as if the Units are to be cancelled, together w ith the unallocated Premium
and Policy Charges, and this Policy w ill be void.
We shall require proof of age of the Life Assured before payment of benefits under this Policy unless the age has
been previously verified and confirmed by Us to be correct.

9. NOTICE
Subject as otherw ise provided in this Policy, all notices, demand or other communications required or permitted to
be given or made under the terms of this Policy shall be in w riting and delivered personally or sent by normal or
prepaid registered post to the addresses set out in this Policy (or to such other address as either party may from
time to time notify the other) or delivered electronically. Any such notice, demand or communication shall be
deemed to have been duly served:
(i) immediately, if delivered personally; or

(ii) five (5) days after posting (excluding Saturday, Sunday and Malaysian federal public holidays), if sent by
normal or prepaid registered post; or
(iii) immediately, if delivered electronically.
10. PARTICIPATION IN DIVISIBLE SURPLUS

This plan does not participate in the Company’s Divisible Surplus
11. POLICY SUSTAINABILITY

The Account Value of this Policy must be projected to be sufficient to pay for the Policy Charges of this Policy,
including any Unit Cancellation Supplementary Contract(s), up to the Maturity Date of this Policy. The financial
projection of the Policy cashflow s, including the Account Value and Policy Charges, is carried out by Us from time
to time as required using Our predefined financial assumptions.
In the event that the financial projection of the Account Value of this Policy is insufficient to pay for the Policy
Charges of this Policy and the respective Unit Cancellation Supplementary Contract(s ), if any, up to the Maturity
Date of the Policy, We reserve the right to increase the Premium to ensure that the Account Value is projected to
be sufficient for the deduction of Policy Charges of this Policy and the respective Unit Cancellation
Supplementary Contract(s), if any, up to the Maturity Date of this Policy.
12. LAPSE
Subject to the In Force Guarantee Provision contained in Part D in this Policy, w hen the value of the balance of
Units in this Policy is insufficient to pay the Policy Charges w hen due, a grace period of thirty one (31) days w ill
be granted during w hich this Policy shall remain in force. How ever, this Policy shall lapse if any Policy Charges
shall remain unpaid at the end of its grace period.
13. REINSTAT EM ENT

You may, upon obtaining Our w ritten consent, reinstate Your Policy subject to the requirements below .
To reinstate Your Policy, We require the follow ing:-

(i) Your w ritten request for reinstatement; and
(ii) Premiums amount as determined by Us; and
(iii) Satisfactory evidence of the Life Assured’s health and insurability.
Provided alw ays the allocation rate shall continue from the last allocation w here it last stopped in accordance w ith
the allocation rate specified in Table 1 and 2 in this Policy respectively; and any reinstatement shall only cov er the
loss or insured event w hich occurs after the Reinstatement Date subject to the limitations and exclusions of this
Policy and the Unit Cancellation Supplementary Contract attached to the Policy, if any.
14. OPTION TO PURCHASE NEW PLAN UPON MATURITY

You have the option to purchase a new plan upon the Maturity Date or Expiry Date of this Policy (“Option”)
w ithout further health underw riting and provided that the follow ing conditions are met:
(i) The Life Assured meets the eligibility age of the new plan;
(ii) You must notify Us of your decision to exercise this Option no earlier than ninety (90) days before the
Maturity Date or Expiry Date by giving Us a w ritten notice to such effect;
(iii) The new policy shall be issued in the name of the same Life Assured of this Policy; and
(iv) The Insured Amount for the new policy shall not exceed the Insured Amount of this Policy.
15. TERMINATION
Your Policy shall automatically be terminated:
(i) if this Policy becomes matured/expired; or
(ii) if this Policy becomes lapsed, or is surrendered; or
(iii) on the Policy Anniversary w hen the Life Assured attains the age of one hundred (100) nearest birthday; or
(iv) upon the death of the Life Assured
w hichever may be the earliest.
For Policy issued before the Life Assured is born, Your Policy shall continue to be inforced and the Policy
Charges shall continue to be charged until the Life Assured’s personal details are updated w ith Us and only by
then the Policy Charges w ill be charged in accordance w ith the Life Assured’s updated personal details.
Before the Life Assured is born, if this Policy is surrendered or death of Life Assured occurs, We shall refund the
Account Value and Cost of Insurance deducted from the Unit Cancellation Supplementary Contracts w hich w ill
vary according to the personal details of the Life Assured.

16. PROVISIONS FOR JUVENILES– LIEN RULE
Where the age of the Life Assured is less than forty nine (49) months at the time of death, the amount payable
under this Policy shall be as follow s:-
(i) If the Life Assured’s age is less than fifteen (15) days old:
We shall pay You the Account Value calculated in the same manner as if the Units are to be cancelled
together w ith the unallocated Premium, Policy Charges and any revision of it, if any, of the premium less
the percentage of the premium granted as bonus unit and any expenses incurred for medical examination;
or
(ii) If the Life Assured’s age is betw een fifteen (15) days to forty-eight (48) months:
We shall pay You the Insured Amount/Benefits Payable based on the percentage stated below :
Age of Life Assured at Death Percentage (%) of Insured Am ount/Benefits Payable
15 days - 12 Months 20
13 - 24 Months 40
25 - 36 Months 60
37 - 48 Months 80
49 Months and above 100
17. TIME
Time w herever mentioned shall be of the essence of this Policy.
18. WAIVER
Failure or neglect by either party to enforce at anytime the provisions of this Policy shall not be construed or be
deemed to be a w aiver of either party's right in this Policy nor in anyw ay affect the validity of the w hole or any part
of this Policy nor prejudice either party's right to take subsequent action.
19. CLAIM NOTIFICATION

The claimant must give w ritten notice w ithin tw o (2) months from the date of death of the Life Assured to claim
under this Policy. Failure to give notice w ithin the time stipulated shall not invalidate any claim if it is show n that it
w as not reasonably possible to give such notice earlier and that notice w as given as soon as w as reason ably
possible. It shall be Our sole discretion w hether to accept the reasons given for the failure to give notice w ithin the
time stipulated.
20. PROOF OF DEATH

Upon Our receipt of the above notice, We w ill furnish to the claimant the appropriate forms for filing proof of
death. Claims shall be made on forms provided by Us together w ith w ritten proof covering the occurrence and
circumstances of death for w hich claims are made. Such proof and other documents satisfactory to Us must be
given at the claimant's expense.
21. FILING PROOF OF DEATH

Proof of death must be furnished to Us w ithin three (3) months after the date of death of the Life Assured.
We reserve the right to require any additional proof. In the case of death, We may require, if appropriate and
legally allow able, an autopsy.
22. SEVERABILITY
If any provision or part of a provision of this Policy shall be held or found to be void, invalid or otherw ise
unenforceable, it shall be deemed to be severed from this Policy, and the remainder of the provisions contained in
this Policy shall remain in full force and effect.
23. APPLICABLE TAX

In the event that any sales and services tax, value added tax or any similar tax and any other duties, taxes, levies
or imposts (collectively “Applicable Tax”) w hatsoever are introduced by any authority and are payable under the
law s of Malaysia in connection w ith any supply of goods and/or services made or deemed to be made under this
Policy, We w ill be entitled to charge any Applicable Tax as allow ed by the law s of Malaysia. Such Applicable Tax
payable shall be paid in addition to the applicable premiums and other charges. All provisions in this Policy on
payment of premiums and default hereof shall apply equally to the Applicable Tax.
24. ANTI-MONEY LAUNDERING, ANTI-TERRORISM FINANCING AND PROCEEDS OF UNLAWFUL ACTIVITIES

ACT 2001
If We receive an order from the relevant authorities to freeze or seize the monies received as premium or monies
payable in respect of this Policy as provided under the Anti-Money Laundering, Anti-Terrorism Financing and
Proceeds of Unlaw ful Activities Act 2001 or such similar legislation or if We discover or have reasonable
suspicion that this Policy is exploited for money laundering activities and/or to finance terrorism, We reserve the
right to terminate this Policy immediately. We shall deal w ith all premiums paid and all benefits/sums payable in
respect of this Policy in any manner w hich We deem appropriate, including but not limited to handing it over to the
relevant authorities.

PART G
FUND PROVISIONS
1. PURPOSE OF THE FUND

We have established the Funds set out in the Schedule of Investment Funds w hich is attached to this Policy, from
w hich part or all of the benefits payable w ill be made under this Policy.
2. INVESTMENT OF THE FUND

The selection of the underlying investments of each Fund established by Us shall be such as We, in Our absolute
discretion, may from time to time determine.
All assets relating to the Fund shall be and shall remain in Our absolute beneficial ow nership. There is no trust
created, w hether expressly or impliedly, by Us in respect of the investments.
We shall have the pow er to delegate all or any of Our discretionary and investment pow ers in this Policy to any
person or fund management company or organisation on such terms as We in Our absolute discretion may
determine.
The investment direction of each fund is specified in the Schedule of Investment Funds. We reserve the right to
make any changes to the Funds including but not limited to investment objectives, strategies and asset allocation
by giving You at least three (3) months prior w ritten notice.
3. FUND VALUATION
The Bid Price of the Fund on any Valuation Day shall be equal to the Fund Value divided by the number of Units
in issue for that Fund on that Valuation Day.
The value of each Fund (the “Fund Value”) specially created by Us shall be determined by Us on the Valuation
Day. How ever, We may value the Fund less frequently if trading in any Stock Exchange in w hich the Fund is
invested is suspended or for any other reason that is beyond Our pow er to control so as to make it impossible to
value the Fund more frequently. We shall seek the services of independent person(s) or firm(s) to obtain the
value w henever appropriate, w hether selling or buying, of the Fund's assets and shall observe applicable law s
and accepted practices in dealing w ith the Fund's assets.
The Fund Value shall be equal to the follow ing:

(i) The fair market value of all the assets held in the Fund valued at the last transacted market price at w hich
those assets could be purchased or sold on the business day immediately preceding the Valuation Day, or
w here appropriate, such value as determined by Us at Our discretion after taking such independent advice
as We deems necessary, less
(ii) The amount w hich We shall determine as being liabilities of the Fund on the business day immediately
preceding the Valuation Day, less
(iii) The Fund Management Charge from each Fund as stipulated in the Schedule of Investment Funds. The
Fund Management Charge w ill be calculated as a percentage of the Fund Value of the appropriate Fund
multiplied by the number of days from the preceding Valuation Day on w hich a Fund Management Charge
w as deducted to the current Valuation Day divided by 365. The Fund Management Charge is a separate
charge not included in the liabilities set out in Clause (ii) and as define above.
The Fund's liabilities shall consist of accrued and unpaid investment expenses incurred by the Fund such as
taxes and stamp duties, registration fees, legal, auditing and custodian fees, stock brokers' and estate agents'
commissions incurred in the sales or purchases of assets, insurance costs and expenses incurred in securing the
Fund's assets and protecting the value of investments and any other expenses incurred in the management and
maintenance of the Fund and incurred to ensure compliance w ith statutory and regulatory requirements relating to
the Fund.
The expenses incurred in respect of the acquisition, realisation, management, maintenance and valuation of the
assets and investments and taxation liability w ill be deducted from the Fund.
4. ALLOCATION OF UNITS
Units are allocated to the Policy depending on the amount of scheduled Premium paid, the allocation rate as set
out in Table 1 and 2 below , and the prevailing Bid Price of each Unit. Such allocations may be made up to
1/10000th of a Unit or such other fraction as We may decide from time to time.
Table 1
Prem ium Insurance Prem ium Allocation Rate
Paym ent Policy Year
Term 1 2 3 4 5 6 7 8 9 10 ≥ 11
1 95% - - - - - - - - - -
2 95% 95% - - - - - - - - -
3 70% 100% 100% - - - - - - - -
4 60% 100% 100% 100% - - - - - - -
5 60% 90% 100% 100% 100% - - - - - -
6 60% 80% 100% 100% 100% 100% - - - - -

7 60% 70% 100% 100% 100% 100% 100% - - - -
8 60% 60% 100% 100% 100% 100% 100% 100% - - -
9 60% 60% 90% 100% 100% 100% 100% 100% 100% - -
10 60% 60% 80% 100% 100% 100% 100% 100% 100% 100% -
11 60% 60% 70% 100% 100% 100% 100% 100% 100% 100% 100%
12 60% 60% 60% 100% 100% 100% 100% 100% 100% 100% 100%
13 60% 60% 60% 90% 100% 100% 100% 100% 100% 100% 100%
14 60% 60% 60% 80% 100% 100% 100% 100% 100% 100% 100%
15 60% 60% 60% 80% 90% 100% 100% 100% 100% 100% 100%
16 60% 60% 60% 80% 80% 100% 100% 100% 100% 100% 100%
17 60% 60% 60% 80% 80% 90% 100% 100% 100% 100% 100%
18 60% 60% 60% 80% 80% 80% 100% 100% 100% 100% 100%
19 60% 60% 60% 80% 80% 80% 95% 95% 100% 100% 100%
≥ 20 60% 60% 60% 80% 80% 80% 95% 95% 95% 95% 100%
Table 2
Allocation Rate for Investm ent Premium 95.00%
The unallocated premium charge is an upfront charge on the premium paid and is used to meet Our expenses
and direct distribution cost, including the commissions payable to Our agents/ brokers/ financial advisers.
We shall, if We deem expedient, at any time and from time to time undertake an exercise to consolidate and/or
split the Units in any one or more of the Funds to bring about an increase (in the case of an exercise to
consolidate the said Units) or as the case may be, a reduction (in the case of an exercise to split the said Units) in
the price of each of the said Units. Such exercise shall be in the manner and upon the terms as shall be
determined by Us at Our discretion provided alw ays that such exercise(s) shall not in any manner w hatsoever
affect the monetary value of the investment under this Policy. We shall give You three (3) months prior w ritten
notice to carrying out any such exercise.
5. CREATION OF UNITS
Units in any of the Funds may be created only if asset equal in value to the value of the Unit created are added to
that Fund.
In the event requests are received by Us for Ad Hoc Top-up, Transfer or “sw itch”, the number of Units created in
the relevant Funds shall be determined by reference to the Bid Price on the Valuation Day w hen such requests
are received. For all other requests and Application, the number of Units created shall be determined by
reference to the Bid Price on that Valuation Day w hen such requests and Application are approved by Us.
We reserve the right at any time and from time to time to change the above process for determining the Bid Price
to be used for calculating the number of Units to be created.
6. CANCELLATION OF UNITS
Units in any of the Funds may be cancelled only if assets equal in value to the value of the Units cancelled are
w ithdraw n from that Fund.
In the event requests are received by Us for Withdraw al of Units, Transfer or “sw itch” or Surrender of Policy, the
number of Units cancelled shall be determined by reference to the Bid Price on the Valuation Day w hen such
requests are received. For all other requests and Applications, the number of Units cancelled shall be determined
by reference to the Bid Price on that Valuation Day w hen such requests and Applications are approved by Us.
We reserve the right at any time and from time to time to change the above process for determining the Bid Price
to be used for calculating the number of Units to be cancelled.
7. OPTIONS
While the Policy is in force, You may, subject to Our approval, exercise any of the follow ing options by using the
prescribed form and meeting the conditions set out in this Policy:
(i) Pay an Ad Hoc Top-up Premium upon w hich We w ill allocate 95% of the Ad Hoc Top-up Premium
tow ards the purchase of Units in accordance to the investment apportionment elected by You. The Bid
Price of the Units to be purchased shall be calculated in the same manner as if those Units are to be
created. Payment of any Ad Hoc Top-up Premiums shall not increase the Insured Amount payable upon
death.
(ii) Transfer or “sw itch” any of the Units in a particular Fund to another Fund or some other new investment-
linked fund w hich may have been established by Us; such “sw itch” w ill be effected by the cancellation of
the Units to be “sw itched” and the creation of new Units in the Fund being “sw itched” to in accordance to
the investment apportionment elected by You.

(iii) Withdraw al of Units from any Fund by:
(i) Specifying the number of Units to be w ithdraw n; or
(ii) Specifying the value of the Units to be w ithdraw n.
The value of Units to be w ithdraw n shall not be less than one thousand Ringgit Malaysia (RM1,000.00)
and the Account Value after the w ithdraw al shall not be less than one thousand Ringgit Malaysia
(RM1,000.00). The value of Units shall be calculated in the same manner as if the Units are to be
cancelled.
A Withdraw al Penalty at the rate show n in table below w ill be imposed upon w ithdraw al of units from any
fund(s).
Withdraw al Penalty
Policy Year
(% of w ithdrawal am ount)
1 20.00%
2 20.00%
3 and above 0.00%
We reserve the right at any time and from time to time to vary the terms and conditions relating to the
Withdraw al Penalty including but not limited to the rate imposed, the minimum value of Units to be
w ithdraw n and/or the minimum balance of value of Units by giving You at least three (3) months prior
w ritten notice.
(iv) Surrender of Policy. The Surrender Value of the Policy w ill be equal to the value of the Policy's Units
calculated in the same manner as if the Units are to be cancelled, less any Surrender Penalty, plus any
unearned Cost of Insurance charged under this Policy. The Policy shall subsequently be terminated upon
payment of the Surrender Value by Us.
A Surrender Penalty at the rate show n in table below w ill be imposed upon surrender of this Policy.
Surrender Penalty
Policy Year
(% of Account Value)
1 20.00%
2 20.00%
3 and above 0.00%
We reserve the right at any time and from time to time to vary the terms and conditions relating to the
Surrender Penalty including but not limited to the rate imposed by giving You at least three (3) months
prior w ritten notice.
(v) Insured Am ount Flexibility. Subject to the minimum and maximum Insured Amount requirement, and the
Policy Sustainability requirement set by Us, You may increase the Insured Amount of this Policy w ithout
changing the Premium at any time.
Subject to the minimum and maximum Insured Amount requirement, and the Policy Sustainability
requirement set by Us, You may also decrease the Insured Amount of this Policy w ithout changing the
Premium at any time.
The distribution of the Insurance Premium and/ or the Investment Premium shall be adjusted accordingly.
Any increase in Insured Amount w ill be subjected to underw riting.
(vi) Coverage Term Flexibility. Subject to the minimum coverage term requirement, and the Policy
Sustainability requirement set by Us, You may decrease the coverage term of this Policy upon Withdraw al
of Units or revision of Cost of Insurance for the purpose of maintaining Your Policy Sustainability .
(vii) Investm ent Apportionm ent. You may at any time request in w riting to change the apportionment
percentage of Your premium to the Fund You w ish to invest.
The investment apportionment to the Fund You w ish to invest must be in multiples of five percent (5%) of
the premium. We reserve the right to revise the above minimum apportionment percentage upon giving
You at least three (3) months prior w ritten notice.
We shall notify You accordingly of the approval or otherw ise of the exercise of any of the aforesaid options.
8. PREMIUM FLEXIBILITY
You may, request to increase or decrease the Premium at any time provided that:
(i) such increase or decrease in Premium is subject to the minimum annual premium, the minimum and
maximum Insured Amount and the minimum term of coverage requirement, as w ell as the Policy
Sustainability requirement set by Us;
(ii) it is subject to the minimum premium increment amount or premium reduction amount as determined by
Us;
(iii) the allocation of Units for any additional Insurance Premium as a result of increase in Premium w ill start as
first (1st) policy year’s premium as set out in Table 1 of the Allocation of Units provision;

(iv) any increase/ reduction in Premium w ill take effect from the next Premium Due Date; and
(v) any reduction in Premium w ill be effected against the preceding Premium increase.
We reserve the right, at Our sole discretion, to impose any further conditions in addition to the above.
The distribution of the Insurance Premium and/or Investment Premium shall be adjusted accordingly follow ing any
increase or decrease in Premium.
We shall notify You accordingly of the approval or otherw ise of Your request for increase or decrease.
9. POLICY CHARGES
The costs of providing the benefits payable under this Policy and all Unit Cancellation Supplementary Contracts
as specified in the Policy Schedule or Endorsement (referred to as Cost of Insurance) shall vary according to:
(i) the attained age (nearest birthday) of the Life Assured;
(ii) the gender of the Life Assured;
(iii) w hether the Life Assured is a smoker; and
(iv) occupation class rating of the Life Assured, if any.
If Your Policy is issued before the Life Assured is born and before the Life Assured’s personal details are updated
w ith Us, the Cost of Insurance charged w ill be in accordance w ith the Cost of Insurance for a male, w here
applicable. We shall charge the Cost of Insurance in accordance w ith the updated details of the Life Assured after
You have provided to Us the required documents for the update. The updated Cost of Insurance shall be charged
commencing from the month of birth of the Life Assured.
The administration costs (referred to as Service Charges) shall be as follow s:

(i) Monthly Service Charge w ill be levied every month in the same manner as that of charging the Cost of
Insurance from the first policy year onw ards. The amount to be levied is eight Ringgit Malaysia (RM8.00)
per month.
(ii) Ad Hoc Top-up Premium Charge is tw enty five Ringgit Malaysia (RM25.00) for each and every Ad Hoc
Top-up request. This Ad Hoc Top-up Premium Charge is deducted from the Ad Hoc Top-up Premium paid
by w ay of cancellation of Units, as if You have requested for such cancellation according to the
apportionment of the Ad Hoc Top-up Premium into the respective Funds.
(iii) Fund sw itching, if made more than five (5) per policy year w ill be subject to a fee charge, w hich w ill not
exceed ten Ringgit Malaysia (RM10.00) per request. This fee is deducted from the amount to be sw itched
by w ay of cancellation of Units according to the apportionment of the amount to be sw itched to, as if You
have requested such cancellation.
We reserve the right to impose Administration Fee on premium payment via certain payment method including
but not limited to credit card. We w ill give You a three (3) months prior w ritten notice to such imposition or
variation of the Administration Fee.
The prevailing rates for the Cost of Insurance and Service Charges at any one time are as determined by Us.
We reserve the right at any time and from time to time to vary the rates for Cost of Insurance and Service
Charges at Our absolute discretion by giving You at least three (3) months prior w ritten notice. The revised rates
w ill only take effect on the next Policy Anniversary.
Upon revision of Cost of Insurance and Service Charges, We reserve the right to revise and to enforce changes
in Your Premium to support the equivalent revision in Cost of Insurance and Service Charges such that Your
Policy is projected to sustain up to the Maturity Date.
10. METHOD OF CHARGING THE COST OF INSURANCE

The Cost of Insurance for this Policy and the respective Unit Cancellation Supplementary Contract(s), if any, shall
be due on the Policy Date and on each monthly anniversary of the Policy Date after that w hile the Policy and the
respective Unit Cancellation Supplementary Contracts, if any, remains in force.
When due, the Cost of Insurance shall be paid for by w ay of cancellation of the Policy's Units at the Bid Price
applicable as if You have requested such cancellation.
The value of the Units cancelled shall be equal to the amount of the Cost of Insurance for this Policy and the
respective Unit Cancellation Supplementary Contracts, if any. In the event that the value of the Policy's Units is
insufficient to pay for the Cost of Insurance, this Policy and the Unit Cancellation Supplementary Contract(s), if
any, shall automatically lapse.
In the event that this Policy has Units in more than one Fund, the cancellation of Units w ill be effected in the same
proportion as the value of the Units held in each Fund.
11. WITHDRAWAL OF ASSETS

Assets may only be draw n from any of the Funds for the follow ing purposes:-
(i) The cancellation of Units;
(ii) Meeting expenses w hich are related to the management of the Funds;
(iii) Reinvestment, or
(iv) Tax
12. FUND ADDITION
New Funds may be established by Us from time to time from w hich part or all of the benefits payable under this
Policy w ill be made if You have invested in those Funds. All the relevant provisions of this Policy relating to the
Fund shall apply to such additional Funds, unless specified by Us in w riting.
We w ill notify You of the establishment of such new Funds and w ill be allow ed to invest in these Funds subject to
terms and conditions w hich may be imposed by Us.
13. FUND CLOSURE

We may at Our absolute discretion cease to allow the allocation of the Premiums or any fund sw itching to any
Fund intended to be closed. We w ill give You at least three (3) months prior w ritten notice of such intention to
close a Fund.
On the Valuation Day immediately preceding the effective closure date of the Fund, if any Premiums of this Policy
is to be allocated to the Fund intended to be closed, We shall reallocate this and future Premiums to other Funds
w ith similar investment objectives, subject to Our terms and conditions.
On the Valuation Day immediately preceding the effective closure date of the Fund, if this Policy is credited w ith
Units of the Fund that is intended to be closed, We shall sw itch all these Units to other Funds w ith similar
investment objectives, subject to Our terms and conditions. The number of Units to be debited and credited shall
be determined by reference to the Unit Prices of the respective Funds on the effective closure date of the Fund.
We may also at Our discretion transfer the assets of a closed Fund to a new Fund w hich has similar investment
objectives by giving You at least three (3) months prior w ritten notice.
On the Valuation Day immediately preceding the effective transfer date of assets, the Units allocated in the
affected Fund shall be redeemed. The proceeds from the redemption w ill be used to purchase Units in the new
Fund.
14. EXCEPTIONAL CIRCUMSTANCES

Should an intervening event such as but not limited to, temporary closure of any Stock Exchange in w hich the
Fund is invested, w hich We consider exceptional, occurs, We reserve the right to defer the payment of benefits
under this Policy for a period of not exceeding six (6) months from the date the payment w ould have been
normally effected if not for such intervening events.
THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK.

SCHEDUL E OF INVESTMENT FUNDS
TYPE OF FUNDS Allianz Life Managed Fund, Allianz Life Equity Fund, Allianz Life Dynamic Grow th
Fund, Allianz Life Equity Income Fund, Allianz Life Bond Fund, Allianz Life Dana
Padu, Allianz Life Amanah Dana Ikhlas, Allianz Life ASEAN Plus Fund, Allianz Life
Total Return Asian Equity Fund and Allianz Life Global Income Fund.
VALUATION DAY Every business day of the w eek or such date as We may determine at w hich
the underlying assets of each Fund shall be valued subject to the provisions of this
Policy.
FUND MANAGED BY Us or any party or person as We may appoint at Our discretion.
FUND MANAGEMENT Allianz Life Managed Fund : up to 1.25% per annum of the Fund assets;
CHARGE Allianz Life Equity Fund : up to 1.50% per annum of the Fund assets;
Allianz Life Dynamic Grow th : up to 1.50% per annum of the Fund assets;
Fund
Allianz Life Equity Income Fund : up to 1.35% per annum of the Fund assets;
Allianz Life Bond Fund : up to 0.75% per annum of the Fund assets;
Allianz Life Dana Padu : up to 1.50% per annum of the Fund assets;
Allianz Life Amanah Dana Ikhlas : up to 1.35% per annum of the Fund assets;
Allianz Life ASEAN Plus Fund : up to 1.50% per annum of the Fund assets;
Allianz Life Total Return Asian
Equity Fund * : up to 1.50% per annum of the Fund assets;
Allianz Life Global Income Fund * : up to 1.25% per annum of the Fund assets.
* The Fund Management Charge as set out above includes fund management fee of
the Target Fund. There w ill be no additional fee that is charged to you other than the
Fund Management Charge above.
The Fund Management Charge w ill be deducted at each Valuation Day. The Fund
Management Charge stated above is the maximum charge that We can impose but
the actual Fund Management Charge w ill vary according to the actual asset mix of
the fund if the fund is invested in more than one investment instrument. The Fund
Management Charge w ill be review ed by Us not less frequent than quarterly basis.
We reserve the right to revise the maximum Fund Management Charge by giving
You at least three (3) months prior w ritten notice.
INVESTMENT OBJECTIVE Allianz Life Managed Fund: An open-ended investment fund w hich aims to provide
medium to long term capital appreciation by investing in diversified equities and
equity-related securities, fixed income securities and money market instruments.
Allianz Life Equity Fund: An open-ended investment fund w hich aims to provide
medium to long term capital appreciation by investing in equities and equity -related
securities.
Allianz Life Dynam ic Grow th Fund: An open-ended investment fund w hich aims to
achieve superior capital appreciation over the medium to long term period by
investing in a diversif ied portfolio of stocks w ith an emphasis on small-to-medium
sized companies.
Allianz Life Equity Incom e Fund: An open-ended investment fund w hich aims to
provide medium to long term capital appreciation by investing in diversified equities
and equity-related securities skew ed tow ards potential dividend yielding equities,
fixed income securities and money market instruments.
Allianz Life Bond Fund: An open-ended investment fund w hich aims to provide a
stable income stream and medium to long term capital appreciation by investing
primarily in fixed income securities.
Allianz Life Dana Padu: An open-ended investment fund w hich aims to provide
medium to long term capital appreciation by investing in Shariah-approved equities
and equity related securities.
Although this fund invests in Shariah-approved securities, the insurance plan is not a
Shariah-compliant product.
Allianz Life Am anah Dana Ikhlas: An open-ended investment fund w hich aims to
seek a mix of regular income stream and possible capital grow th ov er the medium to
long term by investing in listed equities, Islamic debt instruments and other assets
that are permissible under the Shariah Principles.
Although this fund invests in Shariah-approved securities, the insurance plan is not a
Shariah compliant product.
Allianz Life ASEAN Plus Fund: An open-ended investment fund w hich aims to
provide medium to long term capital appreciation by investing primarily in ASEAN
equities and equity-related securities.
Allianz Life Total Return Asian Equity Fund: The Allianz Life Total Return Asian
Equity Fund (the “Fund”) aims to provide long-term capital grow th and income by
investing in the equity markets of the Republic of Korea, Taiw an, Thailand, Hong
Kong, Malaysia, Indonesia, the Philippines, Singapore and/or the People’s Republic
of China (the “PRC”)..
Allianz Life Global Incom e Fund: The Allianz Life Global Income Fund (the “Fund”)
aims to attain long term income and capital grow th by investing in a broad range of
asset classes, in particular in global equity and global bond markets .
FUND ASSET ALLOCATION Allianz Life Managed Fund (i) 30%-55% of Net Asset Value (NAV) in equities
and equity related securities.
(ii) 45%-70% of NAV in fixed income securities/
money market instruments.
(iii) Up to 10% of NAV in foreign investments.
Allianz Life Equity Fund (i) 80%-95% of NAV in equities and equity related
securities.
(ii) Minimum 5% of NAV in liquid assets.
Allianz Life Dynamic (i) Up to 95% of NAV in equities and equity

Grow th Fund related securities.
Allianz Life Equity Income (i) Up to 70% of NAV in equities and equity
Fund related securities.
(ii) Up to 90% of NAV in fixed income securities/
money market instruments.
Allianz Life Bond Fund (i) Up to 98% of NAV in fixed income securities.
Allianz Life Dana Padu (i) Up to 95% of NAV in Shariah-approved

equities and equity related securities.
(ii) Minimum 5% of NAV in Shariah-approved
liquid assets.
Allianz Life Amanah Dana The Fund feeds minimum 95% into the Maybank
Ikhlas Malaysia Balanced-i Fund.
The Fund has maximum 5% in Shariah-approved

liquid assets.
Allianz Life ASEAN Plus (i) 80%-95% of NAV in equities and equity related
Fund securities.
Allianz Life Total Return (i) Minimum 95% into an underlying fund know n
Asian Equity Fund as Allianz Total Return Asian Equity Fund
(ii) Maximum 5% in liquid assets
Allianz Life Global Income (i) Minimum 95% into an underlying fund know n
Fund as Allianz Global Income Fund
(ii) Maximum 5% in liquid assets
INVESTMENT RESTRICTIONS Assets w ill be as prescribed by regulatory authorities from time to time.
BORROWING RESTRICTIONS No borrow ing is allow ed.

TOTAL AND PERMANENT DISABILITY BENEFIT
SUPPLEMENTARY CONTRACT
THIS TOTAL AND PERMANENT DISABILITY BENEFIT SUPPLEMENTARY CONTRACT (subsequently called the
Supplementary Contract) forms a part of the Policy (subsequently called the Basic Policy) to which it is attached. It is
issued in consideration of the payment of Premiums of the Basic Policy. Unless otherwise expressly stated, the terms
defined and construed in the Basic Policy shall bear the same meaning or construction when used in this Supplementary
Contract.
1. BENEFITS PROVISIONS
1.1. AMOUNT PAYABLE IN THE EVENT OF TOTAL AND PERMANENT DISABILITY
While this Supplementary Contract and the Basic Policy are in force, if the Life Assured sustains Total and
Permanent Disability as defined below, We will, subject to the provisions contained in this Policy, pay the
following benefits.
1.1.1. an advance payment equivalent to the Amount of Benefit for this Supplementary Contract subject to
such limit as provided in this Policy provided that the Life Assured has attained the age of forty-nine (49)
months at the date of Total and Permanent Disability if there is any Unit Cancellation Supplementary
Contract attached to the Basic Policy at the date of commencement of the Total and Permanent
Disability; or
1.1.2. one hundred percent (100%) of the Account Value in addition to the amount payable in 1.1.1 above, if
there is no Unit Cancellation Supplementary Contract attached to the Basic Policy at the date of
commencement of the Total and Permanent Disability. The relevant Valuation Day shall be the
Valuation Day on or after the claim approval date.
In the event the Life Assured, before attaining age forty-nine (49) months, sustains Total and Permanent
Disability, the amount payable will be determined as follows:
Age of Life Assured at Total and Permanent Disability Percentage (%) of Amount of Benefit Payable
15 days - 12 Months 20 %
13 - 24 Months 40 %
25 - 36 Months 60 %
37 - 48 Months 80 %
49 Months and above 100%
The advance payment payable under this Supplementary Contract issued with the Basic Policy or any other
basic policies issued by Us for the same benefit inclusive of any Term Insurance Supplementary Contract on
any one (1) life shall not exceed eight million Ringgit Malaysia (RM8,000,000.00). Such advance payment will
only be made upon production of the Basic Policy for endorsement and the Insured Amount of the Basic Policy
and Amount of Benefit of any Term Insurance Supplementary Contract will be reduced by the amount of any
payment made in respect of such Basic Policy or Term Insurance Supplementary Contract. Despite any pre-
existing agreement to the contrary, the aforesaid advance payment shall be subject to the prior deduction of
any outstanding loans or Indebtedness on the Basic Policy.
2. RISKS EXCLUDED PROVISIONS

2.1 RISKS EXCLUDED
This Supplementary Contract shall not cover any Total and Permanent Disability caused directly or indirectly,
wholly or partly, by any one (1) of the following occurrences:
2.1.1. attempted self-destruction or self-inflicted injuries while sane or insane;
2.1.2. war, invasion, act of foreign enemy, hostilities or warlike operations (whether declared or undeclared),
strike, riot and/or civil commotion, mutiny, civil war assuming the proportions of or amounting to a
popular uprising, rebellion, revolution, insurrection, military uprising, military or usurped power, martial
law, state of siege, terrorist activity or any of the events or causes which determine the proclamation or
maintenance of martial law or state of siege;
2.1.3. accidental events that are directly or indirectly related to the use of atomic, biological or chemical
weapons as well as radioactive, biological or chemical warfare agents or substances;
2.1.4. service in the armed forces in time of declared or undeclared war while under orders for warlike
operations or restoration of public order;
2.1.5. entering, exiting, operating, servicing, or being transported by any aerial device or conveyance except
when the Life Assured is a passenger on a commercial passenger airline on a regular passenger trip
over its established passenger route;
2.1.6. any congenital defect which has manifested or was diagnosed before the Life Assured attains
UTPD_06V1 / July 2019 Page 1 of 3

seventeen (17) years of age and of which We were not aware at the Issue Date;
2.1.7. an opportunistic infection or a malignant neoplasm if at the time of disability, there is present in the Life
Assured Acquired Immunodeficiency Syndrome. An opportunistic infection includes but is not limited to
Pneumocystis carini pneumonia, organism of chronic enteritis, virus and/or disseminated fungi infection.
A malignant neoplasm includes but is not limited to Kaposi’s sarcoma, central nervous system
lymphoma, hairy-cell leukemia and/or other malignancies now known or which become known as
immediate cause of disability or death in the presence of Acquired Immunodeficiency Syndrome; or
2.1.8. Pre-Existing Conditions unless declared by You/the Life Assured and accepted by Us, on or prior to the
Issue Date or Reinstatement Date of this Supplementary Contract, whichever is later.
3. TERMINATION PROVISIONS
3.1. TERMINATION
This Supplementary Contract shall automatically terminate:
3.1.1 in the event the Basic Policy becomes matured/expired, terminated, lapsed or is surrendered; or
3.1.2 upon the payment of the benefit in Clause 1 of this Supplementary Contract; or
3.1.3 on the Policy Anniversary of the Basic Policy when the Life Assured attains age seventy one (71)
nearest birthday.
The Total and Permanent Disability benefit under this Supplementary Contract shall terminate in the event of
termination of any Term Insurance Supplementary Contract for the same benefit. The benefits for the Basic
Policy may be continuing regardless of termination of the Total and Permanent Disability benefit under this
Supplementary Contract.
Termination of this Supplementary Contract shall be without prejudice to any claim arising prior to such
termination. The payment or acceptance of any premium subsequent to termination of this Supplementary
Contract shall not create any liability on Our part but We shall refund any such premium.
4. GENERAL PROVISIONS
4.1. ALTERATION
No alteration, variation or waiver of any provision of this Supplementary Contract shall be valid unless such
alteration, variation or waiver is made by an Endorsement and signed by Our authorised person. We may
request for Your Policy to be sent to Us to effect the Endorsement. We will notify You of any amendments,
variations, changes, alterations or modifications required by law or regulatory authorities to be made to this
Policy. Once the Endorsement is effected, the terms and conditions of this Policy shall be read subject to such
Endorsement.
No agent has the authority to make any alteration to or to waive any of the terms and conditions in Your Policy.
4.2. CLAIM NOTIFICATION

You or the claimant must give written notice within six (6) months after the date of commencement of the Total
and Permanent Disability of the Life Assured to claim under this Supplementary Contract. Failure to give notice
within the time stipulated shall not invalidate any claim if it is shown that it was not reasonably possible to give
such notice and that notice was given as soon as was reasonably possible. It shall be Our sole discretion
whether to accept the reasons given for the failure to give notice within the time stipulated.
4.3. PROOF OF TOTAL AND PERMANENT DISABILITY

Upon Our receipt of the above notice, We will furnish to You or the claimant the appropriate forms for filing
proof of Total and Permanent Disability. Claims shall be made on forms provided by Us together with written
proof covering the occurrence, character and extent of the Total and Permanent Disability for which claims are
made. Such proof and other documents satisfactory to Us must be given at Your or the claimant’s expense.
4.4. FILING PROOF OF TOTAL AND PERMANENT DISABILITY

Proof of Total and Permanent Disability must be furnished to Us during the lifetime of the Life Assured and
within one (1) year of the due date of the first premium in default, if there is such default.
We reserve the right to require any additional proof and request medical examination of the Life Assured.
4.5. LEGAL PROCEEDINGS

No action at law or in equity shall be brought to recover on this Supplementary Contract prior to the expiry of
one (1) year.
4.6. DESPITE ANYTHING to the contrary, it is further stipulated and agreed that:
4.6.1. If at the issue of this Supplementary Contract the age of the Life Assured, at nearest birthday, is greater
than seventy one (71) years, this Supplementary Contract shall be void;
4.6.2. No change in the plan of the Basic Policy or Term Insurance Supplementary Contract or in the mode or
premium payment may be made during the continuance of the Total and Permanent Disability; and
4.6.3. This Supplementary Contract shall be non-participating and shall not share in the Divisible Surplus of
the Company.
4.7. SEVERABILITY
If any provision or part of a provision of this Supplementary Contract shall be held or found to be void, invalid
or otherwise unenforceable, it shall be deemed to be severed from this Supplementary Contract, and the
remainder of the provisions in this Policy shall remain in full force and effect.
4.8. APPLICABLE TAX

In the event that any sales and services tax, value added tax or any similar tax and any other duties, taxes,
levies or imposts (collectively “Applicable Tax”) whatsoever are introduced by any authority and are payable
under the laws of Malaysia in connection with any supply of goods and/or services made or deemed to be
made under this Policy, We will be entitled to charge any Applicable Tax as allowed by the laws of Malaysia.
Such Applicable Tax payable shall be paid in addition to the applicable premiums and other charges. All
provisions in this Policy on payment of premiums and default hereof shall apply equally to the Applicable Tax.
4.9. ANTI-MONEY LAUNDERING, ANTI-TERRORISM FINANCING AND PROCEEDS OF UNLAWFUL

ACTIVITIES ACT 2001
If We receive an order from the relevant authorities to freeze or seize the monies received as premium or
monies payable in respect of this Policy as provided under the Anti-Money Laundering, Anti-Terrorism
Financing and Proceeds of Unlawful Activities Act 2001 or such similar legislation or if We discover or have
reasonable suspicion that this Policy is exploited for money laundering activities and/or to finance terrorism,
We reserve the right to terminate this Policy immediately. We shall deal with all premiums paid and all
benefits/sums payable in respect of this Policy in any manner which We deem appropriate, including but not
limited to handing it over to the relevant authorities.
5. DEFINITIONS
When used in this Supplementary Contract:
“PRE-EXISTING CONDITIONS” means any condition or illness that the Life Assured has reasonable knowledge of
prior to the Issue Date or Reinstatement Date of this Supplementary Contract, whichever is later, and he/she had
failed to disclose the same. A Life Assured may be considered to have reasonable knowledge of a Pre-Existing
Conditions where the condition or illness is one (1) for which:
a) the Life Assured had received or is receiving the treatment; and/or
b) medical advice, diagnosis, care or treatment has been recommended; and/or
c) clear and distinct symptoms are or were evident; and/or
d) its existence would have been apparent to a reasonable person in the circumstances.
“TOTAL AND PERMANENT DISABILITY” means

a) totally unable by reason of accident or sickness to perform independently all the normal activities appropriate
to children of a similar age to the child Life Assured without the frequent attention of a third party and in Our
opinion is likely to remain so permanently; or
b) totally unable to engage in any work, occupation, or profession that the Life Assured can ever be capable of
doing or following to earn or obtain any wages, compensation or profit, at the time that the disability
commences and at any time after that,
provided however that such disability must last for a continuous period of not less than six (6) months in duration. If
it is subsequently admitted as a Total and Permanent Disability for the purpose of this Policy, Our liability shall
accrue as from the date of commencement of the disability.
In addition to the aforesaid, the occurrence of any of the following shall also be considered as a Total and
Permanent Disability:
a) total paralysis; or
b) total and irrecoverable loss of the sight of both eyes; or
c) loss by severance of two limbs at or above wrist or ankle; or
d) total paralysis of two limbs; or
e) total and irrecoverable loss of the sight of one eye and loss by severance of one limb at or above wrist or
ankle.

MEDISAFE INFINITE+ HOSPITALISATION AND SURGICAL INSURANCE
UNIT CANCELLATION SUPPLEMENTARY CONTRACT
This MEDISAFE INFINITE+ - HOSPITALISATION AND SURGICAL INSURANCE UNIT CANCELLATION

SUPPLEMENTARY CONTRACT (subsequently called “Supplementary Contract”) forms part of the Policy (hereinafter
called “Basic Policy”) to w hich it is attached. It is issued in consideration of the cancellation of units for the Cost of
Insurance applicable to this Supplementary Contract. Unless otherw ise expressly stated, the terms defined and
construed in the Basic Policy shall bear the same meaning or construction w hen used in this Supplementary Contract.
1. BENEFIT S PROVISIONS
While this Supplementary Contract and the Basic Policy are in force and subject to the provisions and Waiting Period
of this Supplementary Contract, We shall pay Reasonable and Customary Charges for the benefits listed below in
excess of the Deductible, if any. The payment of any benefit shall not exceed the maximum limit for each benefit and
all benefits paid under this Supplementary Contract for a Policy Year shall not exceed the Overall Annual Limit as set
forth in the Table of Benefits.
1.1. HOSPITALISATION AND SURGICAL BENEFIT

If the Life Assured is confined to a Hospital ‘on the recommendation of a registered Physician’, We w ill, upon
request and receipt of satisfactory supporting documents, provide the follow ing benefits subject to the
condition that the follow ing benefits have not been compensated by any other parties or sources and further
subject to the limits as stated in the Table of Benefits and this Supplementary Contract:
1.1.1. HOSPITAL ROOM AND BOARD
This benefit is payable if the Life Assured is Hospitalised. This benefit shall be paid as a
reimbursement for the Reasonable and Customary Charges of each period of Hospital confinement
as follow s:
1.1.1.1. The total room accommodation and meals charged by the Hospital subject to:
(a) the limit of the rate per day of the applicable Hospital Room and Board entitlement;
and
(b) the maximum number of days stated in the Table of Benefits.
1.1.1.2. If there is any balance betw een the initial rate of the Hospital Room and Board
entitlement per day as stated in the Table of Benefits and the actual room
accommodation and meals charged by the Hospital per day, We w ill reimburse the
amount charged by the Hospital and in addition, fifty percent (50%) of the said balance
amount (“Unutilised Benefit”) shall also be payable provided that:
(a) the total Unutilised Benefit amount payable under this benefit for each period of
Hospital confinement shall not be less than RM50; and
(b) the total amount of Unutilised Benefit paid under this benefit shall not exceed
RM5,000 per year.
1.1.2. INTENSIVE CARE UNIT

1.1.2.1. Reimbursement of the Reasonable and Customary Charges Medically Necessary for
actual Room and Board incurred w hen the Life Assured is Hospitalised in the Intensive
Care Unit of a Hospital. The amount of benefit payable shall be equal to the actual
charges made by the Hospital subject to the maximum number of days as set forth in the
Table of Benefits. Where the period of confinement in an Intensive Care Unit exceeds
the maximum limit as set forth in the Table of Benefits, reimbursement w ill be restricted
to the standard daily Hospital Room and Board rate and subject to not exceeding the
maximum number of days of Hospital Room and Board Benefit.
1.1.2.2. No Hospital Room and Board Benefit shall be paid for the same confinement period
w here the daily Intensive Care Unit benefit is payable.
1.1.3. LODGER BENEFIT

Reimbursement of the Reasonable and Customary Charges for meals and lodging incurred by one
(1) person in the Hospital to accompany Life Assured during Hospitalisation of the Life Assured .
The total meals and lodging charged by the Hospital is subjected to:
1.1.3.1. the limit of the rate per day of the applicable Lodger Benefit entitlement; and
1.1.3.2. the maximum number of days stated in the Table of Benefits.
1.1.4. HOSPITAL SUPPLIES & SERVICES

Reimbursement of the Reasonable and Customary Charges Medically Necessary actually incurred
for the follow ing:
1.1.4.1. general nursing;
1.1.4.2. prescribed and consumed drugs and medicines;
1.1.4.3. dressings, splints, plaster casts;
1.1.4.4. x-ray;
1.1.4.5. laboratory examinations;
1.1.4.6. electrocardiograms;
1.1.4.7. physiotherapy;
UMI+_01V2 / Jul 2021 Page 1 of 18

1.1.4.8. basal metabolism tests;
1.1.4.9. intravenous injections and solutions;
1.1.4.10. administration of blood and blood plasma, including the cost of blood and plas ma,
w hilst the Life Assured is Hospitalised.
1.1.5. SURGICAL FEES

Reimbursement of the Reasonable and Customary Charges for a Medically Necessary Surgery by
the Specialists, including Specialist’s pre-surgical assessment visits w hile the Life Assured is
Hospitalised.
1.1.6. ANAESTHETIST FEES

Reimbursement of the Reasonable and Customary Charges for the Medically Necessary
administration of anaesthesia by an anaesthetist w hile the Life Assured is Hospitalised.
1.1.7. OPERATING THEATRE FEES

Reimbursement of the Reasonable and Customary Charges for the Operating Room incidental to a
Medically Necessary surgical procedure w hile the Life Assured is Hospitalised.
1.1.8. IN-HOSPITAL PHYSICIAN VISIT

Reimbursement of the Reasonable and Customary Charges for Medically Necessary visit by a
Physician to the Life Assured during Hospitalisation subject to a maximum of tw o (2) visits per day
and not exceeding the maximum number of days of Hospital Room and Board as set forth in the
Table of Benefits.
1.1.9. PRE-HOSPITALISATION DIAGNOSTIC TESTS

Reimbursement of the Reasonable and Customary Charges for Medically Necessary ECG, X-ray
and laboratory tests w hich are performed for diagnostic purposes on account of a Disability
preceding Hospitalisation or Day-Care Surgery w ithin the maximum number of days as set forth in
the Table of Benefits in a Hospital and w hich are recommended by a Physician. Payment for the
diagnostic services under this benefit shall only be payable if the Life Assured is subsequently
confined in a Hospital or undergoes Day-Care Surgery for the treatment of the medical condition
diagnosed. Medications and consultations charged by the Physician for the said diagnosis w ill not
be payable under this benefit.
1.1.10. PRE-HOSPITALISATION CONSULTATION

1.1.10.1. Reimbursement of the Reasonable and Customary Charges up to tw o (2) consultations
by a General Practitioners and one (1) consultation by a Specialist in connection w ith a
Disability w ithin the maximum number of days as set forth in the Table of Benefits
preceding Hospitalisation or Day-Care Surgery and provided that such consultation is
Medically Necessary and has been recommended in w riting by the attending General
Practitioner.
1.1.10.2. Payment for the consultations (including medications and treatments) under this benefit
shall only be payable if the Life Assured is subsequently confined in a Hospital or
undergoes Day-Care Surgery for the treatment of the medical condition diagnosed.
1.1.11. ORGAN TRANSPLANT

Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary
transplantation surgery w here the Life Assured is the recipient of the transplant. Any costs to
transport, store the organs and the cost to purchase the organs are not covered.
1.1.12. POST-HOSPITALISATION TREATMENT

follow -up treatment for a Disability by the Physician or Specialist as referred by the attending
Physician immediately follow ing discharge from the Hospital or after Day-Care Surgery w ithin the
maximum number of days as set forth in the Table of Benefits. This shall include medicines
prescribed during the follow -up treatment but shall not exceed the supply needed for the maximum
number of days as set forth in the Table of Benefits.
1.1.13. HOME NURSING CARE

Reimbursement of the Reasonable and Customary Charges incurred for full-time or part-time
services of a State-registered or Government-licensed nurse in the Life Assured’s home w hen
prescribed by the original attending Physician for the continued treatment of the specific medical
condition for w hich the Life Assured w as Hospitalised and only w hen such services are considered
Medically Necessary by the original attending Physician subject to a maximum number of days set
forth in the Table of Benefits per lifetime of the Life Assured. The care must be provided w ithin
seven (7) days follow ing discharge from the Hospital subject to a minimum of three (3) days of
Hospitalisation. The number of days of Hospitalisation shall refer to the number of days charged
under Hospital Room and Board Benefit.
UMI+_01V2 / Jul 2021 Page 2 of 18

1.1.14. AMBULANCE FEES
domestic land ambulance services (inclusive of attendant) to and/or from the Hospital of
confinement. Payment w ill not be made if the Life Assured is not Hospitalised.
1.1.15. DAY-CARE SURGERY

1.1.15.1. Reimbursement of the Reasonable and Customary Charges charged by the Hospital or
Specialist centre and for all professional fees charged for Medically Necessary Day-Care
Surgery. Such fees or charges shall include all incidental services and supplies provided
for the procedures. The Day-Care Surgery shall include minor operations such as but not
limited to: Adenoidectomy, Arthroscopy, Broncoscopy, Bunionectomy, Cataract
Removal, Cholecystectomy, Colonoscopy, Coronary Angiography, Digestive Tract
Endoscopy, Dilatation and Curettage of Uterus, Simple Excision of Pilonodal Cyst,
Haemorrhoidectomy, Hammer Toe Repair, Laparascopy, Laryngoscopy and
Tracheoscopy, Lumbosacral Manipulation, Myringotomy, Prostate Biopsy, Reduction of
Nasal Fracture and Tonsillectomy, that is commonly performed safely on an Out-Patient
basis.
1.1.15.2. Any Day-Care Surgery done for investigative and diagnostic purpose not related to
treatment for any specific Disability is not covered.
1.1.15.3. We reserve the right to treat any In-Patient surgical procedure as Day-Care Surgery
w hen in Our opinion such In-Patient treatment could have been done as an Out-Patient
treatment.
1.1.16. MEDICAL REPORT FEES

Reimbursement of expenses for pursuing medical report per admission for In-Patient treatment or
per Disability for Out-Patient treatment subject to the maximum amount as stated in the Table of
Benefits.
1.2. OUT-PATIENT TREATMENT BENEFIT S

We w ill, upon request and receipt of satisfactory supporting documents, provide the follow ing benefits subject
to the condition that the follow ing benefits have not been compensated by any other parties or sources . We
reserve the right to treat any In-Patient surgical procedure as Out-Patient Treatment w hen in Our opinion such
In-Patient treatment could have been done as an Out-Patient treatment.
1.2.1. EMERGENCY ACCIDENTAL OUT-PATIENT TREATMENT

Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum
amount as stated in the Table of Benefits, as a result of a covered Bodily Injury arising from an
Accident for Medically Necessary treatment as an Out-Patient at any registered clinic or Hospital
w ithin forty-eight (48) hours of the Accident causing the covered Bodily Injury. Follow up treatment
by the same Physician or same registered clinic or Hospital for the same covered Bodily Injury w ill
be provided up to the maximum amount and the maximum number of days as set forth in the Table
of Benefits.
1.2.2. OUT-PATIENT KIDNEY DIALYSIS TREATMENT

1.2.2.1. If the Life Assured is diagnosed w ith Kidney Failure, We w ill reimburse the Reasonable
and Customary Charges incurred for the Medically Necessary treatment of kidney
dialysis performed at a legally registered dialysis centre.
1.2.2.2. Such treatment (dialysis including consultation, examination tests, take-home drugs)
must be received at the Out-Patient department of a Hospital or a registered dialysis
treatment centre immediately follow ing discharge from Hospital confinement or Surgery.
1.2.2.3. It is a specific condition of this benefit that notw ithstanding the exclusion of Pre-Existing
Conditions, this benefit w ill not be payable to any Life Assured w ho has chronic renal
diseases and/or is receiving dialysis treatment prior to the effective date of insurance.
1.2.3. OUT-PATIENT DENGUE OR ENTERIC FEVER TREATMENT

1.2.3.1. If the Life Assured is diagnosed w ith Dengue or Enteric Fever, We w ill reimburse the
Reasonable and Customary Charges incurred for the Medically Necessary treatment of
Dengue or Enteric Fever received as an Out-Patient at any registered clinic or Hospital.
1.2.3.2. Such treatment (including consultation, examination tests, take-home drugs) must be
received at the Out-Patient department of a registered clinic or Hospital.
1.3. CANCER TREATMENT BENEFITS
1.3.1. OUT-PATIENT CANCER TREATMENT

1.3.1.1. If the Life Assured is diagnosed w ith Canc er, We w ill reimburse the Reasonable and
Customary Charges incurred for the Medically Necessary treatment of Cancer performed
at a legally registered Cancer treatment centre.
UMI+_01V2 / Jul 2021 Page 3 of 18

1.3.1.2. Such treatments (radiotherapy, chemotherapy, targeted therapy, hormonal therapy or
immunotherapy including consultation, examination tests and prescribed take-home
drugs) must be received at the Out-Patient department of a Hospital or a registered
Cancer treatment centre immediately follow ing discharge from a Hospital confinement or
Surgery. Such treatments have to be licensed and approved by corresponding medical
authority (Ministry of Health) in Malaysia, and its prescription and administration is
regulated.
1.3.1.3. It is a specific condition of this benefit that notw ithstanding the exclusion of Pre-Existing
Conditions, this benefit w ill not be payable to any Life Assured w ho had been diagnosed
as a Cancer patient and/or is receiving Cancer treatment prior to the effective date of
insurance.
1.3.1.4. We reserve the right to treat any In-Patient surgical procedure for Cancer as Out-Patient
Cancer Treatment w hen in Our opinion such In-Patient treatment could have been done
as an Out-Patient treatment.
1.3.2. GENOMIC TEST FOR CANCER

genomic testing for Cancer to determine the treatment option upon diagnosis of Cancer. The
benefit paid under this clause shall not exceed the maximum amount per lifetime as set forth in the
Table of Benefits. Predictive genetic testing is specifically excluded for this benefit.
1.4. OTHER BENEFITS

We w ill, upon request and receipt of satisfactory supporting documents (including the diagnosis of the initial
attending Physician) provide the follow ing benefits subject to the condition that the follow ing benefits have not
been compensated by any other parties or sources:
1.4.1. SECOND MEDICAL OPINION

Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum
amount as stated in the Table of Benefits, as a result of the Life Assured obtaining a Second
Medical Opinion provided that the Life Assured is : (a) an In-Patient; or (b) recommended by a
Physician to be Hospitalised; or (c) is diagnosed w ith Cancer or Kidney Failure. Notw ithstanding the
exclusion of Pre-Existing Conditions, this benefit w ill not be payable to any Life Assured w ho has
Cancer or Kidney Failure, and/or is receiving treatment prior to the effective date of insurance.
1.4.2. REIMBURSEMENT FOR ALTERNATIVE TREATMENT FEES

1.4.2.1. Reimbursement of the Reasonable and Customary Charges for Alternative Treatment up
to one (1) visit per day, w ithin thirty (30) days from the Hospital discharge date.
1.4.2.2. Alternative Treatment refers to chiropractic, chiropody, homeopathy, osteopathy or
acupuncture, provided by a practitioner w ho is practising w ithin the scope of practice of
his/ her profession and is duly registered w ith the Traditional and Complementary
Division of Ministry of Health or the Drug Control Authority or as mandated under any
prevailing or future law s or regulations or under the Traditional and Complementary
Medicine Act 2016 including any subsequent amendment(s) or enactment of it. We shall
require the Life Assured to give Us satisfactory proof that the practitioners of chiropractic,
chiropody, homeopathy, osteopathy or acupuncture is duly registered.
1.4.2.3. The benefit paid under this clause shall not exceed the limits as set forth in the Table of
Benefits. We shall require proof of prior Hospitalisation upon claim for this benefit.
1.4.3. INTRAOCULAR LENS

intraocular lens for cataract or eye injury Surgery.
1.5. NO CLAIM BENEFITS
1.5.1. NO CLAIM REWARD

We shall review the claims experience for this Supplementary Contract every three (3) years
commencing from the Issue Date of this Supplementary Contract (“Review ”). If no claim is claimed
or paid for the three (3) year period prior to each Review , We shall increase the amount of the
Hospital Room and Board Benefit entitlement for the period after each Review by ten percent (10%)
of the initial rate of the Hospital Room and Board Benefit entitlement PROVIDED ALWAYS THAT
the increased amount shall not exceed one hundred and fifty percent (150%) of the initial rate of the
Hospital Room and Board Benefit entitlement as per the Issue Date of this Supplementary Contract.
1.5.2. NO CLAIM REFUND

We shall review the claims experience for this Supplementary Contract every year. If no eligible
claim event is registered for the preceding Policy Year, We shall refund the Cost of Insurance paid
in the preceding Policy Year based on the schedule below (“No Claim Refund”). The refunded
amount w ill be credited into Your Account Value.
UMI+_01V2 / Jul 2021 Page 4 of 18

No Claim Refund
No Claim Period (% of Cost of Insurance Paid* of Preceding Policy
Year)
1 consecutive Policy Year 10%
2 consecutive Policy Years 15%
3 or more consecutive Policy Years 20%
* Cost of Insurance paid does not include Hospital Assistance Fee.
If, after a No Claim Refund has been credited into Your Account Value, an eligible claim event from
the preceding Policy Year(s) is subsequently registered, the No Claim Period shall reset based on
claim event date and the appropriate amount of No Claim Refund for the corresponding year(s)
shall be debited from Your Account Value.
2. CLAIMS PROCEDURES
2.1. EVENTS LEADING TO CLAIMS

2.1.1. The Life Assured shall w ithin thirty (30) days of a Disability that incurs claimable expenses, give
w ritten notice to Us stating full particulars of such event, including all original final tax invoices,
original itemised/ detailed medical bills, original receipts and a full Physician's report stipulating the
diagnosis of the condition treated and the date the Disability commenced in the Phy sician's opinion
and the Physician's summary of the cost of treatment including medicines and services rendered.
2.1.2. Failure to furnish such notice w ithin the time allow ed shall not invalidate any claim if it is show n not
to have been reasonably possible to furnish such notice and that such notice w as furnished as soon
as it w as reasonably possible.
2.1.3. The Life Assured shall immediately procure and act on proper medical advice and We shall not be
held liable in the event of the failure or omission by the Life Assured to take any treatment.
2.2. INCOMPLETE CLAIMS

All claims must be submitted to Us w ithin thirty (30) days of completion of the events for w hich the claim is
being made. Claims are not deemed complete and eligible benefits are not payable unless all original final tax
invoices, original itemised/ detailed medical bills and original receipts for such claims have been submitted
and agreed upon by Us. Only actual costs incurred shall be considered for reimbursement. Any variation or
w aiver of the foregoing shall be at Our sole and absolute discretion.
2.3. CURRENCY OF PAYMENT

All payments under this Supplementary Contract shall be made in the legal currency of Malaysia.

This Supplementary Contract shall not pay any benefit arising from or accelerated by, directly or indirectly, w holly or
partly by:
3.1. Pre-Existing Conditions.

3.2. Specified Illnesses occurring during the first one hundred and tw enty (120) days of continuous cover , w hether
or not caused by Accident.
3.3. Any medical or physical conditions arising during the Waiting Period except for Accidental Injuries.
3.4. Surgery and/ or treatment related to plastic/ cosmetic purposes, circumcision, eye examination, glasses and
refraction or surgical correction of nearsightedness (Radial Keratotomy or Lasik) and the use or acquisition of
external prosthetic, external appliances or corrective devices such as artificial limbs, hearing aids, pacemakers
and prescriptions thereof.
3.5. Dental conditions including dental treatment or oral surgery except as necessitated by Accidental Injuries to
sound natural teeth occurring w holly during the period of cover.
3.6. Private nursing, rest cures or sanitaria care, illegal drugs, intoxication, sterilisation, venereal disease and its
sequelae, AIDS (Acquired Immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV related
diseases, and any communicable diseases requiring quarantine by law .
3.7. Any treatment or surgical operation for Congenital Conditions or deformities including hereditary conditions
w hich w as manifested or w as diagnosed before the Life Assured attains seventeen (17) years of age.
3.8. Pregnancy, child birth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care and
surgical, mechanical or chemical contraceptive methods of birth control or treatment pertaining to infertility,
erectile dysfunction and tests or treatment related to impotence or sterilisation.
3.9. Hospitalisation primarily for investigatory purposes, diagnosis, X-ray examination, general physical or medical
examinations, not incidental to treatment or diagnosis of a covered Disability or any treatment w hich is not
Medically Necessary and any preventive treatments, preventive medicines or examinations carried out by a
Physician, and treatments specifically for w eight reduction or gain.
3.10. Suicide, attempted suicide or intentionally self -inflicted injury w hile sane or insane.
3.11. War or any act of w ar, declared or undeclared, criminal or terrorist activities, active duty in any armed forces,
direct participation in strikes, riots and civil commotion or insurrection.
3.12. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear w aste from process of
nuclear fission or from any nuclear w eapons material.
UMI+_01V2 / Jul 2021 Page 5 of 18

3.13. Expenses incurred for donation of any body organ by the Life Assured and costs of acquisition of the organ
including all costs incurred by the donor during organ transplant and its complications.
3.14. Investigation and treatment of sleep and snoring disorders, hormone replacement therapy and alternative
therapy (other than the Alternative Treatment specified in Reimbursement For Alternative Treatment Fees
provisions) such as treatment, medical service or supplies, including but not limited to acupressure,
reflexology, bonesetting, herbalist treatment, massage or aroma therapy or other alternative treatment.
3.15. Care or treatment for w hich payment is not required or to the extent w hich is payable by any other insurance
or indemnity covering the Life Assured and Disabilities arising out of duties of employment or profession tha t is
covered under a Workman's Compensation Insurance Contract.
3.16. Psychotic, psychiatric, mental or nervous disorders, (including any neuroses and their physiological or
psychosomatic manifestations).
3.17. Costs/expenses of services of a non-medical nature, such as television, telephones, telex services, radios or
similar facilities, admission kit/pack and other ineligible non-medical items.
3.18. Sickness or Injury arising from racing of any kind (except foot racing), hazardous sports such as but not limited
to skydiving, w ater skiing, underw ater activities requiring breathing apparatus, w inter sports, professional
sports and illegal activities.
3.19. Private flying other than in any commercial scheduled airlines licensed to carry passengers over established
routes.
3.20. Expenses incurred for sex changes.
3.21. Experimental Treatments w hich security and reliability have not been recognised by the medical authority
(Ministry of Health) in Malaysia.
4. TERMINATION PROVISION
4.1. This Supplementary Contract shall automatically terminate if any one (1) of the follow ing occurs:
4.1.1. if the Basic Policy expires, lapses, terminated or is surrendered; or
4.1.2. on the anniversary of the Policy Date of the Basic Policy w hen the age of Life Assured is one
hundred (100) nearest birthday; or
4.1.3. upon the death of the Life Assured.
4.2. Termination of this Supplementary Contract shall be w ithout prejudice to any claim arising prior to such
termination. The deduction of Cost of Insurance in this Policy subsequent to termination of this Supplementary
Contract shall not create any liability upon Us but We shall refund any such Cost of Insurance deducted.
5.1. ALTERATIONS
We reserve the right to amend the terms and provisions of this Supplementary Contract by giving a w ritten
notice three (3) months prior to the next Policy Year by ordinary post to Your last know n address in Our
records or electronically, and such amendment w ill be applicable from the next renew al of this Supplementary
Contract. No alteration to this Supplementary Contract shall be valid unless authorised by Us and such
approval is endorsed on it.
5.2. CERTIFICATION, INFORMATION AND EVIDENCE

All certificates, information, medical reports and evidence as required by Us shall be furnished at the expense
of the Life Assured and in such a form that We may require. In any event all notices w hich We shall require
You to give must be in w riting and addressed to Us. The Life Assured shall, at Our request and expense,
submit to Us a medical examination w henever such is deemed necessary.
5.3. CHANGE IN RISK

The Life Assured shall give immediate notice in w riting to Us of any material change in his or her occupation,
business, duties or pursuits and pay any additional Cost of Insurance that may be required by Us.
5.4. CONDITION PRECEDENT TO LIABILITY

The due observance and the fulfillment of the terms, provisions and conditions of this Supplementary Contract
by You and/or Life Assured and in so far as they relate to anything to be done or complied w ith by You and/or
Life Assured shall be conditions precedent to any of Our liability.
5.5. CONTRIBUTION
You may purchase this Supplementary Contract as a Base Plan or to opt for a Deductible.
If this Supplementary Contract is a Base Plan, then subject to the terms and conditions of this Supplementary
Contract, all Eligible Expenses w ill be payable under this Supplementary Contract.
If this Supplementary Contract comes w ith a Deductible, then subject to the terms and conditions of this
Supplementary Contract, all Eligible Expenses in excess of the Deductible w ill be payable under this
UMI+_01V2 / Jul 2021 Page 6 of 18

If the Life Assured carries other insurance covering any Disability or injury insured by this Supplementary
Contract, We shall not be liable for such Disability or injury in a proportion greater than the amount applicable
to it under this Supplementary Contract bears to the total amount of all valid insurance covering such Disability
or injury.
5.6. CONVERSION POLICIES

If the eligible benefits provided under this Supplementary Contract shall have been converted from an existing
coverage of an ‘Inner Limits’ to an ‘As Charged/Full Reimbursement’ coverage, and if such Life Assured shall
have been afflicted w ith a Disability prior to or at the time the benefits w ere converted, the benefits payable in
respect of the Disability shall be in accordance w ith the Table of Benefits prior to the date the eligible benefits
w ere converted. How ever, the Waiting Period shall be re-applied from the approval date for the additional
benefits (new ly added benefits) on the Lif e Assured.
5.7. COST OF INSURANCE

5.7.1. A grace period of thirty one (31) days from its due date w ill be allow ed for the deduction of the Cost
of Insurance, during w hich period this Supplementary Contract w ill remain in force.
5.7.2. The Cost of Insurance at the time of renew al is not guaranteed and We reserve the right to revise
the Cost of Insurance rate applicable at the time of renew al. We w ill notify You in w riting of the
revised Cost of Insurance rates, at least three (3) months before the revised Cost of Insurance rates
take effect at the next renew al date.
5.7.3. Upon revision of Cost of Insurance, We reserve the right to increase the Premium to ensure that the
Account Value is projected to be sufficient for the deduction of Policy Charges up to the Maturity
Date of this Policy.
5.8. ELIGIBILITY
Eligibility of the Life Assured for benefits provided in this Supplementary Contract star ts upon the expiry of the
Waiting Period except for a covered Accident occurring after the Issue Date or Reinstatement Date, w hichever
is later.
5.9. FREE-LOOK PERIOD

You may cancel this Supplementary Contract by giving Us a w ritten request and returning this Supplementary
Contract to Us w ithin fifteen (15) days or such longer period as may be specified by Bank Negara Malaysia,
from the date of receipt of this Supplementary Contract by You. The amount refunded under this
Supplementary Contract shall be the Cost of Insurance deducted for this Supplementary Contract less any
expenses incurred for medical examination.
5.10. GEOGRAPHICAL TERRITORY

All benefits provided in this Supplementary Contract are applicable w orldw ide for tw enty four (24) hours a day
subject to Residence Overseas and Overseas Treatment clause.
5.11. GOVERNING LAW

This Supplementary Contract is issued under the law s of Malaysia and is subjected and governed exclusively
by the law s prevailing in Malaysia.
5.12. LEGAL PROCEEDINGS

No action at law or in equity shall be brought to recover on this Supplementary Contract prior to expiration of
sixty (60) days after w ritten proof of loss has been furnished in accordance w ith the requirements of this
Supplementary Contract. If You and/or Life Assured shall fail to fur nish the requisite proof of loss as stipulated
by the terms, provisions and conditions of this Supplementary Contract at the material time, You and/or Life
Assured may, w ithin a grace period of one (1) calendar year from the time that the w ritten proof of loss w as
required to be furnished, submit the relevant proof of loss to Us accompanied by cogent reason(s) for the
failure to comply w ith the time required to furnish the requisite proof of loss as stipulated under the terms,
provisions, and conditions of this Supplementary Contract. The acceptance of such proof of loss shall be at
the Our sole and absolute discretion. After such grace period has expired, We w ill not accept, for any reason
w hatsoever, such w ritten proof of loss.
5.13. MISREPRESENTATION / FRAUD

If the proposal or declaration from You and/or Life Assured is untrue in any respect or if any material fact
affecting Our risk be incorrectly stated or omitted in this Supplementary Contract, or if this insurance, or any
renew al of it shall have been obtained through any misstatement, misrepresentation or suppression, or if any
claim made shall be fraudulent or exaggerated, or if any false declaration or statement shall be made in
support of it, then in any of these cases, this Supplementary Contrac t shall be void.
5.14. MISSTATEMENT OF AGE AND SEX

5.15.1. If the age and/ or sex of the Life Assured has been misstated and the Cost of Insurance charged as
a result is insufficient, any claim payable under this Supplementary Contract shall be prorated based
on the ratio of the actual Cost of Insurance charged to the correct Cost of Insurance w hich should
have been charged for the year. Any excess Cost of Insurance, w hich may have been charged as a
result of such misstatement of age and/ or sex, shall be refunded w ithout interest.
5.15.2. If at the correct age and/ or sex the Life Assured w ould not have been eligible for cover under this
Supplementary Contract, no benefit shall be payable.
UMI+_01V2 / Jul 2021 Page 7 of 18

5.15. NON-PARTICIPATION
This Supplementary Contract shall be non-participating and shall not share in Our Divisible Surplus.
5.16. NOTICE
Every notice or communication to Us shall be in w riting and sent to Us. No alterations in the terms of this
Supplementary Contract or any Endorsement on it, w ill be held valid unless the same is signed or initialled by
Our authorised representative.
5.17. OVERSEAS TREATMENT

5.17.1. If the Life Assured elects to or is referred by the attending Physician to be treated outside Malaysia,
the benefits in respect of the treatment shall be limited to the Reasonable and Customary Charges
that are Medically Necessary for such equivalent local treatment in Malaysia and shall exclude the
cost of transport to the place of treatment.
5.17.2. For avoidance of doubt, if there is no equivalent local treatment in Malaysia, then the benefits in
respect of any treatment outside Malaysia shall be limited to the cost of the current available
alternative treatment in Malaysia for the Life Assured’s condition as recommended by the attending
Physician.
5.18. OWNERSHIP OF POLICY

Unless otherw ise expressly provided for by Endorsement in the Basic Policy, We shall be entitled to treat You
as the absolute ow ner of this Supplementary Contract. We shall not be bound to recognise any equitable or
other claim to or interest in this Supplementary Contract, and the receipt of this Supplementary Contract or a
benefit by the Life Assured (or by Your legal or authorised representative) alone shall be an effective
discharge of all Our obligations and liabilities.
5.19. PERIOD OF COVER AND RENEWAL

5.19.1. This Supplementary Contract shall become effective as of the date stated in the Policy Schedule or
Endorsement. The Policy Anniversary shall be one (1) year after the effective date and annually
from then on. On each such anniversary, this Supplementary Contract is renew able at the Cost of
Insurance rates in effect at that time as notified by Us.
5.19.2. This Supplementary Contract w ill be renew able at Your option at Policy Anniversary subject to the
terms, conditions, termination provisions and Our right to revise the Cost of Insurance of this
Supplementary Contract. Such changes to the Cost of Insurance, if any shall be applicable to You
irrespective of Your claim experience according to Our risk assessment.
5.19.3. This Supplementary Contract shall not be renew ed upon the occurrence of any of the follow ing:
(a) If the Basic Policy expires, lapses, or is surrendered;
(b) Fraud or misrepresentation of material fact during application; or
(c) The Supplementary Contract is cancelled at Your request.
5.20. REINSTAT EM ENT

If this Supplementary Contract lapses, the benefits in this Supplementary Contract may be reinstated w ith Our
consent. Such reinstatement shall cover Hospitalisation, Surgery and Out-Patient treatment subsequently
occurring. The Waiting Period w ill be re-applied from the approval date of reinstatement.
5.21. RESIDENCE OVERSEAS

No benefit w hatsoever shall be payable for any medical treatment received by the Life Assured outside
Malaysia apart from Singapore and Brunei, if the Life Assured resides or travels outside Malaysia, Singap ore
and Brunei for more than ninety (90) consecutive days from the day the Life Assured leaves Malaysia.
5.22. SUBROGATION
If We shall become liable for any payment under this Supplementary Contract, We shall be subrogated to the
extent of such payment of all the rights and remedies to You against any party and shall be entitled at Our
ow n expense to sue in Your name. You shall give or cause to be given to Us all such assistance in Your
pow er as We shall require to secure the rights and remedies and at Our request shall execute or cause to be
executed all documents necessary to enable Us to effectively to bring suit in Your name.
5.23. UPGRADED POLICIES

If the eligible benefits to any Life Assured under the terms of this Supplementary Contract is increased w hile it
is in force or at the time of renew al or replacement and if such Life Assured shall have been afflicted w ith a
Disability prior to or at the time the benefits w ere increased, the limits of benefits payable in respect of such
Disability shall not exceed the limit of benefits prior to the date the benefits w ere upgraded. How ever,
upgrading of plan w ill be subjected to underw riting and the Waiting Period shall be re-applied from the
approval date for the additional benefits (new ly added benefits) on the Life Assured.
5.24. UPGRADED ROOM AND BOARD

If the Life Assured is Hospitalised at a Room and Board rate w hich is higher than his/her eligible benefit, the
Life Assured shall bear the difference in the Hospital Room and Board charges.
UMI+_01V2 / Jul 2021 Page 8 of 18

5.25. APPLICABLE TAX
levies or imposts (collectively “Applicable Tax”) w hatsoever are introduced by any authority and are payable
under the law s of Malaysia in connection w ith any supply of goods and/or services made or deemed to be
made under this Policy, We w ill be entitled to charge any Applicable Tax as allow ed by the law s of Malaysia.
5.26. ANTI-MONEY LAUNDERING, ANTI-TERRORISM FINANCING AND PROCEEDS OF UNLAWFUL

ACTIVITIES ACT 2001
If We receive an order from the relevant authorities to freeze or seize the monies received as premium or
monies payable in respect of this Supplementary Contract/this Policy as provided under the Anti-Money
Laundering, Anti-Terrorism Financing and Proceeds of Unlaw ful Activities Act 2001 or such similar legislation
or if We discover or have reasonable suspicion that this Supplementary Contract/this Policy is exploited for
money laundering activities and/or to finance terrorism, We reserve the right to terminate this this
Supplementary Contract/Policy immediately. We shall deal w ith all premiums paid and all benefits/sums
payable in respect of this this Supplementary Contract/Policy in any manner w hich We deem appropriate,
including but not limited to handing it over to the relevant authorities.
6. DEFINITION
The follow ing terms shall have the follow ing meaning assigned below :
RELATING TO CONTRACTUAL DETAILS
6.1. BASE PLAN shall mean any hospitalisation and surgical coverage of the Life Assured that pays the claims for
Eligible Expenses of the Life Assured for any Disability. The coverage includes this Supplementary Contract
w hen the Retirement Option that converts the current plan to Base Plan is exercised.
6.2. DEDUCTIBLE shall mean that portion of Eligible Expenses for w hich You are liable before any benefits are
payable under this Supplementary Contract. The applicable Deductible amount is as set forth in the Policy
Schedule. The Eligible Expenses are accumulated on per Policy Year basis.
6.3. ISSUE DATE shall mean the date the Supplementary Contract is issued as stated in the Policy Schedule or
the effective date of Endorsement as stated in the letter of Endorsement, w hichever is later.
6.4. LIFE ASSURED shall mean the person described in the Policy Schedule or Endorsement, w hichever is later.
6.5. POLICY ANNIVERSARY shall mean the same date each year as the Issue Date.
6.6. POLICY OWNER shall mean a person or a corporate body to w hom the Supplementary Contract has been
issued in respect of cover for persons specifically identified as Life Assured in this Supplementary Contract.
6.7. POLICY YEAR shall mean the one (1) year period including the effective date of commencement of Insurance
and immediately follow ing that date, or the one (1) year period follow ing the renew al or renew ed
6.8. REINSTAT EM ENT DATE shall mean the date Your application for reinstatement is approved by Us.
6.9. RETIREMENT OPTION shall mean the option as indicated in the Policy Schedule w hich w ill be exercised
w hen the Life Assured attains age sixty (60) years old nearest birthday on the Policy Anniversary.
6.10. WE/US/OUR means Allianz Life Insurance Malaysia Berhad.
6.11. YOU/YOUR shall mean the Policy Ow ner. The Policy Ow ner may be the Life Assured or someone other than
the Life Assured.
RELATING TO INSURANCE COVER
6.12. ACCIDENT shall mean a sudden, unintentional, unexpected, unusual, and specific event that occurs at an
identifiable time and place w hich shall, independently of any other cause, be the sole cause of Bodily Injury.
6.13. ANY ONE (1) DISABILITY shall mean all of the periods of Disability arising from the same cause including
any and all complications therefrom except that if the Life Assured completely recovers and remains free from
further treatment (including drugs, medicines, special diet or injection or advice for the condition) of the
Disability for at least ninety (90) days follow ing the latest date of discharge and subsequent Disability from the
same cause shall be considered as though it w ere a new Disability.
UMI+_01V2 / Jul 2021 Page 9 of 18

6.14. CANCER is defined as any malignant tumour positively diagnosed w ith histological c onfirmation and
characterised by the uncontrolled grow th of malignant cells and invasion of tissue. The term malignant tumour
includes leukemia, lymphoma and sarcoma. The follow ing conditions are excluded:
(a) All Cancers w hich are histologically classified as pre-malignant, non-invasive; carcinoma in situ; having
either borderline malignancy; or having low malignant potential;
(b) All tumours of the prostate, thyroid and urinary bladder histologically classified as T1N0M0 (TNM
Classification);
(c) Chronic Lymphocytic Leukemia less than RAI Stage 3;
(d) All Cancers in the presence of HIV;
(e) Any skin Cancer other than malignant melanoma.
6.15. CONGENITAL CONDITIONS shall mean any medical or physical abnormalities existing at the time of birth, as
w ell as neo-natal physical abnormalities developing w ithin six (6) months from the time of birth. They w ill
include hernias of all types and epilepsy except w hen caused by a trauma w hich occurred after the date that
the Life Assured w as continuously covered under this Supplementary Contract.
6.16. DENGUE shall mean an acute infectious disease caused by an arthropod-borne virus and transmitted to
humans by the Aedes Mosquito. The disease must be diagnosed by a Medical Practitioner and be supported
by acceptable clinical, serology, histology and laboratory evidence. Diagnosis based solely on clinical
observation is not sufficient.
6.17. DISABILITY shall mean a Sickness, Disease, Illness or the entire injuries arising out of a single or continuous
series of causes.
6.18. ELIGIBLE EXPENSES shall mean Medically Necessary expenses incurred due to a covered Disability but not
exceeding the benefits provided in this Supplementary Contract and the limits in the Table of Benefits.
6.19. ENTERIC FEVER shall mean symptomatic bacterial infection due to Salmonella Typhi. The disease must be
diagnosed by a Medical Practitioner and be supported by acceptable clinical, serology, histology and
laboratory evidence. Diagnosis based solely on clinical observation is not sufficient.
6.20. EXPERIMENTAL TREATMENT shall mean a treatment, procedure, course of treatment, equipment, medicine
or pharmaceutical product, intended for medical or surgical use, w hich has not been generally accepted as
safe, effective and appropriate for the treatment of Diseases, or injuries by the various scientific organisations
recognised by the international medical community; or w hich is undergoing study, research, testing or is at any
stage of clinical experimentation.
6.21. HOSPITALISATION/ HOSPITALISED shall mean admission to a Hospital as a registered In-Patient for
Medically Necessary treatments for a covered Disability for a minimum period of six (6) hours upon
recommendation of a Physician and continuously stay in Hospital prior to discharge. A patient shall not be
considered as an In-Patient if the patient does not physically stay in the Hospital for the w hole period of
confinement.
6.22. BODILY INJURY/ INJURY shall mean bodily injury caused, directly and independently of all other causes by
accident of w hich, except in the cause of drow ning or of internal injury revealed by autopsy, there is evidence
of a visible contusion or w ound on the exterior of the body. Internal injury is also compensated provided it is
proven that the internal injury is accidental and not due to sickness. All internal injury must be substantiated by
an x-ray report or other relevant medical report(s).
6.23. IN-PATIENT shall mean the Life Assured w ho undergoes confinement for a Disability, as a registered resident
bed patient using and being charged for the Room and Board facilities in Hospital.
6.24. INTENSIVE CARE UNIT shall mean a section w ithin a Hospital w hich is designated as an Intensive Care Unit
by the Hospital, and w hich is maintained on a tw enty four (24) hours basis solely for treatment of patients in
critical condition and is equipped to provide special nursing and medical services not available elsew here in
the Hospital.
6.25. KIDNEY FAILURE shall mean end stage Kidney Failure presenting as chronic irreversible failure of both
kidneys to function, as a result of w hich regular renal dialysis initiated or renal transplantation is carried out.
6.26. MEDICALLY NECESSARY shall mean a medical service w hich is:

(a) Consistent w ith the diagnosis and customary medical treatment for a covered Disability,
(b) In accordance w ith standards of good medical practice, consistent w ith current standard of professional
medical care, and of proven medical benefits,
(c) Not for the convenience of the Life Assured or the Physician, and unable to be reasonably render ed out
of Hospital (if admitted as an In-Patient),
(d) Not of an experimental, investigational or research nature, preventive or screening nature, and
(e) For w hich the charges are fair and reasonable and customary for the Disability.
6.27. OUT-PATIENT shall mean the Life Assured is receiving medical care or treatment w ithout being Hospitalised
and includes Day-Care Surgery.
UMI+_01V2 / Jul 2021 Page 10 of 18

6.28. OVERALL ANNUAL LIMIT shall mean the Overall Annual Limit as stated in Table of Benefits. The benefits
payable in respect of expenses incurred for treatment provided to the Life Assured during the Policy Year,
shall be limited to Overall Annual Limit irrespective of a type/ types of Disability. In the event all the Overall
Annual Limit having been paid, all insurance for the Life Assured in this Supplementary Contract shall
immediately cease to be payable for the remaining Policy Year.
6.29. OVERALL LIFETIME LIMIT shall mean the Overall Lifetime Limit as stated in Table of Benefits. The total
benefits payable in respect of expenses incurred for treatment provided to the Life Assured w hile this
Supplementary Contract is in force, shall be limited to Overall Lifetime Limit irrespective of a type/ types of
Disability. In the event all the Overall Lifetime Limit having been paid, this Supplementary Contract shall
terminate.
6.30. PRE-EXISTING CONDITIONS shall mean any Disabilities that the Life Assured has reasonable know ledge of
prior to the Issue Date or Reinstatement Date. A Life Assured may be considered to have reasonable
know ledge of a Pre-Existing Condition w here the Disability is any one (1) for w hich:
(a) The Life Assured had received or is receiving the treatment;
(b) Medical advice, diagnosis, care or treatment has been recommended;
(c) Clear and distinct symptoms are or w ere evident; or
(d) Its existence w ould have been apparent to a reasonable person in the circumstances.
6.31. REASONABL E AND CUSTOMARY CHARGES

Shall mean charges for medical care w hich is Medically Necessary shall be considered reasonable and
customary to the extent that it does not exceed the general level of charges being made by others of similar
standing in the locality w here the charge is incurred in Malaysia, w hen furnishing like or comparable treatment,
services or supplies to individual of the same sex and of comparable age for a similar Sickness, Disease or
injury and in accordance w ith accepted medical standards and practice could not have been omitted w ithout
adversely affecting the Life Assured’s Medical Condition.
We reserve the right to determine w hether any particular Hospital/medical charge is a Reasonable and
Customary Charges w ith reference but not limited to the Private HealthCare Facilities and Services (Private
Hospitals and Other Private HealthCare Facilities) Regulation 2006 of Malaysia including any subsequent
amendment(s) or enactment of it.
6.32. SECOND MEDICAL OPINION shall mean consultation and diagnostic tests (ECG, X-ray and laboratory tests)
by another Physician, to confirm the diagnosis and treatment plan of the initial Physician or to offer an
alternative diagnosis and/or treatment approach.
6.33. SICKNESS, DISEASE OR ILLNESS shall mean a physical condition marked by a pathological deviation from
the normal healthy state.
6.34. SPECIFIED ILLNESSES shall mean any one (1) of the follow ing Disabilities and its related complications,
occurring w ithin the first one hundred and tw enty (120) days of insurance coverage of the Life Assured:
(a) Hypertension, diabetes mellitus and cardiovascular diseases;
(b) All tumours, Cancers, cysts, nodules, polyps, stones of the urinary system and biliary system;
(c) All ear, nose (including sinuses) and throat conditions;
(d) Hernias, haemorrhoids, fistulae, hydrocele, varicocele;
(e) Endometriosis including disease of the reproduction system; or
(f) Vertebro-spinal disorders (including disc) and knee conditions.
6.35. WAITING PERIOD shall mean the first thirty (30) days from the Issue Date, Reinstatement Date or the date of
birth of the Life Assured, w hichever is later.
RELATING TO MEDICAL SUPPLIERS
6.36. DAY-CARE SURGERY shall mean a patient w ho needs the use of a recovery facility for a Surgery on a pre-
plan basis at the Hospital/ Specialist clinic (but not for overnight stay).
6.37. PHYSICIAN shall mean a registered medical practitioner qualified and licensed to practise w estern medicine
and w ho, in rendering such treatment, is practising w ithin the scope of his licensing and training in the
geographical area of practice, but excluding a physician w ho is the Life Assured himself.
6.38. GENERAL PRACTITIONER shall mean a Physician w hose practice is not oriented to specific medical
specialty but instead covers a variety of medical problems in patients of all ages.
6.39. HOME NURSING CARE shall mean continued medical care or other type of skilled care furnished on a
visiting basis in the Life Assured's home, w hen he or she is recuperating.
6.40. HOSPITAL shall mean only an establishment duly constituted and registered as a Hospital for the care and
treatment of sick and injured persons as paying bed-patients, and w hich:
(a) Has facilities for diagnosis and major Surgery,
(b) Provides tw enty four (24) hours a day nursing services by registered and graduate nurses,
(c) Is under the supervision of a Physician, and
UMI+_01V2 / Jul 2021 Page 11 of 18
(d) Is not primarily a clinic; an ambulatory care centre; a place for alcoholics or drug addicts; a nursing, rest
or convalescent home or a home for the aged or similar establishment.
6.41. MALAYSIAN GOVERNMENT HOSPITAL shall mean a Hospital w hich charges of services are subject to the
Fee Act 1951, Fees (Medical) Order 1982 and/or its subsequent amendments or enactments if any.
6.42. PRESCRIBED MEDICINES shall mean medicines that are dispensed by a Physician, a Registered
Pharmacist or a Hospital and w hich have been prescribed by a Physician or Specialist in respect of treatment
for a covered Disability, excluding supplements, vitamins, probiotics and herb products.
6.43. SPECIALIST shall mean a Physician w ho is classified by the appropriate health authorities as a person w ith
superior and special expertise in specified fields of medicine, but excluding a physician w ho is the Life
Assured himself.
6.44. SURGERY shall mean any one (1) of the follow ing medical procedures:
(a) To incise, excise or electrocauterise any organ or body part;
(b) To repair, revise, or reconstruct any organ or body part;
(c) To reduce by manipulation a fracture or dislocation; or
(d) Use of endoscopy to remove a stone or object from the larynx, bronchus, trachea, esophagus, stomach,
intestine, urinary bladder, or urethra,
and excludes all dental treatment.
UMI+_01V2 / Jul 2021 Page 12 of 18

IMPORTANT NOTES:
Should there be any claim under this Supplementary Contract,
(a) The original final tax invoices, original itemised/ detailed medical bills and original receipts are required; and
(b) The principle of indemnity w ill be strictly adhered to.
The Cost of Insurance chargeable per annum for this Supplementary Contract shall vary in accordance to the age nearest birthday at
the time of renew al as per the follow ing:
Cost of Insurance (“COI”) per Annum

Zero Deductible (Base Plan)
Male Fem ale
Age Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan
Group 150 200 250 300 350 400 500 150 200 250 300 350 400 500
(RM) (RM) (RM) (RM) (RM) (RM) (RM) (RM) (RM) (RM) (RM) (RM) (RM) (RM)
0-4 1,228 1,352 1,492 1,608 1,753 1,917 2,025 1,169 1,287 1,420 1,530 1,668 1,825 1,926
5-9 694 765 822 875 933 1,009 1,057 694 765 822 875 933 1,009 1,057
10 -
649 715 776 815 897 985 1,017 649 715 776 815 897 985 1,017
14
15 -
754 831 908 1,004 1,101 1,195 1,240 711 782 863 945 1,036 1,124 1,167
19
20 -
889 961 1,025 1,085 1,196 1,322 1,366 827 881 942 998 1,100 1,215 1,256
24
25 -
940 1,031 1,130 1,198 1,333 1,494 1,540 895 973 1,066 1,130 1,258 1,409 1,453
29
30 -
996 1,115 1,265 1,371 1,519 1,671 1,721 996 1,115 1,265 1,371 1,519 1,671 1,721
34
35 -
1,204 1,331 1,468 1,552 1,714 1,884 1,980 1,264 1,395 1,538 1,628 1,799 1,975 2,076
39
40 -
1,373 1,531 1,730 1,877 2,083 2,281 2,381 1,456 1,622 1,794 1,985 2,205 2,412 2,518
44
45 -
1,764 1,962 2,186 2,353 2,602 2,877 3,024 1,914 2,125 2,363 2,545 2,815 3,111 3,270
49
50 -
2,134 2,381 2,664 2,888 3,218 3,538 3,717 2,170 2,421 2,710 2,937 3,276 3,599 3,783
54
55 -
2,708 3,037 3,358 3,580 4,009 4,381 4,605 2,657 2,978 3,289 3,510 3,931 4,294 4,514
59
60 -
4,259 4,561 5,045 5,378 5,973 6,592 6,906 3,747 4,016 4,446 4,747 5,275 5,824 6,097
64
65 -
5,578 5,970 6,607 7,042 7,823 8,632 9,040 4,668 5,004 5,535 5,909 6,563 7,246 7,587
69
70 -
7,186 7,677 8,493 9,074 10,075 11,131 11,664 5,815 6,235 6,891 7,357 8,166 9,017 9,442
74
75 -
9,314 9,912 10,975 11,722 13,014 14,370 15,065 7,243 7,768 8,579 9,159 10,160 11,220 11,749
79
80 -
12,026 12,727 14,094 15,147 16,730 18,412 20,255 9,021 9,678 10,680 11,480 12,677 13,961 15,350
84
85 -
14,995 15,984 17,457 19,134 21,110 23,087 25,519 12,413 13,248 14,465 15,861 17,508 19,155 21,181
89
90 -
21,443 22,858 24,964 27,362 30,188 33,015 36,493 17,255 18,415 20,107 22,047 24,337 26,626 29,442
94
95 -
30,878 32,915 35,948 39,401 43,470 47,541 52,549 24,156 25,781 28,149 30,866 34,071 37,276 41,219
99
RM5,000 Deductible
Male Fem ale
Group 150 200 250 300 350 400 500 150 200 250 300 350 400 500
0-4 860 946 1,044 1,126 1,227 1,342 1,418 818 901 994 1,071 1,168 1,278 1,348
5-9 486 536 575 613 653 706 740 486 536 575 613 653 706 740
10 -
14 454 501 543 571 628 690 712 454 501 543 571 628 690 712
15 -
19 528 582 636 703 771 837 868 498 547 604 662 725 787 817
20 -
24 622 673 718 760 837 925 956 579 617 659 699 770 851 879
25 -
29 658 722 791 839 933 1,046 1,078 627 681 746 791 881 986 1,017
30 -
34 697 781 886 960 1,063 1,170 1,205 697 781 886 960 1,063 1,170 1,205
35 - 843 932 1,028 1,086 1,200 1,319 1,386 885 977 1,077 1,140 1,259 1,383 1,453
UMI+_01V2 / Jul 2021 Page 13 of 18

39
40 -
44 961 1,072 1,211 1,314 1,458 1,597 1,667 1,019 1,135 1,256 1,390 1,544 1,688 1,763
45 -
49 1,235 1,373 1,530 1,647 1,821 2,014 2,117 1,340 1,488 1,654 1,782 1,971 2,178 2,289
50 -
54 1,494 1,667 1,865 2,022 2,253 2,477 2,602 1,519 1,695 1,897 2,056 2,293 2,519 2,648
55 -
59 1,896 2,126 2,351 2,506 2,806 3,067 3,224 1,860 2,085 2,302 2,457 2,752 3,006 3,160
60 -
64 2,981 3,193 3,532 3,765 4,181 4,614 4,834 2,623 2,811 3,112 3,323 3,693 4,077 4,268
65 -
69 3,905 4,179 4,625 4,929 5,476 6,042 6,328 3,268 3,503 3,875 4,136 4,594 5,072 5,311
70 -
74 5,030 5,374 5,945 6,352 7,053 7,792 8,165 4,071 4,365 4,824 5,150 5,716 6,312 6,609
75 -
79 6,520 6,938 7,683 8,205 9,110 10,059 10,546 5,070 5,438 6,005 6,411 7,112 7,854 8,224
80 -
84 8,418 8,909 9,866 10,603 11,711 12,888 14,179 6,315 6,775 7,476 8,036 8,874 9,773 10,745
85 -
89 10,497 11,189 12,220 13,394 14,777 16,161 17,863 8,689 9,274 10,126 11,103 12,256 13,409 14,827
90 -
94 15,010 16,001 17,475 19,153 21,132 23,111 25,545 12,079 12,891 14,075 15,433 17,036 18,638 20,609
95 -
99 21,615 23,041 25,164 27,581 30,429 33,279 36,784 16,909 18,047 19,704 21,606 23,850 26,093 28,853
UMI+_01V2 / Jul 2021 Page 14 of 18

RM10,000 Deductible
Male Fem ale
Group 150 200 250 300 350 400 500 150 200 250 300 350 400 500
0-4 614 676 746 804 877 959 1,013 585 644 710 765 834 913 963
5-9 347 383 411 438 467 505 529 347 383 411 438 467 505 529
10 -
14 325 358 388 408 449 493 509 325 358 388 408 449 493 509
15 -
19 377 416 454 502 551 598 620 356 391 432 473 518 562 584
20 -
24 445 481 513 543 598 661 683 414 441 471 499 550 608 628
25 -
29 470 516 565 599 667 747 770 448 487 533 565 629 705 727
30 -
34 498 558 633 686 760 836 861 498 558 633 686 760 836 861
35 -
39 602 666 734 776 857 942 990 632 698 769 814 900 988 1,038
40 -
44 687 766 865 939 1,042 1,141 1,191 728 811 897 993 1,103 1,206 1,259
45 -
49 882 981 1,093 1,177 1,301 1,439 1,512 957 1,063 1,182 1,273 1,408 1,556 1,635
50 -
54 1,067 1,191 1,332 1,444 1,609 1,769 1,859 1,085 1,211 1,355 1,469 1,638 1,800 1,892
55 -
59 1,354 1,519 1,679 1,790 2,005 2,191 2,303 1,329 1,489 1,645 1,755 1,966 2,147 2,257
60 -
64 2,130 2,281 2,523 2,689 2,987 3,296 3,453 1,874 2,008 2,223 2,374 2,638 2,912 3,049
65 -
69 2,789 2,985 3,304 3,521 3,912 4,316 4,520 2,334 2,502 2,768 2,955 3,282 3,623 3,794
70 -
74 3,593 3,839 4,247 4,537 5,038 5,566 5,832 2,908 3,118 3,446 3,679 4,083 4,509 4,721
75 -
79 4,657 4,956 5,488 5,861 6,507 7,185 7,533 3,622 3,884 4,290 4,580 5,080 5,610 5,875
80 -
84 6,013 6,364 7,047 7,574 8,365 9,206 10,128 4,511 4,839 5,340 5,740 6,339 6,981 7,675
85 -
89 7,498 7,992 8,729 9,567 10,555 11,544 12,760 6,207 6,624 7,233 7,931 8,754 9,578 10,591
90 -
94 10,722 11,429 12,482 13,681 15,094 16,508 18,247 8,628 9,208 10,054 11,024 12,169 13,313 14,721
95 -
99 15,439 16,458 17,974 19,701 21,735 23,771 26,275 12,078 12,891 14,075 15,433 17,036 18,638 20,610
RM30,000 Deductible
Male Fem ale
Group 150 200 250 300 350 400 500 150 200 250 300 350 400 500
0-4 368 406 448 482 526 575 608 351 386 426 459 500 548 578
5-9 208 230 247 263 280 303 317 208 230 247 263 280 303 317
10 -
14 195 215 233 245 269 296 305 195 215 233 245 269 296 305
15 -
19 226 249 272 301 330 359 372 213 235 259 284 311 337 350
20 -
24 267 288 308 326 359 397 410 248 264 283 299 330 365 377
25 -
29 282 309 339 359 400 448 462 269 292 320 339 377 423 436
30 -
34 299 335 380 411 456 501 516 299 335 380 411 456 501 516
35 -
39 361 399 440 466 514 565 594 379 419 461 488 540 593 623
40 -
44 412 459 519 563 625 684 714 437 487 538 596 662 724 755
45 -
49 529 589 656 706 781 863 907 574 638 709 764 845 933 981
50 -
54 640 714 799 866 965 1,061 1,115 651 726 813 881 983 1,080 1,135
55 - 812 911 1,007 1,074 1,203 1,314 1,382 797 893 987 1,053 1,179 1,288 1,354
UMI+_01V2 / Jul 2021 Page 15 of 18

59
60 -
64 1,278 1,368 1,514 1,613 1,792 1,978 2,072 1,124 1,205 1,334 1,424 1,583 1,747 1,829
65 -
69 1,673 1,791 1,982 2,113 2,347 2,590 2,712 1,400 1,501 1,661 1,773 1,969 2,174 2,276
70 -
74 2,156 2,303 2,548 2,722 3,023 3,339 3,499 1,745 1,871 2,067 2,207 2,450 2,705 2,833
75 -
79 2,794 2,974 3,293 3,517 3,904 4,311 4,520 2,173 2,330 2,574 2,748 3,048 3,366 3,525
80 -
84 3,608 3,818 4,228 4,544 5,019 5,524 6,077 2,706 2,903 3,204 3,444 3,803 4,188 4,605
85 -
89 4,499 4,795 5,237 5,740 6,333 6,926 7,656 3,724 3,974 4,340 4,758 5,252 5,747 6,354
90 -
94 6,433 6,857 7,489 8,209 9,056 9,905 10,948 5,177 5,525 6,032 6,614 7,301 7,988 8,833
95 -
99 9,263 9,875 10,784 11,820 13,041 14,262 15,765 7,247 7,734 8,445 9,260 10,221 11,183 12,366
Notes:
1. COI rates are NOT guaranteed and are charged according to the attained age nearest birthday at each Policy renew al.
2. The COI rates are applicable to Occupational Class I and II only. For Occupation Class III, the COI rates w ill be charged at 25%
loading and for Occupation Class IV, the COI rates w ill be charged at 50% loading.
3. The rates for age group 71 – 99 are for renew al only.
4. The rates above are not inclusive of Hospital Assistance Fee of RM23.00 per annum. Hospital Assistance Fee is charged by w ay
of cancellation of units. We reserve the right to revise the fee by giving a w ritten notice three (3) months prior to the next Policy
Anniversary.
UMI+_01V2 / Jul 2021 Page 16 of 18

Table of Benefits
Plan 150 Plan 200 Plan 250 Plan 300 Plan 350 Plan 400 Plan 500
Plan Type
(RM) (RM) (RM) (RM) (RM) (RM) (RM)
Overall Annual Limit 850,000 1,500,000 1,600,000 1,700,000 1,800,000 2,000,000 2,500,000
Overall Lifetime Limit No limit.
 zero deductible (Base Plan); or
Deductible Option  RM5,000, RM10,000 or RM30,000 per Policy Year w ith Retirement Option at
age 60
A) Hospitalisation & Surgical Benefit
Hospital Room & Board (subject to a
1 maximum of one hundred and fifty (150) 150 200 250 300 350 400 500
days per Any One (1) Disability)
Intensive Care Unit (subject to a maximum
2 of one hundred and fifty (150) days per As charged. Subject to Reasonable & Customary Charges*
confinement)
Lodger Benefit (subject to a maximum of
3 one hundred and fifty (150) days per Any 75 100 125 150 175 200 250
One (1) Disability)
4 Hospital Supplies and Services
5 Surgical Fees
6 Anaesthetist Fees
7 Operating Theatre Fees
In-Hospital Physician Visit (subject to a
8
maximum of two (2) visits per day)
Pre-Hospitalisation Diagnostic Tests (within
9
ninety (90) days prior to hospitalisation)
Pre-Hospitalisation Consultation (within
ninety (90) days prior to hospitalisation –
10
maximum of two(2) General Practitioner As charged. Subject to Reasonable & Customary Charges*
and one (1) Specialist consultations)
11 Organ Transplant
Post Hospitalisation Treatment (within one
12 hundred and eighty (180) days following
discharge from hospital)
Home Nursing Care (subject to a maximum
13 of one hundred and eighty (180) days per
lifetime)
14 Ambulance Fees
15 Day-Care Surgery
As charged.
16 Medical Report Fees Reimbursement Up to a maximum of RM200 per admission for In-Patient treatment or per
Disability for Out-Patient treatment.
B) Out-Patient Treatm ent Benefits
Emergency Accidental Out-Patient
Up to Up to Up to Up to Up to Up to Up to
1 Treatment & thirty (30) days follow up
1,500 2,000 2,500 3,000 3,500 4,000 5,000
treatment (Annual Limit)
Out-Patient Kidney Dialysis Treatment
2 (includes consultation , examination tests
and prescribed take-home drugs)
Out-Patient Dengue or Enteric Fever As charged. Subject to Reasonable & Customary Charges*
Treatment (includes consultation ,
3
examination tests and prescribed take-
home drugs)
C) Cancer Treatm ent Benefits
Out-Patient Cancer Treatment
(radiotherapy, chemotherapy, targeted
therapy, hormonal therapy or
1 As charged. Subject to Reasonable & Customary Charges*
immunotherapy including consultation,
examination tests and prescribed take-
home drugs)
2 Genomic Test for Cancer (per lifetime)
10,000 15,000 20,000 25,000 30,000 35,000 40,000
D) Other Benefits
UMI+_01V2 / Jul 2021 Page 17 of 18

Reimbursement of the claimable cost, subject to Reasonable and Customary
1 Second Medical Opinion Charges*
(up to a maximum of RM2,000 per annum).
As charged, subject to Reasonable and Customary Charges*
(limited to one (1) visit per day)
Reimbursement for Alternative Treatment
fees (post Hospitalisation Out-Patient Limit per day
2
benefit, within thirty (30) days following 150 200 250 300 350 400 500
discharge from hospital) Maximum per annum
1,500 2,000 2,500 3,000 3,500 4,000 5,000
3 Intraocular Lens As charged. Subject to Reasonable & Customary Charges*
E) No Claim Benefits
10% increase in the initial rate of Hospital Room and Board Benefit every 3 years,
1 No Claim Rew ard provided that no claim is made in the previous 3 years and the increased amount
shall not exceed 150% of the initial rate of Hospital Room and Board Benefit.
No Claim Refund
No Claim Period (% of Cost of Insurance Paid** of
Preceding Policy Year)
2 No Claim Refund
* Reasonable and Customary Charges based on Private HealthCare Facilities and Services (Private Ho spitals and Other Private
HealthCare Facilities) Regulation 2006 of Malaysia, including any subsequent amendment(s) or enactment of it.
** Cost of Insurance paid does not include Hospital Assistance Fee.
Value Added Service

International Second Medical Opinion
The International Second Medical Opinion is a value added service provided by a third party w hich gives the Life Assured
access to top experts from around the w orld to facilitate the medical decision making. A licensed doctor w ill be assigned to
conduct a thorough clinical conversation, collect all available medical information and identify top experts to provide
independent assessment.
If You w ish to utilise this service, kindly contact Us for further arrangements.
We reserve the right to amend the terms and provisions of this service or terminate this service by giving you a w ritten notice
three (3) months prior to the revisions.
UMI+_01V2 / Jul 2021 Page 18 of 18

HEALTHCOVER PLUS
This HEALTHCOVER PLUS UNIT CANCELLATION SUPPLEMENTARY CONTRACT (hereinafter called Supplementary
Contract) forms part of the Policy (hereinafter called Basic Policy) to which it is attached. It is issued in consideration of the
cancellation of units for the Cost of Insurance applicable to this Supplementary Contract. Unless otherwise expressly stated,
the terms defined and construed in the Basic Policy shall bear the same meaning or construction when used in this
1. BENEFITS PROVISION
1.1. AMOUNT PAYABLE UPON DIAGNOSIS OF CRITICAL ILLNESS BEFORE MATURITY/EXPIRY DATE
While this Supplementary Contract is in force and subject to the Risk Excluded, Juvenile-Lien Rule and other
provisions contained in this Supplementary Contract, We shall pay:
1.1.1 Angioplasty and Other Invasive Treatments For Coronary Artery Disease Benefit
If the Life Assured undergoes Angioplasty and Other Invasive Treatments for Coronary Artery Disease
and upon Our receipt and approval of the proof of undergoing Angioplasty and Other Invasive
Treatments For Coronary Artery Disease, the benefit payable shall be fifteen percent (15%) of the
Insured Amount under this Supplementary Contract or RM30,000, whichever is lower.
This benefit is payable once only. The Insured Amount of this Supplementary Contract will be reduced
accordingly by the amount paid under this benefit.
1.1.2 Critical Illness Benefit

If the Life Assured is diagnosed as suffering from a Critical Illness, except Angioplasty and Other
Invasive Treatments for Coronary Artery Disease, and upon Our receipt and approval of the proof of
Critical Illness of the Life Assured, the benefit payable shall be one hundred percent (100%) of the
Insured Amount under this Supplementary Contract. Thereafter, this Supplementary Contract shall
terminate.
1.2. JUVENILE – LIEN RULE

Where the age of the Life Assured is less than forty-nine (49) months at the time of diagnosis of a Critical
Illness, the benefit payout under this Supplementary Contract shall be based on the following:
Attained Age of Life Assured
% of Benefit Payable
at the time of diagnosis
15 days - 12 months 20%
13 - 24 months 40%
25 - 36 months 60%
37 - 48 months 80%
49 months and above 100%
2.1. RISKS EXCLUDED

This Supplementary Contract does not cover any Critical Illness caused directly or indirectly, wholly or partly, by
any one (1) of the following occurrences:
2.1.1 any illness or surgery other than diagnosis of or surgery for a Critical Illness as defined herein;
2.1.2 the signs or symptoms of Cancer - of specified severity and does not cover very early cancers, Heart
Attack - of specified severity, Coronary Artery Bypass Surgery, Serious Coronary Artery Disease, and
Angioplasty and Other Invasive Treatments for Coronary Artery Disease has manifested prior to or
within sixty (60) days from the Issue Date or Reinstatement Date, whichever is later;
2.1.3 the signs or symptoms of Critical illness, other than those Critical Illness specified in 2.1.2 has
manifested prior to or within thirty (30) days from the Issue Date or Reinstatement Date, whichever is
later;
2.1.4 the Critical Illness arises directly or indirectly from a Pre-Existing Condition as defined, and which has
existed prior to the Issue Date or Reinstatement Date of this Supplementary Contract, whichever is
later;
2.1.5 the Critical Illness, where in Our opinion, was caused directly or indirectly by the existence of Acquired
Immune Deficiency Syndrome (AIDS) or by the presence of any Human Immunodeficiency Virus (HIV)
UHCPR_03V1 /January 2019 Page 1 of 15

infection. We reserve the right to require the Life Assured to undergo a blood test for HIV as a condition
precedent to acceptance of any claim. This exclusion does not apply to HIV Infection due to Blood
Transfusion or Occupationally Acquired Human Immunodeficiency Virus (HIV) Infection as defined in
this Supplementary Contract. For the purpose of this Supplementary Contract,
a) the definition of AIDS shall be that used by the World Health Organization in 1987, or any
subsequent revision by the World Health Organization of that definition.
b) an infection shall be deemed to have occurred where in Our opinion, the blood or other relevant
test(s) indicate either the presence of any Human Immunodeficiency Virus (HIV) or Antibodies to
such a Virus.
2.1.6 any Critical Illness which was diagnosed to be due, directly or indirectly, to a congenital defect or
disease, which was manifested or was diagnosed before the Life Assured attains seventeen (17) years
of age;
2.1.7 any Critical Illness caused by a self-inflicted injury;
2.1.8 any Critical Illness resulting directly from alcohol or drug abuse; or
2.1.9 the Life Assured did not survive for at least thirty (30) days after the diagnosis of a Critical Illness.
3. TERMINATION PROVISIONS
3.1. TERMINATION
3.1.1. if the Basic Policy matures/expires or is terminated, lapsed, or surrendered; or

3.1.2. when one hundred percent (100%) of the Insured Amount for this Supplementary Contract has been
paid; or
3.1.3. upon the expiry date of this Supplementary Contract as specified in the Policy Schedule or
Endorsement
Termination of this Supplementary Contract shall be without prejudice to any claim arising prior to such
termination. The payment or acceptance of any Cost of Insurance subsequent to termination of this
Supplementary Contract shall not create any liability but We shall refund any such Cost of Insurance.
4.1. ALTERATION
No alteration, variation or waiver of any provision of this Supplementary Contract shall be valid unless such
alteration, variation or waiver is made by an Endorsement and signed by Our authorised person. We may
request for Your Policy to be sent to Us to effect the Endorsement. We will notify You of any amendments,
variations, changes, alterations or modifications required by law or regulatory authorities to be made to this
Policy. Once the Endorsement is effected, the terms and conditions of this Policy shall be read subject to such
Endorsement.
No agent has the authority to make any alteration to or to waive any of the terms and conditions in Your Policy.
4.2. CLAIM NOTIFICATION

Written notice must be given to Us within two (2) months from the date of diagnosis of a Critical Illness of the
Life Assured to claim under this Supplementary Contract. Failure to give notice within the time stipulated shall
not invalidate any claim if it is shown that it was not reasonably possible to give such notice earlier and that
notice was given as soon as was reasonably possible.
4.3. PROOF OF CRITICAL ILLNESS

Upon Our receipt of the above notice, We will furnish to You or Your claimant the appropriate forms for filing
proof of Critical Illness. Claims shall be made on forms provided by Us together with written proof covering the
occurrence, character and the extent of the Critical Illness for which claims are made. Such proof and other
documents satisfactory to Us must be given at You or Your claimant's expense.
4.4. FILING PROOF OF CRITICAL ILLNESS

Proof of Critical Illness must be furnished to Us during the lifetime of the Life Assured and within six (6) months
after the diagnosis of such Critical Illness. We reserve the right to require any additional proof and request
medical examination of the Life Assured.
4.5. FREE-LOOK PERIOD

You may cancel this Supplementary Contract by giving Us a written request and by returning this
Supplementary Contract to Us within fifteen (15) days or such longer period as may be specified by Bank
Negara Malaysia, from the date of receipt of this Supplementary Contract by You. The amount refunded under
this Supplementary Contract shall be the Cost of Insurance deducted for this Supplementary Contract less any
expenses incurred for medical examination.

4.6. COST OF INSURANCE
A grace period of thirty one (31) days from its Due Date shall be allowed for the deduction of the Cost of
Insurance, during which period this Supplementary Contract shall remain in force.
The Cost of Insurance at the time of renewal is not guaranteed and We reserve the right to revise the Cost of
Insurance rate applicable at the time of renewal. We shall notify You in writing of the revised Cost of Insurance
rates, at least three (3) months before the revised Cost of Insurance rates take effect at the next renewal date.
4.7. PERIOD OF COVER AND RENEWAL

This Supplementary Contract shall become effective as of the date stated in the Policy Schedule or
Endorsement. The Policy Anniversary shall be one (1) year after the effective date and annually from then on.
On each anniversary, this Supplementary Contract is renewable at the Cost of Insurance rates in accordance
with the age nearest birthday at the time of renewal.
This Supplementary Contract shall be renewable at Your option on the Policy Anniversary subject to the terms,
conditions, termination provisions and our right to revise the Cost of Insurance of this Supplementary Contract.
Such changes to the Cost of Insurance, if any shall be applicable to You irrespective of Your claim experience
according to Our risk assessment.
4.8. NON PARTICIPATING

4.9. SEVERABILITY
If any provision or part of a provision of this Supplementary Contract shall be held or found to be void, invalid or
otherwise unenforceable, it shall be deemed to be severed from this Supplementary Contract and the
remainder of the provisions contained in this Supplementary Contract shall remain in full force and effect.
4.10. APPLICABLE TAX

levies or imposts (collectively “Applicable Tax”) whatsoever are introduced by any authority and are payable
under the laws of Malaysia in connection with any supply of goods and/or services made or deemed to be
made under this Policy, We will be entitled to charge any Applicable Tax as allowed by the laws of Malaysia.
4.11. ANTI-MONEY LAUNDERING AND COUNTER FINANCING OF TERRORISM

If we receive an order from the relevant authorities to freeze or seize the monies received as premium or
monies payable in respect of this Policy as provided under the Anti-Money Laundering and Anti-Terrorism
Financing Act 2001 or such similar legislation or if we discover or have reasonable suspicion that this Policy is
exploited for money laundering activities and/or to finance terrorism, we reserve the right to terminate this
Policy immediately. We shall deal with all premiums paid and all benefits/sums payable in respect of this Policy
in any manner which we deem appropriate, including but not limited to handing it over to the relevant
authorities.
5. DEFINITIONS
“Activities of Daily Living” (ADL) are as follows:

a) Transfer
Getting in and out of a chair without requiring physical assistance.
b) Mobility
The ability to move from room to room without requiring any physical assistance.
c) Continence
The ability to voluntarily control bowel and bladder functions to maintain personal hygiene.
d) Dressing
Putting on and taking off all necessary items of clothing without requiring the assistance of another person.
e) Bathing/Washing
The ability to wash in the bath or shower (including getting in or out of the bath or shower) or wash by any other
means.
f) Eating
All tasks of getting food into the body once it has been prepared.
“Assessment Period” means the period during which the insurer will assess a condition before deciding whether or
not the condition qualifies as being Permanent. The assessment period will be for the minimum period time frame
stated in the relevant definition and will not be longer than twelve (12) months (provided all required evidence has been
submitted).

“Insured Amount” means the amount specified in the Policy Schedule upon which the benefits payable under this
Supplementary Contract is based on and shall include any variation thereof.
“Irreversible” means cannot be reasonably improved upon by medical treatment and/or surgical procedures
consistent with the current standard of the medical services available in Malaysia.
“Myasthenia Gravis Foundation of America Clinical Classification” is as follows:

Class I : Any eye muscle weakness, possible ptosis, no other evidence of muscle weakness elsewhere
Class II : Eye muscle weakness of any severity, mild weakness of other muscles
Class III : Eye muscle weakness of any severity, moderate weakness of other muscles
Class IV : Eye muscle weakness of any severity, severe weakness of other muscles
Class V : Intubation needed to maintain airway
“New York Heart Association (NYHA) classification of cardiac impairment” is as follows:

Class III : Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes
symptoms
Class IV : Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest
“Permanent” means expected to last throughout the lifetime of the Life Assured.
“Permanent Neurological Deficit with Persisting Clinical Symptoms” means symptoms of dysfunction in the
nervous system that are present on clinical examination which are expected to last throughout the lifetime of the Life
Assured. Symptoms that are covered include numbness, paralysis, localised weakness, dysarthria (difficulty with
speech), aphasia (inability to speak), dysphagia (difficulty swallowing), visual impairment, difficulty in walking, lack of
coordination, tremor, seizures, dementia, delirium and coma.
“Pre-Existing Condition” shall mean any disability (physical or mental) that the Life Assured has reasonable
knowledge of prior to the Issue Date or Reinstatement Date of this Supplementary Contract, whichever is later, and
he/she had failed to disclose the same. A Life Assured may be considered to have reasonable knowledge of a pre-
existing illness where the disability is one (1) for which:
a) The Life Assured had received or is receiving the treatment; and/or
b) Medical advice, diagnosis, care or treatment has been recommended; and/or
c) Clear and distinct symptoms are or were evident; and/or
d) Its existence would have been apparent to a reasonable person in the circumstances.
“Reinstatement Date” means the date Your Application for reinstatement is approved by Us.
“We/Us/Our” means Allianz Life Insurance Malaysia Berhad.
“You/Your” means the Policy Owner. The Policy Owner may be the Life Assured or someone other than the Life
Assured.
“Critical Illness” means any of the illnesses specified and defined below:
No. Critical Illness
1 Heart Attack - of specified severity
Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of
acute myocardial infarction:
(a) a history of typical chest pain;
(b) new characteristic electrocardiographic changes; with the development of any of the following:
 ST elevation or depression;
 T wave inversion;
 pathological Q waves;or
 left bundle branch block; and
(c) elevation of the cardiac biomarkers, including the CPK-MB being above the generally accepted normal
laboratory levels or Troponins recorded at the following levels or higher:
 Cardiac Troponin T or Cardiac Troponin I > / = 0.5 ng/ml.
The evidence must show the occurrence of a definite acute myocardial infarction which should be confirmed
by a cardiologist or physician.
For the above definition, the following are not covered:

(a) occurrence of an acute coronary syndrome including but not limited to unstable angina; and
(b) a rise in cardiac biomarkers resulting from a percutaneous procedure for coronary artery disease.
2 Coronary Artery Bypass Surgery

Refers to the actual undergoing of open-chest surgery to correct or treat Coronary Artery Disease (CAD) by
way of Coronary Artery Bypass Grafting.


(a) angioplasty;
(b) other intra-arterial or catheter based techniques;
(c) keyhole procedures; and
(d) laser procedures.
3 Serious Coronary Artery Disease

The narrowing of the lumen of Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and
Circumflex Artery (not inclusive of their branches) occurring at the same time by a minimum of sixty percent
(60%) in each artery as proven by coronary arteriography (non-invasive diagnostic procedures are not
covered). A narrowing of sixty percent (60%) or more of the Left Main Stem will be considered as a narrowing
of LAD and Circumflex Artery. This covered event is payable regardless of whether or not any form of
coronary artery surgery has been performed.
4 Angioplasty and Other Invasive Treatments for Coronary Artery Disease

The actual undergoing for the first time of Coronary Artery Balloon Angioplasty, artherectomy, laser treatment
or the insertion of a stent to re-vascularise a narrowing or blockage of one or more coronary arteries as
shown by angiographic evidence.
Intra-arterial investigative procedures are excluded.
5. Cancer – of specified severity and does not cover very early cancers
Any malignant tumour positively diagnosed with histological confirmation and characterised by the
uncontrolled growth of malignant cells and invasion of tissue.
The term malignant tumour includes leukemia, lymphoma and sarcoma.
For the above definition, the following are excluded:

(a) all cancers which are histologically classified as any of the following:
 pre-malignant;
 non-invasive;
 carcinoma in situ (CIS);
 having borderline malignancy; or
 having malignant potential;
(b) all tumours of the prostate histologically classified as T1N0M0 (TNM classification);
(c) all tumours of the thyroid histologically classified as T1N0M0 (TNM classification);
(d) all tumours of the urinary bladder histologically classified as T1N0M0 (TNM classification);
(e) Chronic Lymphocytic Leukaemia less than RAI Stage 3;
(f) all cancers in the presence of Human Immunodeficiency Virus (HIV); and
(g) any skin cancer other than malignant melanoma.
6 Heart Valve Surgery

The actual undergoing of open-heart surgery to replace or repair cardiac valves as a consequence of heart
valve defects or abnormalities.

(a) repair via intra-arterial procedure; and
(b) repair via key-hole surgery or similar techniques.
7 Surgery to Aorta
The actual undergoing of surgery via a thoracotomy or laparotomy (surgical opening of thorax or abdomen)
to repair or correct an aortic aneurysm, an obstruction of the aorta or a dissection of the aorta. For this
definition, aorta shall mean the thoracic and abdominal aorta but not its branches.

(a) angioplasty;
(b) other intra-arterial or catheter based techniques;
(c) other keyhole procedures; and
(d) laser procedures.
8 Primary Pulmonary Arterial Hypertension - of specified severity

A definitive diagnosis of Primary Pulmonary Arterial Hypertension with substantial right ventricular
enlargement established by investigations including cardiac catheterisation, resulting in Permanent physical
impairment to the degree of at least Class III of the New York Heart Association (NYHA) classification of
cardiac impairment.

Pulmonary arterial hypertension resulting from other causes shall be excluded from this benefit.
9 Cardiomyopathy - of specified severity

A definitive diagnosis of Cardiomyopathy by a cardiologist which results in Permanently impaired ventricular
function and resulting in Permanent physical impairment of at least Class III of the New York Heart
Association (NYHA) classification of cardiac impairment. The diagnosis has to be supported by
echocardiographic findings of compromised ventricular performance.
Cardiomyopathy directly related to alcohol or drug abuse is not covered.
10 Stroke - resulting in Permanent Neurological Deficit with Persisting Clinical Symptoms

Death of brain tissue due to inadequate blood supply, bleeding within the skull or embolisation from an extra
cranial source resulting in Permanent Neurological Deficit with Persisting Clinical Symptoms. The diagnosis
must be based on changes seen in a CT scan or MRI and certified by a neurologist. A minimum Assessment
Period of three (3) months applies.

(a) transient ischemic attacks;
(b) cerebral symptoms due to migraine;
(c) traumatic injury to brain tissue or blood vessels; and
(d) vascular disease affecting the eye or optic nerve or vestibular functions.
11 Paralysis of Limbs
Total, Permanent and Irreversible loss of use of both arms or both legs, or of one (1) arm and one (1) leg,
through paralysis caused by illness or injury. A minimum Assessment Period of six (6) months applies.
12 Multiple Sclerosis
A definitive diagnosis of multiple sclerosis by a neurologist. The diagnosis must be supported by all of the
following:
(a) investigations which confirm the diagnosis to be Multiple Sclerosis;
(b) multiple neurological deficits resulting in the impairment of motor and sensory functions occurring over a
continuous period of at least six (6) months; and
(c) well documented history of exacerbations and remissions of said symptoms or neurological deficits.
13 Alzheimer's Disease / Severe Dementia

Deterioration or loss of intellectual capacity confirmed by clinical evaluation and imaging tests arising from
Alzheimer's Disease or Severe Dementia as a result of Irreversible organic brain disorders. The covered
event must result in a significant reduction in the mental and social functions requiring continuous
supervision of the Life Assured. The diagnosis must be clinically confirmed by a neurologist.
From the above definition, the following are not covered:

(a) non organic brain disorders such as neurosis;
(b) psychiatric illnesses; and
(c) drug or alcohol related brain damage.
14 Coma - resulting in Permanent Neurological Deficit with Persisting Clinical Symptoms

A state of unconsciousness with no reaction to external stimuli or internal needs, persisting continuously for
at least ninety six (96) hours, requiring the use of life support systems and resulting in a Permanent
Neurological Deficit with Persisting Clinical Symptoms. A minimum Assessment Period of thirty (30) days
applies. Confirmation by a neurologist must be present.
Coma resulting directly from alcohol or drug abuse is excluded.
15 Parkinson's Disease - resulting in Permanent inability to perform Activities of Daily Living

A definitive diagnosis of Parkinson's Disease by a neurologist where all the following conditions are met:
(a) it cannot be controlled with medication;
(b) the Life Assured shows signs of progressive impairment; and
(c) confirmation of the Permanent inability of the Life Assured to perform without assistance three (3) or
more of the Activities of Daily Living.
Only idiopathic Parkinson's Disease is covered. Drug-induced or toxic causes of Parkinsonism are not
covered.
16 Bacterial Meningitis - resulting in Permanent inability to perform Activities of Daily Living

Bacterial meningitis causing inflammation of the membranes of the brain or spinal cord resulting in

Permanent functional impairment. The Permanent functional impairment must result in an inability to perform
at least three (3) of the Activities of Daily Living. A minimum Assessment Period of thirty (30) days applies.
The diagnosis must be confirmed by:

(a) an appropriate specialist; and
(b) the presence of bacterial infection in the cerebrospinal fluid by lumbar puncture.
For the above definition, other forms of meningitis, including viral meningitis are excluded.
17 Benign Brain Tumour - of specified severity

A benign tumour in the brain or meninges within the skull, where all of the following conditions are met:
(a) it is life threatening;
(b) it has caused damage to the brain;
(c) the Life Assured has undergone surgical removal of the tumour or the tumour has caused a Permanent
Neurological Deficit with Persisting Clinical Symptoms; and
(d) its presence must be confirmed by a neurologist or neurosurgeon and supported by findings on MRI, CT
or other reliable imaging techniques.
The following are not covered:

 cysts;
 granulomas;
 malformations in or of the arteries or veins of the brain;
 hematomas;
 tumours in the pituitary gland;
 tumours in the spine; and
 tumours of the acoustic nerve.
18 Encephalitis - resulting in Permanent inability to perform Activities of Daily Living

Severe inflammation of brain substance, resulting in Permanent functional impairment. The Permanent
functional impairment must result in an inability to perform at least three (3) of the Activities of Daily Living. A
minimum Assessment Period of thirty (30) days applies. The covered event must be certified by a
neurologist.
Encephalitis in the presence of HIV infection is not covered.
19 Major Head Trauma - resulting in Permanent inability to perform Activities of Daily Living
Physical head injury resulting in Permanent functional impairment verified by a neurologist. The Permanent
functional impairment must result in an inability to perform at least three (3) of the Activities of Daily Living. A
minimum Assessment Period of three (3) months applies.
20 End Stage Lung Disease

End stage lung disease causing chronic respiratory failure.
All of the following criteria must be met:
(a) the need for regular oxygen treatment on a Permanent basis;
(b) Permanent impairment of lung function with a consistent Forced Expiratory Volume (FEV) of less than
one (1) litre during the first second;
(c) shortness of breath at rest; and
(d) Baseline Arterial Blood Gas analysis with partial oxygen pressures of 55mmHg or less.
21 End Stage Liver Failure

End Stage Liver Failure as evidenced by all of the following:
(a) permanent jaundice;
(b) ascites (excessive fluid in peritoneal cavity); and
(c) hepatic encephalopathy.
Liver failure secondary to alcohol or drug abuse is excluded.
22 Chronic Aplastic Anemia - resulting in Permanent Bone Marrow Failure

Irreversible Permanent bone marrow failure which results in anemia, neutropenia and thrombocytopenia
requiring at least two (2) of the following treatments:
(a) regular blood product transfusion;
(b) marrow stimulating agents;
(c) immunosuppressive agents; or
(d) bone marrow transplantation.
The diagnosis must be confirmed by a bone marrow biopsy.

23 Fulminant Viral Hepatitis
A sub-massive to massive necrosis (death of liver tissue) caused by any virus as evidenced by all of the
following diagnostic criteria:
(a) a rapidly decreasing liver size as confirmed by abdominal ultrasound;
(b) necrosis involving entire lobes, leaving only a collapsed reticular framework;
(c) rapidly deteriorating liver functions tests; and
(d) deepening jaundice.
Viral hepatitis infection or carrier status alone (inclusive but not limited to Hepatitis B and Hepatitis C) without
the above diagnostic criteria is not covered.
24 Third Degree Burns - of specified severity

Third degree (i.e. full thickness) skin burns covering at least twenty percent (20%) of the total body surface
area.
25 Kidney Failure - requiring dialysis or kidney transplant

End stage kidney failure presenting as a chronic Irreversible failure of both kidneys to function, a result of
which regular dialysis is initiated or kidney transplantation is carried out.
26 Major Organ/ Bone Marrow Transplant

The receipt of a transplant of:
(a) human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or
(b) one (1) of the following human organs: heart, lung, liver, kidney, or pancreas, as a result of Irreversible
end stage failure of the relevant organ.
Other stem cell transplants are excluded.
27 Muscular Dystrophy
The definitive diagnosis of Muscular Dystrophy by a Neurologist which must be supported by all of the
following:
(a) clinical presentation of progressive muscle weakness;
(b) no central/peripheral nerve involvement as evidenced by absence of sensory disturbance; and
(c) characteristic electromyogram and muscle biopsy findings.
No benefit will be payable under this covered event before the Life Assured has reached the age of twelve
(12) years next birthday.
28 Systemic Lupus Erythematosus with Severe Kidney Complications

A definitive diagnosis of Systemic Lupus Erythematosus confirmed by a rheumatologist.
For this definition, the covered event is payable only if it has resulted in Type III to Type V Lupus Nephritis as
established by a renal biopsy. Other forms such as discoid lupus or those forms with only hematological or
joint involvement are not covered.
World Health Organisation Lupus Classification:

Type III - Focal Segmental glomerulonephritis
Type IV- Diffuse glomerulonephritis
Type V - Membranous glomerulonephritis
29 HIV Infection due to Blood Transfusion

Infection with the Human Immunodeficiency Virus (HIV) through a blood transfusion, provided that all of the
following conditions are met:
(a) the blood transfusion was medically necessary or given as part of a medical treatment;
(b) the blood transfusion was received in Malaysia or Singapore after the commencement of the policy;
(c) the source of the infection is established to be from the institution that provided the blood transfusion
and the institution is able to trace the origin of the HIV tainted blood;
(d) the Life Assured does not suffer from Hemophilia; and
(e) the Life Assured is not a member of any high risk groups including but not limited to intravenous drug
users.
30 Loss of Speech
Total, Permanent and Irreversible loss of the ability to speak as a result of injury or illness. A minimum
Assessment Period of six (6) months applies. Medical evidence to confirm injury or illness to the vocal cords
to support this disability must be supplied by an Ear, Nose, and Throat (ENT) specialist.
All psychiatric related causes are excluded.

31 Medullary Cystic Disease
A progressive hereditary disease of the kidney characterised by the presence of cysts in the medulla, tubular
atrophy and interstitial fibrosis with the clinical manifestations of anemia, polyuria and renal loss of sodium,
progressing to chronic kidney failure. Diagnosis must be supported by a renal biopsy.
32 Terminal Illness
The conclusive diagnosis of a condition that is expected to result in the death of the Life Assured within
twelve (12) months. The Life Assured must no longer be receiving active treatment other than for pain relief.
The diagnosis must be supported by written confirmation from an appropriate specialist and confirmed by
Our appointed doctor.
33 Motor Neuron Disease - Permanent Neurological Deficit with Persisting Clinical Symptoms
A definitive diagnosis of motor neuron disease by a neurologist with reference to either spinal muscular
atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis or primary lateral sclerosis. There must be
Permanent Neurological Deficit with Persisting Clinical Symptoms.
34 Loss of Independent Existence

Confirmation by an appropriate specialist of the loss of independent existence resulting in a Permanent
inability to perform at least three (3) of the Activities of Daily Living. A minimum Assessment Period of six (6)
months applies.
35 Brain Surgery
The actual undergoing of surgery to the brain under general anesthesia during which a craniotomy (surgical
opening of skull) is performed.
For the above definition, the following are excluded:

(a) burr hole procedures;
(b) transphenoidal procedures;
(c) endoscopic assisted procedures or any other minimally invasive procedures; and
(d) brain surgery as a result of an accident.
36 Full-blown AIDS
The clinical manifestation of AIDS (Acquired Immunodeficiency Syndrome) must be supported by the results
of a positive HIV (Human Immuno-deficiency Virus) antibody test and a confirmatory test. In addition, the Life
Assured must have a CD4 cell count of less than two hundred (200)/µL and one (1) or more of the following
criteria are met:
(a) weight loss of more than ten percent (10%) of the Life Assured’s body weight over a period of six (6)
months or less (wasting syndrome);
(b) Kaposi Sarcoma;
(c) Pneumocystis Carinii Pneumonia;
(d) progressive multifocal leukoencephalopathy;
(e) active Tuberculosis;
(f) less than one thousand (1,000) lymphocytes/µL; or
(g) malignant lymphoma.
37 Occupationally Acquired Human Immunodeficiency Virus (HIV) Infection

Infection with the Human Immunodeficiency Virus (only if the Life Assured is a Medical Staff as defined
below), where it was acquired as a result of an accident occurring during the course of carrying out normal
occupational duties with seroconversion to Human Immunodeficiency Virus (HIV) infection occurring within
six (6) months of the accident. Any accident giving rise to a potential claim must be reported to Us within
thirty (30) days of the accident taking place supported by a negative HIV test taken within seven (7) days of
the accident.
“Medical Staff” is defined as doctors (General Physicians and Specialists), traditional practitioners, nurses,
paramedics, laboratory technicians, dentists, dental nurses, ambulance workers who are working in a
medical centre or hospital or dental clinic/polyclinic in Malaysia. Doctors, traditional practitioners, nurses and
dentists must be registered with the Ministry of Health of Malaysia.
38 Deafness - Permanent and Irreversible

Permanent and Irreversible loss of hearing as a result of accident or illness to the extent that the loss is
greater than eighty (80) decibels across all frequencies of hearing in both ears.
Medical evidence in the form of audiometry and sound-threshold test results must be provided and certified
by an Ear, Nose, and Throat (ENT) specialist.

39 Blindness - Permanent and Irreversible
Permanent and Irreversible loss of sight as a result of accident or illness to the extent that even when tested
with the use of visual aids, vision is measured at 3/60 or worse in both eyes using a Snellen eye chart or
equivalent test and the result must be certified by an ophthalmologist.
40 Severe Eisenmenger's Syndrome

Eisenmenger's Syndrome shall mean the occurrence of a reversed or bidirectional shunt as a result of
pulmonary hypertension, caused by a heart disorder.

(a) presence of Permanent physical impairment classified as NYHA IV; and
(b) the diagnosis of Eisenmenger’s Syndrome and the level of physical impairment must be confirmed by a
registered medical practitioner who is a cardiologist.
41 Infective Endocarditis
Inflammation of the inner lining of the heart caused by infectious organisms, where all of the following criteria
are met:
(a) positive result of the blood culture proving presence of the infectious organism(s);
(b) presence of at least moderate heart valve incompetence (meaning regurgitant fraction of twenty percent
(20%) or above) or moderate heart valve stenosis (resulting in heart valve area of thirty percent (30%) or
less of normal value) attributable to Infective Endocarditis; and
(c) the diagnosis of Infective Endocarditis and the severity of valvular impairment are confirmed by a
registered medical practitioner who is a cardiologist.
42 Poliomyelitis
Polio virus shall be the cause, and muscle paralysis on moving muscle components or breathing muscles
causing the Life Assured unable to perform at least three (3) of the Activities of Daily Living continuously
minimal for three (3) months.
43 Progressive Scleroderma
It is a kind of collagen blood vessel disorder that systematically causes total fibrosis progressively within the
skin, blood vessel and other body organs. Diagnosis of this disorder shall be supported by biopsy and other
supporting evidences as results of serology and this illness shall be in accordance with systemic proportion
related to heart, lungs or kidney.
The following shall be excluded from this illness:

(a) local scleroderma (linier or morphea scleroderma);
(b) Eosinophilic Fasciitis; and
(c) CREST syndrome.
44 Chronic Rheumatoid Arthritis

Chronic rheumatoid arthritis is a result of an autoimmune disorder confirmed by a physician who specialised
in rheumatology and immunology. It is characterised by all of the following:
(a) diagnosis according to American College of Rheumatology;
(b) destruction and deformity of at least three (3) of the following joints: interphalangeal hand joint, wrist,
elbow, knee, hip, ankle, cervical spine or interphalangeal foot joint. Clinical findings and imaging study
must evidence these changes; and
(c) physical impairment resulting in inability to perform at least three (3) of the Activities of Daily Living
without the continual physical assistant of another person for a continuous period of at least one
hundred and eighty (180) days.
45 Crohn’s Disease with Fistula

Crohn’s Disease is a chronic granulomatous inflammatory bowel disease. For the purposes of this benefit
Crohn’s disease must have resulted in fistula formation, or intestinal obstruction or intestinal perforation that
has required surgery and continuous immunosuppressive treatment or continuous treatment with
immunomodulating drugs.
Crohn’s disease must be proven on biopsy and there must be continuous treatment under the care of a
gastroenterologist.
46 Ulcerative Colitis with Total Colectomy

For the purposes of this Supplementary Contract, Ulcerative Colitis shall mean pan colitis with inflammation
involving the entire colon with bloody diarrhoea and systemic signs and symptoms for which the treatment is
total colectomy and ileostomy. Diagnosis must be based on histopathological features and surgery in the
form of colectomy and ileostomy must have been undertaken either to control poorly responsive disease or
to treat or prevent the development of malignancy.

47 Myasthenia Gravis
Myasthenia Gravis shall mean an acquired autoimmune disorder of neuromuscular transmission leading to
fluctuating muscle weakness and fatiguability.

(a) presence of Permanent muscle weakness categorised as Class IV or V according to the Myasthenia
Gravis Foundation of America Clinical Classification; and
(b) the diagnosis of Myasthenia Gravis and categorisation must be confirmed by a registered medical
practitioner who is a neurologist.
48 Progressive Muscular Atrophy

Involving the wasting of muscles, increased spasticity and the Life Assured’s Permanent inability to perform
at least three (3) of the six (6) Activities of Daily Living as diagnosed by a consultant neurologist The
diagnosis must be confirmed by appropriate neuromuscular testing such as Electromyogram (EMG).
These conditions have to be medically documented for at least three (3) months.
49 Progressive Supranuclear Palsy

Progressive supranuclear palsy resulting independently of all other causes and directly resulting lack of
control of gait and balance, and Permanent inability to perform (without aided) at least three (3) of the
Activities of Daily Living. The diagnosis must be made by a neurologist as progressive and resulting in
neurological deficit for at least a continuous period of six (6) months.
Only Life Assured age above five (5) on first diagnosis is eligible to receive a benefit under this illness.
50 Chronic Autoimmune Hepatitis

A chronic necro-inflammatory liver disorder of unknown cause associated with circulating auto-antibodies
and a high serum globulin level.
The diagnosis must be based on all of the following criteria:

(a) Hypergammaglobulinaemia;
(b) the presence of at least one of the following auto-antibodies:
• Anti-Nuclear Antibody;
• Anti-smooth muscle antibodies;
• Anti-actin antibodies;
• Anti-LKM-1 antibodies;
• Anti-LC1 antibodies; or
• Anti-SLA/LP antibodies
(c) liver biopsy confirmation of the diagnosis of auto-immune hepatitis.
This only covered if the Life Assured has been put on continuous immunosuppressive therapy for a period of
at least six (6) months and the diagnosis must be confirmed by a specialist in gastroenterology or
hepatology.
51 Chronic Adrenal Insufficiency

An autoimmune disorder causing a gradual destruction of the adrenal gland resulting in the need for life long
glucocorticoid and mineral corticoid replacement therapy. The disorder must be confirmed by a specialist in
endocrinology through:
(a) ACTH simulation tests;
(b) insulin-induced hypoglycemia test;
(c) plasma ACTH level measurement; and
(d) Plasma Renin Activity (PRA) level measurement.
Only autoimmune cause of primary adrenal insufficiency is included. All other causes of adrenal insufficiency
are excluded.
52 Osteogenesis Imperfecta
This is characterised by brittle, osteoporotic, easily fractured bone. The Life Assured must be diagnosed as a
type III Osteogenesis Imperfecta confirmed by the occurrence of all of the following conditions:
(a) the result of physical examination of the Life Assured by a registered specialist that the Life Assured
suffers from growth retardation and hearing impairment;
(b) the result of X-ray studies reveals multiple fracture of bones and progressive kyphoscoliosis; and
(c) positive result of skin biopsy.
Diagnosis of Osteogenesis Imperfecta must be confirmed by a registered specialist acceptable to Us.

53 Meningeal Tuberculosis
Meningitis caused by tubercle bacilli, resulting in Permanent Neurological Deficit for at least a continuous
period of six (6) months.
The diagnosis must be confirmed by a neurologist and supported by analysis of cerebrospinal fluid by lumbar
puncture.
54 Accidental Fracture of Spinal Column

A new spinal fracture caused by an accident, and requiring hospitalisation for open surgical repair, or which
results in a Permanent Neurological Deficit in motor function or bladder function. The spinal column is
defined as one bone as a whole, and the diagnosis of the fracture of the spinal column must be based on an
examination of an X-ray or any other similar imaging technology acceptable to Us by a specialist orthopaedic
surgeon or a radiologist acceptable to Us. The diagnosis of any neurological deficits must be made by a
consultant neurologist or attending orthopaedic surgeon acceptable to Us.
55 Apallic Syndrome
Total brain cortex damage while the brain stem is still normal. This diagnosis shall be confirmed by
neurologist and condition of this syndrome shall constantly occur minimal for one (1) month.
56 Cerebral Aneurysm Requiring Brain Surgery

The actual undergoing of brain surgery to correct an abnormal widening of the cerebral artery involving all
three (3) layers of the cerebral arterial wall. The diagnosis must be made by a licensed neurosurgeon, using
standard cerebral angiography which indicates the need for open surgery.
Exclusions:
(a) infection and mycotic aneurysm; and
(b) limited craniectomy and burr hole procedures.
57 Multiple Root Avulsions of Brachial Plexus

The complete and Permanent loss of use and sensory functions of an upper extremity caused by avulsion of
two (2) or more nerve roots of the brachial plexus through accident or injury. Complete injury of two (2) or
more nerve roots should be confirmed by electrodiagnostic study done by a physiatrist or neurologist.
58 Stroke Requiring Carotid Endarterectomy Surgery

Stroke Requiring Carotid Endarterectomy Surgery means the undergoing of carotid Endarterectomy by
expert and licensed surgeon, based on current standard medical indications, to prevent recurrent ischemic
cerebrovascular events.
59 Surgery for Idiopathic Scoliosis

Surgery for idiopathic scoliosis means the undergoing of spinal surgery to correct an abnormal curvature of
the spine from its normal straight line viewed from the back. The condition must be present without an
identifiable underlying cause and the curve of the spine must be more than cobb angle forty (40) degree.
Spinal deformity associated with congenital defects and neuromuscular diseases are excluded.
60 Chronic Relapsing Pancreatitis

Chronic Relapsing Pancreatitis as a result of progressive severe destruction of pancreas, this condition must
be a result of recurrent acute pancreatitis and characterised by:
(a) recurrent acute pancreatitis for a period of at least two (2) years;
(b) generalise calcium deposits in pancreas from imaging study; and
(c) chronic continuous pancreatic function impairment resulting in mal-absorption of intestine (high fat in
stool) or diabetes.
Chronic Relapsing Pancreatitis directly cause by alcohol consumption is excluded.
61 Elephantiasis
Chronic filariasis characterised by:
(a) severe and Permanent edema of arm and leg or other part of body from lymphatic obstruction; and
(b) the presence of microfilariae infection from laboratory study.
Lymphatic obstruction caused by sexual transmitted disease, cancer, wound, surgery scar, radiation, heart
failure or congenital anomaly is excluded.
62 Kawasaki Disease with Heart Complications

The diagnosis of Kawasaki disease by a consultant paediatrician or other appropriate medical specialist.
There must be echocardiographic evidence of cardiac involvement manifested by dilatation or aneurysm
formation in the coronary arteries which must persist for at least six (6) consecutive months.

63 Acute Necrohemorrhagic Pancreatitis
Acute inflammation and necrosis of pancreas parenchyma, focal enzymic necrosis of pancreatic fat and
hemorrhage due to blood vessel necrosis, where all of the following criteria are met:
(a) the necessary treatment is surgical clearance of necrotic tissue or pancreatectomy; and
(b) the diagnosis is based on histopathological features and confirmed by a registered medical practitioner
who is a gastroenterologist.
Pancreatitis due to alcohol or drug abuse is excluded.
64 Cerebral Metastasis
A complication of systemic cancer spreading to the brain. The diagnosis must be confirmed by a specialist
oncologist and supported by a valid pathology report. If biopsy of the lesion is not indicated clinically, the
claim must be supported with evidence of increasing tumor size and worsening neurological dysfunction.
Cerebral Metastasis is not a covered condition if the Life Assured also has infection with Human
Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS).
65 Creutzfeldt – Jakob disease (Mad Cow Disease)

Creutzfeld - Jakob disease is a rare, usually fatal spongiform encephalopathy accompanied by signs and
symptoms of cerebellar dysfunction, severe progressive dementia, uncontrolled muscle spasm, tremor and
athetosis.
Diagnosis must be made by a consultant neurologist and based on conclusive electroencephalography

(EEG) and cerebrospinal fluid (CSF) findings as well as CT scan and magnetic resonance imaging (MRI).
66 Ebola Hemorrhagic Fever

The infection with the Ebola virus causing fever and internal or external bleeding.

(a) presence of the Ebola virus has been confirmed by laboratory testing;
(b) mucosal or gastrointestinal bleeding has occurred; and
(c) the diagnosis of Ebola Hemorrhagic Fever must be confirmed by a specialist medical practitioner
specialised in infectious disease.
67 Pheochromocytoma
Presence of a neuroendocrine tumour of the adrenal or extra-chromaffin tissue that secretes excess
catecholamines requiring the actual undergoing of surgery to remove the tumour.
The diagnosis of Pheochromocytoma must be confirmed by a registered medical practitioner who is an

endocrinologist.
68 Severe Relapsing Nephrotic Syndrome

Confirmatory diagnosis of Nephrotic Syndrome where all of the following criteria must be fulfilled:
(a) Oedema caused by renal protein loss;
(b) Hypoalbuminaemia of < 25g/l;
2 2
(c) Proteinuria > 150 mg/m /hour ( > 3.6g/m /day ); and
(d) four (4) or more relapses of the above defined severe nephrotic syndrome (as defined under (a) to (c))
within twelve (12) months after the initial severe nephrotic syndrome episode which requires continuous
treatment for at least six (6) months.
69 Wilson’s Disease
A potentially fatal disorder of copper toxicity characterised by progressive liver disease and/ or neurologic
deterioration due to copper deposit. The diagnosis must be confirmed by a specialist medical practitioner and
the treatment with a chelating agent must be documented for at least six (6) months.
70 Hydrocephalus
Refers to the enlargement of the cerebrospinal fluid (CSF) spaces resulting from obstruction of flow pathway
between the secretion sites in the ventricles and absorption sites in the subarachnoid space. This benefit will
only be paid if the condition is serious enough to warrant the placement of a shunt. Proof of actual
undergoing of shunt placement is required.
71 Systemic Arthritis Chronic Child (Still's Disease)

A form of juvenile chronic arthritis characterised by high fever and signs of systemic illness that can exist for
months before the onset of arthritis. The condition must be characterised by cardinal manifestations which
include high spiking, daily (quotidian) fevers, evanescent rash, arthritis, splenomegaly, lymphadenopathy,
serositis, weight loss, neutrophilic leucocytosis, increased acute phase proteins and seronegative tests for
Antinuclear Antibodies (ANA) and Rheumatoid Factor (RF).

A claim for this benefit will be admitted only if the diagnosis is confirmed by a pediatric rheumatologist and
the condition has to be documented for at least six (6) months, with evidence of major clinical deformity of at
least three (3) or more of the following joints area:
(a) hands;
(b) wrists;
(c) elbows;
(d) knees;
(e) hips;
(f) ankle;
(g) cervical spine; and
(h) metatarsophalangeal joints in the feet.
The diagnosis of the condition must be completed and confirmed by medical evidence or a duly qualified
medical practitioner prior to the policy anniversary when the Life Assured attains age nineteen (19) nearest
birthday.
72 Severe Dengue Haemorrhagic Fever

Severe Dengue Haemorrhagic Fever requiring the admission into an Intensive Care Unit (ICU). The condition
must be severe to have reached at least Stage 3 Dengue Haemorrhagic Fever, based on the World Health
Organisation case definition, with unequivocal evidence of the Dengue Shock Syndrome and confirmation of
dengue infection, with confirmatory serological testing of dengue.
birthday.
73 Insulin-Dependent Diabetes Mellitus

The occurrence of Insulin Dependent Diabetes Mellitus (Type I Diabetes Mellitus) where all of the following
conditions are met:
(a) the diagnosis is must be confirmed by a registered medical practitioner who is an endocrinologist; and
(b) the disease has persisted for at least six (6) months following such diagnosis, during which period insulin
administration on a daily basis is medically necessary to regulate glucose metabolism.
birthday.
74 Hand, Foot , Mouth Disease with Severe Complications (Life-threatening)

The unequivocal diagnosis of Hand, Foot and Mouth disease with evidence of infection by Coxsackie A17
and Entenovirus 71.
For the purpose of this Supplementary Contract, only severe Hand, foot and mouth disease requiring the
admission into an Intensive Care Unit (ICU) and associated with either encephalitis and/ or myocarditis will
be covered. Positive isolation of the causative virus to support the diagnosis has to be provided together with
documented evidence of the presence of encephalitis and/ or myocarditis.
A claim for this benefit will only be made with evidence of neurological deficit at least thirty (30) days after the
event.
birthday.
75 Severe Hemophilia
The Life Assured must be suffering from severe Hemophilia with a clotting factor VIII or factor IX of less than
one percent (1%). Diagnosis must be confirmed by a specialist.
birthday.
76 Spinal Amyotrophy Children with Type I

The Life Assured must be diagnosed as a Type I Juvenile Spinal Amyotrophy which is an infantile form of
spinal muscular atrophy characterised by progressive dysfunction of the anterior horn cells in the spinal cord
and brainstem cranial nerves with profound weakness and bulbar dysfunction. Electromyography and muscle
biopsy are needed to confirm this diagnosis.

birthday.
77 Rheumatic Fever with Heart Valve Disorders

A confirmed diagnosis by a qualified paediatrician acceptable by Us of an acute rheumatic fever according to
the revised Jones criteria for its diagnosis.
There must be involvement of one (1) or more heart valves and at least severe valve incompetence
attributable to rheumatic fever as confirmed by quantitative investigations of the valve function by a qualified
cardiologist acceptable to Us and supported by echocardiography.
birthday.

SECURECOVER
THIS UNIT CANCELLATION SUPPLEMENTARY CONTRACT (subsequently called the Supplementary Contract) forms part of the Policy
(subsequently called the Basic Policy) to which it is attached. It is issued in consideration of the payment of Premium of the Basic Policy.
1. BENEFITS
If, while the Basic Policy and this Supplementary Contract are in force, You under this Supplementary Contract as shown in the
Policy Schedule or Endorsement to the Basic Policy, dies or sustains Total and Permanent Disability (as defined below) or suffers a
Critical Illness (as defined below), We will, subject to the provisions contained in this Supplementary Contract, pay the Premium of
the Basic Policy for You until the expiry of this Supplementary Contract or termination of the Basic Policy, whichever is earlier.
Provided the claim is approved, the first such premium payable shall be the one due immediately after the event date of death,
date of commencement of the Total and Permanent Disability or date of diagnosis of Critical Illness.
The Premium of the Basic Policy shall be allocated towards purchase of Units in the same manner as set out in Table 2 of the
provision for Allocation of Units in the Basic Policy.
Our liability in respect of any losses to You shall not exceed one hundred percent (100%) of the Premium of the Basic Policy.
2. DEFINITIONS
“We/Us/Our” means Allianz Life Insurance Malaysia Berhad.
“You/Your” means the Policy Owner. The Policy Owner may be the Life Assured or someone other than the Life Assured.
“Total and Permanent Disability” means disability such that there is neither at the time disability commences nor at any time after
that, any work, occupation, or profession that You can ever be capable of doing or failing to earn or obtain any wages,
compensation or profit, provided however, that such disability must last for not less than six (6) months in duration. If it is
subsequently admitted as Total and Permanent for the purpose of this Supplementary Contract, liability of Us shall accrue as from
the date of commencement of the disability. The occurrence of any of the following shall also be considered as Total and
Permanent Disability: (1) total paralysis; or (2) total and irrecoverable loss of the sight of both eyes; or (3) loss by severance of two
limbs at or above wrist or ankle; or (4) total paralysis of two limbs; or (5) total and irrecoverable loss of the sight of one eye and
loss by severance of one limb at or above wrist or ankle.
“Irreversible” means cannot be reasonably improved upon by medical treatment and/or surgical procedures consistent with the
current standard of the medical services available in Malaysia.
“Permanent Neurological Deficit with Persisting Clinical Symptoms” means symptoms of dysfunction in the nervous system that
are present on clinical examination which are expected to last throughout the lifetime of the Life Assured. Symptoms that are
covered include numbness, paralysis, localised weakness, dysarthria (difficulty with speech), aphasia (inability to speak), dysphagia
(difficulty swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, seizures, dementia, delirium and
coma.

a) Transfer
b) Mobility
c) Continence
d) Dressing
e) Bathing/Washing
The ability to wash in the bath or shower (including getting in or out of the bath or shower) or wash by any other means.
f) Eating
“Assessment Period” means the period during which the insurer will assess a condition before deciding whether or not the
condition qualifies as being Permanent. The assessment period will be for the minimum period time frame stated in the relevant
definition and will not be longer than twelve (12) months (provided all required evidence has been submitted).
USCRT_03V8 / January 2019 Page 1 of 8

“Critical Illness” means any of the illnesses specified and defined below:
1. Stroke - resulting in Permanent Neurological Deficit with Persisting Clinical Symptoms
Death of brain tissue due to inadequate blood supply, bleeding within the skull or embolisation from an extra cranial source
resulting in Permanent Neurological Deficit with Persisting Clinical Symptoms. The diagnosis must be based on changes
seen in a CT scan or MRI and certified by a neurologist. A minimum Assessment Period of three (3) months applies.

(i) transient ischemic attacks;
(ii) cerebral symptoms due to migraine;
(iii) traumatic injury to brain tissue or blood vessels; and
(iv) vascular disease affecting the eye or optic nerve or vestibular functions.
2. Heart Attack - of specified severity

Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial
infarction:
(i) a history of typical chest pain;
(ii) new characteristic electrocardiographic changes; with the development of any of the following:
 ST elevation or depression;
 T wave inversion;
 pathological Q waves;or
 left bundle branch block; and
(iii) elevation of the cardiac biomarkers, including the CPK-MB being above the generally accepted normal laboratory levels
or Troponins recorded at the following levels or higher:
 Cardiac Troponin T or Cardiac Troponin I > / = 0.5 ng/ml.
The evidence must show the occurrence of a definite acute myocardial infarction which should be confirmed by a
cardiologist or physician.

 occurrence of an acute coronary syndrome including but not limited to unstable angina; and
 a rise in cardiac biomarkers resulting from a percutaneous procedure for coronary artery disease.
3. Kidney Failure - requiring dialysis or kidney transplant

End-stage kidney failure presenting as a chronic Irreversible failure of both kidneys to function, a result of which regular
dialysis is initiated or kidney transplantation is carried out.
4. Cancer - of specified severity and does not cover very early cancers
Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of
malignant cells and invasion of tissue. The term malignant tumour includes leukemia, lymphoma and sarcoma.

(i) all cancers which are histologically classified as any of the following:
 pre-malignant;
 non-invasive;
 carcinoma in situ;
 having borderline malignancy; or
 having malignant potential;
(ii) all tumours of the prostate histologically classified as T1N0M0 (TNM classification);
(iii) all tumours of the thyroid histologically classified as T1N0M0 (TNM classification);
(iv) all tumours of the urinary bladder histologically classified as T1N0M0 (TNM classification);
(v) Chronic Lymphocytic Leukemia less than RAI Stage 3;
(vi) all cancers in the presence of HIV; and
(vii) any skin cancer other than malignant melanoma.
5. Coronary Artery By-Pass Surgery

Refers to the actual undergoing of open-chest surgery to correct or treat Coronary Artery Disease (CAD) by way of coronary
artery by-pass grafting.

(i) angioplasty;
(ii) other intra-arterial or catheter based techniques;
(iii) keyhole procedures; and
(iv) laser procedures.
6. Serious Coronary Artery Disease

The narrowing of the lumen of Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and Circumflex Artery
(not inclusive of their branches) occurring at the same time by a minimum of sixty percent (60%) in each artery as proven by
coronary arteriography (non-invasive diagnostic procedures are not covered). A narrowing of sixty percent (60%) or more of
the Left Main Stem will be considered as a narrowing of the LAD and Circumflex Artery. This covered event is payable
regardless of whether or not any form of coronary artery surgery has been performed.

7. Paralysis of Limbs
Total, Permanent and Irreversible loss of use of both arms or both legs, or of one arm and one leg, through paralysis caused
by illness or injury. A minimum Assessment Period of six (6) months applies.
8. End-Stage Liver Failure

End-stage liver failure as evidenced by all of the following:
(i) Permanent jaundice;
(ii) ascites (excessive fluid in peritoneal cavity); and
(iii) hepatic encephalopathy.
Liver failure secondary to alcohol or drug abuse is not covered.
9. Fulminant Viral Hepatitis

A sub-massive to massive necrosis (death of liver tissue) caused by any virus as evidenced by all of the following diagnostic
criteria:
(i) a rapidly decreasing liver size as confirmed by abdominal ultrasound;
(ii) necrosis involving entire lobules, leaving only a collapsed reticular framework;
(iii) rapidly deteriorating liver functions tests; and
(iv) deepening jaundice.
Viral hepatitis infection or carrier status alone (inclusive but not limited to Hepatitis B and Hepatitis C) without the above
diagnostic criteria is not covered.
10. Coma - resulting in Permanent Neurological Deficit with Persisting Clinical Symptoms
A state of unconsciousness with no reaction to external stimuli or internal needs, persisting continuously for at least ninety
six (96) hours, requiring the use of life support systems and resulting in a Permanent Neurological Deficit with Persisting
Clinical Symptoms. A minimum Assessment Period of thirty (30) days applies. Confirmation by a neurologist must be
present.
Coma resulting directly from alcohol or drug abuse is not covered.
11. Benign Brain Tumour - of specified severity

A benign tumour in the brain or meninges within the skull, where all of the following conditions are met:
(i) it is life threatening;
(ii) it has caused damage to the brain;
(iii) the Life Assured has undergone surgical removal of the tumour or the tumour has caused a Permanent Neurological
Deficit with Persisting Clinical Symptoms; and
(iv) its presence must be confirmed by a neurologist or neurosurgeon and supported by findings on MRI, CT or other
reliable imaging techniques.
The following are not covered:

 cysts;
 granulomas;
 malformations in or of the arteries or veins of the brain;
 hematomas;
 tumours in the pituitary gland;
 tumours in the spine; and
 tumours of the acoustic nerve.
12. Deafness - Permanent and Irreversible

Permanent and Irreversible loss of hearing as a result of accident or illness to the extent that the loss is greater than eighty
(80) decibels across all frequencies of hearing in both ears. Medical evidence in the form of audiometry and sound-threshold
test results must be provided and certified by an Ear, Nose, and Throat (ENT) specialist.
13. Third Degree Burns - of specified severity

Third degree (i.e. full thickness) skin burns covering at least twenty percent (20%) of the total body surface area.
14. HIV Infection due to Blood Transfusion

Infection with the Human Immunodeficiency Virus (HIV) through a blood transfusion, provided that all of the following
conditions are met:
(i) the blood transfusion was medically necessary or given as part of a medical treatment;
(ii) the blood transfusion was received in Malaysia or Singapore after the commencement of the policy;
(iii) the source of the infection is established to be from the institution that provided the blood transfusion and the
institution is able to trace the origin of the HIV tainted blood;
(iv) the Life Assured does not suffer from hemophilia; and
(v) the Life Assured is not a member of any high risk groups including but not limited to intravenous drug users.

15. Occupationally Acquired Human Immunodeficiency Virus (HIV) Infection
Infection with the Human Immunodeficiency Virus (only if the Life Assured is a Medical Staff as defined below), where it was
acquired as a result of an accident occurring during the course of carrying out normal occupational duties with
seroconversion to HIV infection occurring within six (6) months of the accident. Any accident giving rise to a potential claim
must be reported to the Company within thirty (30) days of the accident taking place supported by a negative HIV test taken
within seven (7) days of the accident.
“Medical Staff” is defined as doctors (General Physicians and Specialists), traditional practitioners, nurses, paramedics,
laboratory technicians, dentists, dental nurses, ambulance workers who are working in a medical centre or hospital or dental
clinic/polyclinic in Malaysia. Doctors, traditional practitioners, nurses and dentists must be registered with the Ministry of
Health of Malaysia.
16. Full-blown AIDS

The clinical manifestation of AIDS (Acquired Immuno-deficiency Syndrome) must be supported by the results of a positive
HIV (Human Immuno-deficiency Virus) antibody test and a confirmatory test. In addition, the Life Assured must have a CD4
cell count of less than two hundred (200)/µL and one (1) or more of the following criteria are met:
(i) weight loss of more than ten percent (10%) of the Life Assured’s body weight over a period of six (6) months or less
(wasting syndrome);
(ii) Kaposi Sarcoma;
(iii) Pneumocystis Carinii Pneumonia;
(iv) progressive multifocal leukoencephalopathy;
(v) active Tuberculosis;
(vi) less than one-thousand (1000) lymphocytes/µL; or
(vii) malignant lymphoma.
17. End-Stage Lung Disease

End-stage lung disease causing chronic respiratory failure.
(i) the need for regular oxygen treatment on a Permanent basis;
(ii) Permanent impairment of lung function with a consistent Forced Expiratory Volume (FEV) of less than one (1) litre
during the first second;
(iii) shortness of breath at rest; and
(iv) Baseline Arterial Blood Gas analysis with partial oxygen pressures of 55mmHg or less.
18. Encephalitis - resulting in Permanent inability to perform Activities of Daily Living

Severe inflammation of brain substance, resulting in Permanent functional impairment. The Permanent functional
impairment must result in an inability to perform at least three (3) of the Activities of Daily Living. A minimum Assessment
Period of thirty (30) days applies. The covered event must be certified by a neurologist.
Encephalitis in the presence of HIV infection is not covered.
19. Major Organ / Bone Marrow Transplant

The receipt of a transplant of:
(i) human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or
(ii) one of the following human organs: heart; lung; liver; kidney; or pancreas; as a result of Irreversible end-stage failure of
the relevant organ.
Other stem cell transplants are not covered.
20. Loss of Speech

Total, Permanent and Irreversible loss of the ability to speak as a result of injury or illness. A minimum Assessment Period of
six (6) months applies. Medical evidence to confirm injury or illness to the vocal cords to support this disability must be
supplied by an Ear, Nose, and Throat (ENT) specialist.
All psychiatric related causes are not covered.
21. Brain Surgery

The actual undergoing of surgery to the brain under general anaesthesia during which a craniotomy (surgical opening of
skull) is performed.

(i) burr hole procedures;
(ii) transphenoidal procedures;
(iii) endoscopic assisted procedures or any other minimally invasive procedures; and
(iv) brain surgery as a result of an accident.
22. Heart Valve Surgery

The actual undergoing of open-heart surgery to replace or repair cardiac valves as a consequence of heart valve defects or
abnormalities.

(i) repair via intra-arterial procedure; and
(ii) repair via key-hole surgery or any other similar techniques.
23. Terminal Illness

The conclusive diagnosis of a condition that is expected to result in the death of the Life Assured within twelve (12) months.
The Life Assured must no longer be receiving active treatment other than for pain relief. The diagnosis must be supported by
written confirmation from an appropriate specialist and confirmed by the Company’s appointed doctor.
24. Bacterial Meningitis - resulting in Permanent inability to perform Activities of Daily Living
Bacterial meningitis causing inflammation of the membranes of the brain or spinal cord resulting in Permanent functional
impairment. The Permanent functional impairment must result in an inability to perform at least three (3) of the Activities of
Daily Living. A minimum Assessment Period of thirty (30) days applies.
The diagnosis must be confirmed by:

(i) an appropriate specialist; and
(ii) the presence of bacterial infection in the cerebrospinal fluid by lumbar puncture.
For the above definition, other forms of meningitis, including viral meningitis are not covered.
25. Major Head Trauma - resulting in Permanent inability to perform Activities of Daily Living
Physical head injury resulting in Permanent functional impairment verified by a neurologist. The Permanent functional
impairment must result in an inability to perform at least three (3) of the Activities of Daily Living. A minimum Assessment
Period of three (3) months applies.
26. Chronic Aplastic Anemia - resulting in Permanent Bone Marrow Failure

Irreversible Permanent bone marrow failure which results in anemia, neutropenia and thrombocytopenia requiring at least
two (2) of the following treatments:
(i) regular blood product transfusion;
(ii) marrow stimulating agents;
(iii) immunosuppressive agents; or
(iv) bone marrow transplantation.
The diagnosis must be confirmed by a bone marrow biopsy.
27. Motor Neuron Disease - Permanent Neurological Deficit with Persisting Clinical Symptoms
A definitive diagnosis of motor neuron disease by a neurologist with reference to either spinal muscular atrophy, progressive
bulbar palsy, amyotrophic lateral sclerosis or primary lateral sclerosis. There must be Permanent Neurological Deficit with
Persisting Clinical Symptoms.
28. Parkinson's Disease - resulting in Permanent inability to perform Activities of Daily Living
A definitive diagnosis of Parkinson's Disease by a neurologist where all the following conditions are met:
(i) it cannot be controlled with medication;
(ii) the Life Assured shows signs of progressive impairment; and
(iii) confirmation of the Permanent inability of the Life Assured to perform without assistance three (3) or more of the
Activities of Daily Living.
Only idiopathic Parkinson's Disease is covered. Drug-induced or toxic causes of Parkinsonism are not covered.
29. Alzheimer's Disease / Severe Dementia

Deterioration or loss of intellectual capacity confirmed by clinical evaluation and imaging tests arising from Alzheimer's
Disease or Severe Dementia as a result of Irreversible organic brain disorders. The covered event must result in a significant
reduction in the mental and social functions requiring continuous supervision of the Life Assured. The diagnosis must be
clinically confirmed by a neurologist.
From the above definition, the following are not covered:

(i) non organic brain disorders such as neurosis;
(ii) psychiatric illnesses; and
(iii) drug or alcohol related brain damage.
30. Muscular Dystrophy

The definitive diagnosis of Muscular Dystrophy by a Neurologist which must be supported by all of the following:
(i) clinical presentation of progressive muscle weakness;
(ii) no central/peripheral nerve involvement as evidenced by absence of sensory disturbance; and
(iii) characteristic electromyogram and muscle biopsy findings.
No benefit will be payable under this covered event before the Life Assured has reached the age of twelve (12) years next
birthday.

31. Surgery to Aorta
The actual undergoing of surgery via a thoracotomy or laparotomy (surgical opening of thorax or abdomen) to repair or
correct an aortic aneurysm, an obstruction of the aorta or a dissection of the aorta. For this definition, aorta shall mean the
thoracic and abdominal aorta but not its branches.

(i) angioplasty;
(ii) other intra-arterial or catheter based techniques;
(iii) other keyhole procedures; and
(iv) laser procedures.
32. Multiple Sclerosis

A definitive diagnosis of multiple sclerosis by a neurologist. The diagnosis must be supported by all of the following:
(i) investigations which confirm the diagnosis to be Multiple Sclerosis;
(ii) multiple neurological deficits resulting in the impairment of motor and sensory functions occurring over a continuous
period of at least six (6) months; and
(iii) well documented history of exacerbations and remissions of said symptoms or neurological deficits.
33. Primary Pulmonary Arterial Hypertension - of specified severity

A definitive diagnosis of primary pulmonary arterial hypertension with substantial right ventricular enlargement established
by investigation including cardiac catheterisation, resulting in Permanent physical impairment to the degree of at least Class
III of the New York Heart Association (NYHA) classification of cardiac impairment.
The NYHA classification of cardiac impairment for Class III and Class IV means the following:
Class III: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms.
Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.
Pulmonary arterial hypertension resulting from other causes shall be excluded from this benefit.
34. Medullary Cystic Disease

A progressive hereditary disease of the kidney characterised by the presence of cysts in the medulla, tubular atrophy and
interstitial fibrosis with the clinical manifestations of anemia, polyuria and renal loss of sodium, progressing to chronic kidney
failure. Diagnosis must be supported by a renal biopsy.
35. Cardiomyopathy - of specified severity

A definitive diagnosis of cardiomyopathy by a cardiologist which results in Permanently impaired ventricular function and
resulting in Permanent physical impairment of at least Class III of the New York Heart Association (NYHA) classification of
cardiac impairment. The diagnosis has to be supported by echocardiographic findings of compromised ventricular
performance.
The NYHA classification of cardiac impairment for Class III and Class IV means the following:
Class III: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms.
Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.
Cardiomyopathy directly related to alcohol or drug abuse is not covered.
36. Systemic Lupus Erythematosus with Severe Kidney Complications

A definitive diagnosis of Systemic Lupus Erythematosus confirmed by a rheumatologist.
For this definition, the covered event is payable only if it has resulted in Type III to Type V Lupus Nephritis as established by a
renal biopsy. Other forms such as discoid lupus or those forms with only hematological or joint involvement are not covered.
World Health Organisation Lupus Classification:

Type III - Focal Segmental glomerulonephritis
Type IV - Diffuse glomerulonephritis
Type V - Membranous glomerulonephritis
“Pre-Existing Conditions” means any condition or illness that the Life Assured has reasonable knowledge of prior to the Issue Date
or Reinstatement Date of this Supplementary Contract, whichever is later, and he/she had failed to disclose the same. A Life
Assured may be considered to have reasonable knowledge of a Pre-Existing Conditions where the condition or illness is one (1) for
which:
a) the Life Assured had received or is receiving the treatment; and/or
b) medical advice, diagnosis, care or treatment has been recommended; and/or
c) clear and distinct symptoms are or were evident; and/or
d) its existence would have been apparent to a reasonable person in the circumstances.

Written notice within two (2) months from Your date of death or diagnosis of a Critical Illness or within six (6) months after the
date of commencement of Total and Permanent Disability must be given to Us to claim under this Supplementary Contract.
Failure to give such notice within the time stipulated shall not invalidate any claim if it is shown that it was not reasonably possible
to give such notice earlier and that notice was given as soon as was reasonably possible.
4. PROOF OF TOTAL AND PERMANENT DISABILITY, DEATH OR CRITICAL ILLNESS

Upon Our receipt of the notice above, We will furnish to You or Your claimant the appropriate forms for filing proof of Critical
Illness, Total and Permanent Disability or death. Claims shall be made on forms provided by Us together with written proof
covering the occurrence and circumstances of death or the occurrence, character and the extent of the Total and Permanent
Disability or the diagnosis of the Critical Illness for which claims are made. Such proof and other documents satisfactory to Us
must be given at Your claimant's expense.
5. FILING PROOF OF TOTAL AND PERMANENT DISABILITY, DEATH OR CRITICAL ILLNESS

Proof of Critical Illness must be furnished to Us during Your lifetime and within six (6) months after diagnosis of such Critical
Illness. Proof of Total and Permanent Disability must be furnished to Us during Your lifetime and within one (1) year of the Due
Date of the first premium in default, if there is such default. Proof of death must be furnished to Us within three (3) months after
the date of death.
We reserve the right to require any additional proof and request Your medical examination. In the case of death, We may require,
if appropriate and legally allowable, an autopsy.
6. PROOF OF CONTINUANCE OF TOTAL AND PERMANENT DISABILITY

Though proof of Total and Permanent Disability may have been accepted as satisfactory by Us, We shall be entitled to demand, at
reasonable intervals from You, proof of the continuance of such disability, but after such disability has continued for two (2) full
years We shall not demand such proof more than once in each subsequent year. If You fail to furnish such proof or becomes able
to perform any work, engage in any occupation or profession to earn or obtain any wages, compensation or profit, We shall cease
to pay Premium of the Basic Policy and all the premiums falling due after either of such events contained in this clause shall be
payable according to the terms of the Basic Policy and this Supplementary Contract.
7. AGE AND SEX

This Supplementary Contract is issued at the age shown on the Policy Schedule which is Your age at nearest birthday. If the age or
sex is misstated in the application, We may vary the term of coverage or the amount payable and every benefit accruing under the
Supplementary Contract shall be adjusted according to the cost of insurance which would have been deducted on the basis of
correct age and sex. If at the correct age You are not insurable under this Supplementary Contract, the Supplementary Contract
shall be void. Your proof of shall be required prior to payment of any benefits under this Supplementary Contract.
8. INCONTESTABILITY
This Supplementary Contract shall be incontestable by Us, except for fraud, after it has been in force during the lifetime of You for
two (2) years from Issue Date, or Reinstatement Date, whichever is later.
9. SUICIDE CLAUSE
The amount payable in the event of death of You resulting from suicide within twelve (12) months from the issue date or date of
reinstatement of this Supplementary Contract whichever is later, while You are sane or insane, shall be the total cost of insurance
charged from the issue date or date of reinstatement, whichever is the later.
10. TERMINATION
This Supplementary Contract shall automatically terminate upon the first occurrence of any one of the following:
a) if the Basic Policy expires, lapses or is surrendered; or
b) upon the death of the Life Assured; or
c) upon the expiry date of this Supplementary Contract as specified in the Policy Schedule or Endorsement; or
d) upon We paying the Premium of the Basic Policy under any one (1) of the unit cancellation Supplementary Contract
attached to the Basic Policy; or
e) in the event of termination or expiry of SecureCover (Extended Total and Permanent Disability) Unit Cancellation
Termination of this Supplementary Contract shall be without prejudice to any claim arising prior to such termination. The
payment or acceptance of any cost of insurance in this Supplementary Contract subsequent to termination of this Supplementary
Contract shall not create any liability on the part of Us but We shall refund any such cost of insurance.
11. FREE-LOOK PERIOD

This Supplementary Contract may be cancelled by written request and by returning it to Us within fifteen (15) days or such longer
period as may be specified by Bank Negara Malaysia, from the date of receipt of this Supplementary Contract by You. The amount
refunded shall be the premium paid less any expenses incurred for medical examination.
12. RISKS EXCLUDED

This Supplementary Contract shall not cover any Total and Permanent Disability caused directly or indirectly, wholly or partly, by
any one of the following occurrences or circumstances:
a) attempted self-destruction or self-inflicted injuries while sane or insane;

b) war, invasion, act of foreign enemy, hostilities (whether declared or not), strike, riot and/or civil commotion, civil war,
rebellion, revolution, insurrection, military, usurped power or terrorist activity;
c) accidental events that are directly or indirectly related to the use of atomic, biological or chemical weapons as well as
radioactive, biological or chemical warfare agents or substances;
d) service in the armed forces in time of declared or undeclared war while under orders for warlike operations or restoration of
public order;
e) entering, exiting, operating, servicing, or being transported by any aerial device or conveyance except when You are on a
commercial passenger airline on a regular scheduled passenger trip over its established passenger route as a passenger;
f) any congenital defect which manifests itself or is diagnosed before You attain seventeen (17) years of age and of which We
was not aware at the time of Supplementary Contract Issue Date;
g) an opportunistic infection or a malignant neoplasm if at the time of disability, there is present in You Acquired Immune
Deficiency. An opportunistic infection includes but is not limited to pneumocystis carini pneumonia, organism of chronic
enteritis, virus and/or disseminated fungi infection. A malignant neoplasm includes but is not limited to Karposi’s sarcoma,
central nervous system lymphoma, hairy-cell leukemia and/or other malignancies now known or which become known as
immediate cause of disability or death in the presence of Acquired Immune Deficiency; or
h) Pre-Existing Conditions unless declared by You/the Life Assured and accepted by Us, on or prior to the Issue Date or
Reinstatement Date of this Supplementary Contract, whichever is later.
This Supplementary Contract shall not cover:

a) any Critical Illness other than illnesses in Provisions 2.2, 2.4, 2.5 and 2.6 (as defined in this Supplementary Contract) , which
first manifests itself prior to the thirtieth (30th) day following the issue date or any reinstatement date of this Supplementary
Contract, whichever is later; or
b) Illnesses in Provisions 2.2, 2.4, 2.5 and 2.6 (as defined in this Supplementary Contract) which first manifests itself prior to the
sixtieth (60th) day following the issue date or any reinstatement date of this Supplementary Contract, whichever is later; or
c) any Critical Illness which existed at the Issue Date or Reinstatement Date of this Supplementary Contract, whichever is later;
or
d) any Critical Illness which is due to self-inflicted injuries while sane or insane.
13. NON-PARTICIPATING
14. REGARDLESS OF ANYTHING to the contrary, it is further stipulated and agreed that:
a) no change in the plan or in the mode of premium payments on the Basic Policy may be made during the continuance of
Total and Permanent Disability of You; and
b) the Total and Permanent Disability benefit provided under this Supplementary Contract shall cease automatically on the
policy anniversary when You attain age sixty five (65) nearest birthday.
15. APPLICABLE TAX

In the event that any sales and services tax, value added tax or any similar tax and any other duties, taxes, levies or imposts
(collectively “Applicable Tax”) whatsoever are introduced by any authority and are payable under the laws of Malaysia in
connection with any supply of goods and/or services made or deemed to be made under this Policy, We will be entitled to charge
any Applicable Tax as allowed by the laws of Malaysia. Such Applicable Tax payable shall be paid in addition to the applicable
premiums and other charges. All provisions in this Policy on payment of premiums and default hereof shall apply equally to the
Applicable Tax.
16. ANTI-MONEY LAUNDERING, ANTI-TERRORISM FINANCING AND PROCEEDS OF UNLAWFUL ACTIVITIES ACT 2001
If We receive an order from the relevant authorities to freeze or seize the monies received as premium or monies payable in
respect of this Policy as provided under the Anti-Money Laundering, Anti-Terrorism Financing and Proceeds of Unlawful Activities
Act 2001 or such similar legislation or if We discover or have reasonable suspicion that this Policy is exploited for money
laundering activities and/or to finance terrorism, We reserve the right to terminate this Policy immediately. We shall deal with all
premiums paid and all benefits/sums payable in respect of this Policy in any manner which We deem appropriate, including but
not limited to handing it over to the relevant authorities.

SECURECOVER
(EXTENDED TOTAL AND PERMANENT DISABILITY)
SUPPLEMENTARY CONTRACT
THIS SUPPLEMENTARY CONTRACT forms a part of the SecureCover Unit Cancellation Supplementary Contract to which it is attached. Unless
otherwise expressly stated, the terms defined and construed in the SecureCover Unit Cancellation Supplementary Contract shall bear the same
meaning or construction when used in this Supplementary Contract.
1. BENEFITS
If, while the Basic Policy and this Supplementary Contract are in force, You under this Supplementary Contract as shown in the Policy
Schedule or Endorsement to the Basic Policy sustain Extended Total and Permanent Disability (as defined below), We will, subject to the
provisions contained in this Supplementary Contract, pay the Premium of the Basic Policy for You until the expiry of this Supplementary
Contract or termination of the Basic Policy, whichever is earlier.
Provided the claim is approved, the first such premium payable shall be the one due immediately after the event date of death, date of
commencement of the Extended Total and Permanent Disability.
The Premium of the Basic Policy shall be allocated towards purchase of Units in the same manner as set out in Table 2 of the provision for
Allocation of Units in the Basic Policy.
Our liability in respect of any losses to You shall not exceed one hundred percent (100%) of the Premium of the Basic Policy.
2. DEFINITIONS
“We/Us/Our” means Allianz Life Insurance Malaysia Bhd.
“You/Your” means the Policy Owner. The Policy Owner may be the Life Assured or someone other than the Life Assured.
“Irreversible” means cannot be reasonably improved upon by medical treatment and/or surgical procedures consistent with the current
standard of the medical services available in Malaysia.

a) Transfer
b) Mobility
c) Continence
d) Dressing
e) Bathing/Washing
The ability to wash in the bath or shower (including getting in or out of the bath or shower) or wash by any other means.
f) Eating
“Assessment Period” means the period during which the insurer will assess a condition before deciding whether or not the condition
qualifies as being Permanent. The assessment period will be for the minimum period time frame stated in the relevant definition and will
not be longer than twelve (12) months (provided all required evidence has been submitted).
“Extended Total and Permanent Disability” for the purpose of this Supplementary Contract shall mean any one of the following disabilities
defined below:
a) Blindness - Permanent and Irreversible
Permanent and Irreversible loss of sight as a result of accident or illness to the extent that even when tested with the use of visual
aids, vision is measured at 3/60 or worse in both eyes using a Snellen eye chart or equivalent test and the result must be certified by
an ophthalmologist.
EUSCRT_03V6 / September 2018 Page 1 of 2

b) Loss of Independent Existence
Confirmation by an appropriate specialist of the loss of independent existence resulting in a Permanent inability to perform at least
three (3) of the Activities of Daily Living. A minimum Assessment Period of six (6) months applies.
You or Your claimant must give written notice within six (6) months after the date of commencement of the Extended Total and
Permanent Disability of the Life Assured to claim under this Supplementary Contract. Failure to give notice within the time stipulated shall
not invalidate any claim if it is shown that it was not reasonably possible to give such notice and that notice was given as soon as was
reasonably possible. It shall be Our sole discretion whether to accept the reasons given for the failure to give notice within the time
stipulated.
4. PROOF OF EXTENDED TOTAL AND PERMANENT DISABILITY

Upon Our receipt of the above notice, We will furnish to You or Your claimant the appropriate forms for filing proof of Extended Total and
Permanent Disability. Claims shall be made on forms provided by Us together with written proof covering the occurrence, character and
extent of the Extended Total and Permanent Disability for which claims are made. Such proof and other documents satisfactory to Us
must be given at Your or Your claimant’s expense.
5. LEGAL PROCEEDINGS
No action at law or in equity shall be brought to recover on this Supplementary Contract prior to the expiry of one (1) year.
6. TERMINATION
a) in the event of termination or expiry of the SecureCover Unit Cancellation Supplementary Contract.
7. SEVERABILITY
If any provision or part of a provision of this Supplementary Contract shall be held or found to be void, invalid or otherwise unenforceable,
it shall be deemed to be severed from this Supplementary Contract. However, the remainder of the provisions in this Policy shall remain
in full force and effect.
8. APPLICABLE TAX
In the event that any sales and services tax, value added tax or any similar tax and any other duties, taxes, levies or imposts (collectively
“Applicable Tax”) whatsoever are introduced by any authority and are payable under the laws of Malaysia in connection with any supply
of goods and/or services made or deemed to be made under this Policy, We will be entitled to charge any Applicable Tax as allowed by
the laws of Malaysia. Such Applicable Tax payable shall be paid in addition to the applicable premiums and other charges. All provisions in
this Policy on payment of premiums and default hereof shall apply equally to the Applicable Tax.
9. ANTI-MONEY LAUNDERING AND COUNTER FINANCING OF TERRORISM

If we receive an order from the relevant authorities to freeze or seize the monies received as premium or monies payable in respect of
this Policy as provided under the Anti-Money Laundering and Anti-Terrorism Financing Act 2001 or such similar legislation or if we
discover or have reasonable suspicion that this Policy is exploited for money laundering activities and/or to finance terrorism, we reserve
the right to terminate this Policy immediately. We shall deal with all premiums paid and all benefits/sums payable in respect of this Policy
in any manner which we deem appropriate, including but not limited to handing it over to the relevant authorities.
EUSCRT_03V6 / September 2018 Page 2 of 2

Allianz Life Insurance Malaysia Berhad (198301008983) ("ALIM")
(Licensed under the Financial Services Act 2013 and regulated by Bank Negara Malaysia) /
(Dilesen di bawah Akta Perkhidmatan Kewangan 2013 dan diatur oleh Bank Negara Malaysia)
Application Form For Life Assurance / Borang Permohonan Untuk Insurans Hayat
Instructions / Arahan
1. Please complete in CAPITAL LETTERS and tick (✓) in the appropriate boxes and please do not answer with "BLANK" or " - ". Use BLACK
ink only.
Sila lengkapkan dengan menggunakan HURUF BESAR dan tandakan (✓) dalam kotak yang berkenaan dan jangan "KOSONGKAN" atau isi
dengan " - " . Gunakan dakwat HITAM sahaja.
2. Do not strike out unused blank box/page.
Jangan pangkah atau tandakan bahagian yang tidak berkenaan.
General Important Notice / Notis Penting Umum

1. Consumer Insurance contract / Kontrak Insurans Pengguna
Pursuant to Paragraph 5 Schedule 9 of the Financial Services Act 2013, if you are applying for this insurance wholly for purposes unrelated
to your trade, business or profession, you have a duty to take reasonable care not to make a misrepresentation in answering the questions
in this Application Form and in addition disclose any other matter that you know to be relevant to ALIM's decision in accepting the risks and
determining the rates and terms to be applied.
Menurut Perenggan 5 Jadual 9 di bawah Akta Perkhidmatan Kewangan 2013, sekiranya anda memohon Insurans ini sepenuhnya bagi
tujuan yang tidak berkaitan dengan perdagangan, perniagaan atau profesion anda, anda mempunyai kewajipan untuk mengambil penjagaan
munasabah supaya tidak membuat salah nyataan semasa menjawab soalan-soalan di dalam Borang Permohonan dan juga mendedahkan
apa-apa perkara lain yang anda ketahui sebagai berkaitan dengan keputusan ALIM menerima risiko dan menentukan kadar dan terma yang
hendak dipakai.
2. Non-Consumer Insurance Contract/ Kontrak Insurans Bukan Pengguna
Pursuant to Paragraph 4(1) Schedule 9 of the Financial Services Act 2013, if you are applying for this insurance for purposes related to your
trade, business or profession, you have a duty to disclose any matter that you know to be relevant to ALIM's decision in accepting the risks
and determining the rates and terms to be applied and any matter a reasonable person in the circumstances could be expected to know to
be relevant.
Menurut Perenggan 4(1) Jadual 9 di bawah Akta Perkhidmatan Kewangan 2013, sekiranya anda memohon Insurans bagi tujuan berkaitan
dengan perdagangan, perniagaan atau profesion anda, anda mempunyai kewajipan untuk mendedahkan apa-apa perkara yang anda
ketahui sebagai berkaitan dengan keputusan ALIM dalam menerima risiko dan dalam menentukan kadar dan terma yang hendak dipakai
dan apa-apa perkara yang seorang yang munasabah dalam hal keadaan itu boleh dijangka untuk tahu sebagai berkaitan.
3. This duty of disclosure for Consumer and Non-Consumer Insurance Contract shall continue until the time the contract is entered into, varied
or renewed.
Kewajipan pendedahan ini bagi Kontrak Insurans Pengguna dan Bukan Pengguna akan berterusan sehingga masa kontrak tersebut
dimasuki, diubah atau diperbaharui.
4. Proof of age of the Life Assured shall be required prior to payment of any benefit under the Policy unless the age has been previously
admitted.
Bukti umur Orang Diinsuranskan diperlukan bagi pembayaran faedah yang terkandung di dalam Polisi kecuali salinan bukti umur telah
disertakan dahulu dan diakui.
5. If the age of the Life Assured is wrongly stated, ALIM may adjust the benefits or the period of coverage at its sole and absolute discretion,
subject to the provision of the Financial Services Act 2013.
Jika umur Orang Diinsuranskan salah dinyatakan, ALIM boleh mengubah faedah atau tempoh perlindungan atas budi bicara mutlak kami
mengikut peruntukan di bawah Akta Perkhidmatan Kewangan 2013.
6. As an applicant, you are given the privilege to ask, examine and understand the brochure and sales illustration in respect of the insurance
applied for, paying particular attention to the benefits which are guaranteed and benefits which are not guaranteed.
Sebagai pemohon, anda diberi keutamaan untuk mengajukan sebarang pertanyaan demi memahami akan risalah serta ilustrasi jualan
berkenaan permohonan insurans, tumpukan perhatian kepada faedah yang dijamin dan faedah yang tidak dijamin.
7. Purchase of any supplementary benefits or riders or extensions to the basic policy under this application is not compulsory and is entirely at
your own discretion.
Pembelian mana-mana faedah tambahan pelan asas tidak diwajibkan kecuali dengan persetujuan anda sendiri.
8. Please retain the Conditional Interim Cover Receipt (CICR) as proof of first premium deposit. In consideration of the payment, Life Assured
is temporarily covered for the basic Sum Assured specified in the Application Form For Life Assurance subject to the TERMS, CONDITIONS
AND LIMITATIONS contained in the CICR.
Sila simpan Resit Lindungan Sementara Bersyarat sebagai bukti deposit premium pertama. Dengan mengambil kira pembayaran tersebut,
Orang Diinsuranskan adalah dilindungi secara sementara untuk Jumlah Asas Diinsuranskan yang tertera di dalam Borang Permohonan
Untuk Insurans Hayat tertakluk kepada Terma, Syarat dan Had yang terkandung di dalam Resit Lindungan Sementara Bersyarat.
9. When the Policy is issued, the issued date is the Policy Cover Date of the life policy provided no age has increased. If age has increased,
the Policy Cover Date will be the back dated date (for non-investment-linked insurance plan ONLY) or short payment received date (for ALL
IMAGINE/UW/AF/Dec 2020 1/20
other plans).
Tarikh perlindungan Polisi adalah tarikh Polisi dikeluarkan dengan syarat umur tidak meningkat. Jikalau umur meningkat, Tarikh Polisi akan
menjadi tarikh yang diundurkan (untuk pelan insurans bukan berkaitan-pelaburan SAHAJA) atau tarikh penerimaan bayaran yang tidak
mencukupi (untuk SEMUA pelan yang lain).
10. For Policy details including the duration of the life insurance contract and the date of maturity or date on which the benefits are payable,
please refer to the Policy Contract and Schedule issued hereinafter.
Untuk butir-butir Polisi termasuk durasi kontrak hayat insurans dan tarikh matang atau tarikh di mana faedah akan dibayar, sila rujuk Kontrak
dan Jadual Polisi yang diterbitkan kemudian.
Allianz Customer Service Center : AF001

Allianz Arena, Ground Floor,Block 2A, Plaza Sentral,
Jalan Stesen Sentral 5, Kuala Lumpur Sentral, 50470 Kuala Lumpur
Customer Contact Center: 1 300 22 5542
Email: Customer.Service@allianz.com.my
11. The standard time frame required for ALIM to issue a policy will be 6 working days from the submission date of the Application Form For Life
Assurance subject to ALIM receiving full documentations and that ALIM is satisfied that no further investigation is necessary.
Jangka masa yang diperlukan oleh ALIM untuk menerbitkan polisi adalah 6 hari bekerja bermula daripada tarikh penyerahan Borang
Permohonan Untuk Insurans Hayat tertakluk kepada penerimaan dokumentasi penuh oleh ALIM dan ALIM berpuas hati tiada penyelidikan
selanjutnya diperlukan.
12. After payment of the first premium and upon issuance of the Policy, failure to pay a premium to ALIM on or before the Due Date will
constitute a default of payment in premium.
Selepas bayaran premium yang pertama dan ketika Polisi dikeluarkan, kegagalan untuk membayar premium kepada ALIM pada atau
sebelum Tarikh Perlu Bayar akan membentuk pemungkiran dalam bayaran premium.
13. If the Policy is terminated due to non-payment of premium, you may, upon obtaining our written consent, reinstate it at any time from the Due
Date of the premium in default subject to the reinstatement requirements in the Policy Contract.
Sekiranya Polisi ditamatkan akibat ketakbayaran premium, anda boleh, selepas mendapatkan kebenaran bertulis daripada kami,
mengembalikan ia semula pada bila-bila masa daripada Tarikh Perlu Bayar premium dimungkiri tertakluk kepada syarat-syarat
pengembalian semula di dalam Polisi kontrak.
14. It is important to notify ALIM of any change in contact details, including the mailing address, mobile phone no., the nominee and/or trustee.
Adalah penting untuk memberitahu ALIM di atas perubahan di dalam butir-butir perhubungan, termasuk alamat surat-menyurat, no telefon
bimbit, penama dan/atau pemegang amanah.
15. It may not be advantageous to replace an existing life insurance policy with a new one. If you intend to do so, we recommend that you
consult your present insurer before making a final decision.
Penggantian polisi sedia ada dengan polisi yang baru mungkin tidak membawa faedah. Jika anda merancang untuk berbuat demikian, kami
mencadangkan anda mendapatkan nasihat dari syarikat insurans anda sebelum membuat keputusan muktamad.
16. You should satisfy yourself that this plan would best serve your needs and that the premium payable under the policy is affordable.
Anda harus memastikan bahawa pelan ini adalah yang terbaik untuk memenuhi keperluan anda dan premium yang perlu dibayar untuk
polisi ini adalah jumlah yang anda mampu bayar.
Important Notice for Ordinary Life Plan
Notis Penting untuk Pelan Ordinari Hayat
1. You are given a 15 day free-look period from the date of receipt of the Policy by you to review the suitability of the newly purchased Policy. If
you decide to cancel the Policy during the free-look period, all premium paid less any expenses incurred for medical examination will be
refunded.
Anda diberi masa 15 hari tempoh percubaan daripada tarikh anda menerima Polisi untuk anda menilai kesesuaian Polisi yang baru dibeli.
Jikalau anda berhasrat untuk membatalkan Polisi semasa tempoh percubaan, semua premium dibayar akan ditolak perbelanjaan ke atas
pemeriksaan perubatan akan dipulangkan.
2. You are allowed a grace period of thirty-one (31) days from the Due Date to pay your premium, during this period the Policy shall remain in
force. If any premium remains unpaid at the end of the grace period, the Policy shall lapse and have no further value except as provided in
the AUTOMATIC NON-FORFEITURE PROVISIONS.
Anda diberikan tempoh tenggang selama tiga puluh satu (31) hari dari Tarikh Perlu Bayar untuk membayar premium anda, dalam tempoh ini
Polisi akan kekal berkuatkuasa. Sekiranya sebarang premium kekal tidak berbayar pada akhir tempoh tenggang, Polisi akan luput dan tidak
mempunyai nilai selanjutnya kecuali sebagaimana mungkin diperuntukkan dalam PERUNTUKAN TIDAK LUCUT HAK AUTOMATIK.
Important Notice for Regular Premium/Single Premium Investment-Linked Insurance Plan (ILIP)
Notis Penting untuk Premium Tetap/Premium Tunggal Pelan Insuran Berkaitan-Pelaburan (ILIP)
1. You are advised to consider whether the allocation of insurance premium towards protection and investment meets your financial
circumstances and whether the investment-linked fund chosen match your investment objectives and risk appetite.
Anda dinasihatkan untuk menimbang samada peruntukan premium insurans terhadap perlindungan dan pelaburan memenuhi keadaan
kewangan anda dan samada dana berkaitan pelaburan yang dipilih sesuai dengan objektif pelaburan dan risiko anda.
2. You are advised to consider whether you understand the financial risk and the potential losses that may arise from investment in the ILIP.
Anda dinasihatkan untuk menimbang samada anda faham risiko kewangan dan potensi kerugian yang mungkin timbul daripada melabur
dalam ILIP.
3. Historical Investment Returns in the Sales Illustration do not guarantee the future investment returns of the fund. The returns are uncertain
and you may risk earning no return at all. If the investment is redeemed early, you may lose part of the principal sum invested. Where a fund
is guaranteed or capital guaranteed for a specified period, such guarantee is not applicable to any premature withdrawal.
Sejarah Pulangan Pelaburan di dalam Illustrasi Jualan tidak menjamin pulangan dana pelaburan masa hadapan. Pulangan adalah tidak
menentu dan anda berisiko untuk tidak mendapat pulangan sama sekali. Jikalau pelaburan ditebus awal, anda mungkin akan kehilangan
sebahagian daripada jumlah dasar yang dilaburkan. Dimana dana adalah terjamin atau dana modal terjamin dan jaminan tersebut hanya
sah pada satu masa tertentu, jaminan tersebut tidak sah pada pengeluaran pramatang.
you decide to cancel the Policy during the free-look period, the amount refunded shall be the Account Value calculated in the same manner
as if the Units are to be cancelled together with the unallocated Premium, Policy Charges and any revision thereof, if any, of the premium
less the percentage of the premium granted as bonus unit and any expenses incurred for medical examination.
Jikalau anda bercadang untuk membatalkan polisi ketika tempoh percubaan, amaun dipulangkan adalah Nilai Akaun yang dikira dalam cara
yang sama seolah-olah Unit-unit akan dibatalkan bersama dengan Premium yang tidak diperuntukan, Caj Polisi dan mana-mana pemindaan
selepas itu, sekiranya ada, bagi premium tolak peratusan premium yang boleh diberikan sebagai unit bonus dan mana-mana perbelanjaan
ditanggung bagi pemeriksaan perubatan.
Application No. / No. Permohonan 8 0 0 5 7 6 7 4 2 4
5. If premium remains unpaid on the premium Due Date, the Policy shall be kept in force by effecting a premium holiday. However, there would
be a possibility of the Policy lapsing if the required charges including rider charges exceed the value of investment-linked funds unit
available.
Jika premium tidak dibayar pada tarikh premium sepatutnya dibayar, Polisi akan kekal berkuatkuasa dengan pelaksanaan percutian
premium. Bagaimanapun, terdapat kemungkinan Polisi akan luput jika caj-caj termasuk caj-caj rider melebihi nilai unit dana-dana berkaitan
pelaburan yang ada.
6. When the Account Value of the ILIP is insufficient to pay for the insurance and other charges for both the basic policy and all unit deducting
riders attached to the basic policy when due, you will be given a grace period of thirty-one (31) days to pay your premium, during which the
ILIP will remain in force. However, the ILIP shall lapse at the end of the grace period if any insurance and other charges shall remain unpaid
at the end of the grace period.
Apabila nilai akaun dari ILIP tidak cukup untuk membayar kos insurans dan kos-kos lain untuk kedua-dua polisi asas dan semua rider
penolakan unit yang terlampir pada polisi asas apabila tiba tarikh pembayaran premium, anda akan diberikan tempoh penangguhan selama
tiga puluh satu (31) hari untuk membayar premium anda, semasa itu ILIP akan kekal berkuatkuasa. Bagaimanapun, ILIP akan luput pada
akhir tempoh penangguhan sekiranya caj insurans dan caj-caj lain tetap tidak dibayar pada akhir tempoh penangguhan.
7. The surrender benefit is the Account Value determined by reference to the Bid Price on the Valuation Day when such request is received. If
you surrender the Policy in the early years, you may receive an amount which is much less than the premiums paid./ Manfaat serahan ialah
Nilai Akaun yang ditentukan dengan merujuk kepada Harga Bida pada Hari Penilaian ketika permintaan diterima. Jika anda menyerahkan
Polisi anda dalam tahun-tahun awal, anda mungkin akan menerima amaun yang jauh lebih kecil daripada premium yang telah dibayar.
8. You may vary the level of death benefit and premium and switch investment-linked fund. You may also top-up your existing ILIP at any time
to enhance the investment portion of the Policy without any change in the insurance coverage. Please refer to the Policy Contract for the
conditions for each of the options.
Anda boleh mengubah tahap faedah kematian dan premium dan menukar dana berkaitan pelaburan. Anda juga boleh menambah nilai ILIP
yang sedia ada pada bila-bila masa bagi meningkatkan pelaburan Polisi anda tanpa sebarang perubahan terhadap perlindungan insurans.
Sila rujuk kontrak Polisi untuk syarat-syarat bagi setiap opsyen-opsyen itu.
9. You are advised to refer to the Sales Illustration for further information on the significant risks and benefits of investing in an ILIP.
Anda dinasihatkan merujuk kepada Illustrasi Jualan untuk maklumat tambahan atas risiko penting dan faedah melabur dalam suatu ILIP.
Important Notice for Universal Life Plan

Notis Penting untuk Pelan Universal Life
you decide to cancel the Policy during the free-look period, the amount refunded shall be the Account Value, Premium Charge, Cost of
Insurance, Policy Fee, extra premium charged on sub-standard risk (if any) less any medical fee incurred.
Jikalau anda bercadang untuk membatalkan polisi ketika tempoh percubaan, amaun dipulangkan adalah Nilai Akaun , Caj Premium, Kos
Insurans, Yuran Polisi, premium tambahan yang dicaj ke atas risiko sub-standard (jika ada) tolak mana-mana perbelanjaan ditanggung bagi
pemeriksaan perubatan.
Important Notice for Medical and Health Insurance (MHI)

Notis Penting untuk Insuran Perubatan dan Kesihatan
1. You are given a 15 day free-look period from the date of receipt of the Policy by you to review the suitability of the newly purchased policy. If
you decide to cancel the policy during the free-look period, all premiums paid less any expenses incurred for medical examination will be
refunded.
Anda diberi masa 15 hari tempoh percubaan daripada tarikh anda menerima polisi untuk anda menilai kesesuaian polisi yang baru dibeli.
Jikalau anda berhasrat untuk membatalkan polisi semasa tempoh percubaan, semua premium dibayar akan ditolak perbelanjaan ke atas
pemeriksaan perubatan akan dipulangkan.
2. You may cancel the Policy by giving written notice to us. For certain types of policies you may be entitled to a certain amount of premium
refund provided you have not made any claims on the Policy.
Anda boleh membatalkan Polisi dengan memberi notis bertulis kepada kami. Untuk polisi tertentu anda mungkin berhak menerima pulangan
premium tertentu sekiranya anda belum membuat tuntutan terhadap polisi tersebut.
IMPORTANT NOTE ON YOUR CHOICE TO OPT OUT OF E-POLICY

Notis penting berkenaan e-polisi
Please take note that we will issue to you an electronic policy (e-policy) by default and it will be sent to your email address registered with us. You
may request for a hardcopy of your e-policy within 30 days from the date of the e-policy issue date by registering and logging into MyAllianz-
Customer Portal.
Opsyen E-Polisi telah ditetapkan kepada Ya dan Kami akan manghantar e-polisi ke alamat emel yang berdaftar. Anda boleh memohon untuk
salinan bercetak dengan mendaftar atau log masuk ke Portal Pelanggan - MyAllianz. Sila ambil perhatian bahawa permohonan untuk salinan
bercetak di Portal Pelanggan-MyAllianz adalah 30 hari daripada Tarikh Perlindungan Polisi.
For Agent Use / Untuk Kegunaan Ejen
Copy of NRIC/BC/Passport / Salinan KP/SK/Pasport Customer Fact Find Form (CFF) and Confirmation of Advice /
Borang Carian Fakta Pelanggan dan Pengesahan Nasihat
Name of Agent / Nama Ejen LAI SIEW CHING
Agent Code / Kod Ejen 100442-3
Phone No. of Agent / No. Telefon Ejen 60195899169
Name of Partner / Nama Partner Partner Code / Kod Partner
Purpose of Transaction / Tujuan Transaksi

Protection / Perlindungan Education / Pendidikan
Protection, Retirement / Perlindungan, Persaraan Partnership / Perkongsian
Loan Protection / Perlindungan Pinjaman Employee Benefit / Faedah Pekerja
Protection, Savings, Investment / Perlindungan, Simpanan, Pelaburan Keyman / Orang Utama
Others / Lain-lain
Language Preference for Policy Contract and its related document. English
Please tick (✓) one option only. In the event no option elected, the default option is English Bahasa Malaysia
Bahasa Utama untuk Polisi Kontrak dan dokumen berkaitannya.
Sila tandakan (✓) satu pilihan sahaja. Sekiranya tiada pilihan dinyatakan, Bahasa Inggeris akan digunakan.
Personal Particulars of Applicant

Section 1 Personal Particulars of Life Assured (If Different From Life Assured)
Seksyen 1 : Butir-butir Peribadi Orang Diinsuranskan Butir-butir Pemohon
(Jika Berlainan Dari Orang Diinsuranskan)
1. Title Ms Madam
Gelaran
2. Name (as per NRIC/ BC) SIEW EUNG YUE CHIA SWEE YEE
Nama (seperti di dalam
KP/SK)
For Malaysian & Malaysia Permanent Resident only (Question 3 & 4)
Untuk Warganegara & Penduduk Tetap Malaysia sahaja (Soalan 3 & 4)
3. NRIC No. (New) 200831-13-0030 820516-05-5218
No. KP (Baru)
4. NRIC No. (old)/Passport
No. /BC No.
No. KP (Lama)/No.
Passport/ No. SK
For Foreigner only / Untuk Warganegara Asing sahaja (Question / Soalan 5 & 6)
5. Passport No.
No. Pasport
6. Expiry Date
Tarikh Luput
For Entity Customer only / Untuk Pelanggan Entiti sahaja (Question / Soalan 7 - 11)
(Please also complete the Entity Questionnaire Form / Sila lengkapkan Borang Soal Selidik Entiti)
7. Type of Entity 8. Number of Certificate of Incorporation/ Partnership
Jenis Entiti Certificate/ Business Registration / Nombor Sijil
Perbadanan/ Sijil Perkongsian/ Pendaftaran
Perniagaan*
9. Country of Incorporation If Country of Incorporation is not Malaysia, please 10. Country of Operations /
Negara Diperbadankan*1 complete "Tax Information" section in item 11. / Jika Negara Beroperasi
Negara Diperbadankan bukan Malaysia, sila
lengkapkan item 11 seksyen "Informasi Cukai".
Application No. / No. Permohonan
8 0 0 5 7 6 7 4 2 4
Personal Particulars of Applicant (If Different
Personal Particulars of Life Assured /
Section 1 / Seksyen 1 : From Life Assured) / Butir-butir Pemohon (Jika
Butir-butir Peribadi Orang Diinsuranskan
Berlainan Dari Orang Diinsuranskan)
11. Country of Residence Not Applicable / Malaysia / Other country (please specify below) /
for Tax Purpose* Tidak berkenaan Malaysia Negara selain Malaysia (sila nyatakan di bawah)
Negara mastautin untuk
Tax information / Informasi Cukai
tujuan pencukaian*
Country 1/ Negara 1
(more than 1 selection is Country */ Negara *
allowed
TIN*2 / Nombor
Pilihan lebih dari satu
adalah dibenarkan) cukai*2
Reason*3/ Sebab*3 Other reason. Please specify. /
Sebab lain. Tolong nyatakan.
Country 2 (if applicable) / Negara 2 (Jika berkenaan)
Country */ Negara *
TIN*2 / Nombor
cukai*2
Reason*3/ Sebab*3 Other reason. Please specify. /
Sebab lain. Tolong nyatakan.
*Mandatory / *Mandatori
1 If not Malaysia, it is mandatory to provide tax information in Country of Residence for Tax Purpose column/
Jika bukan Malaysia, adalah wajib untuk menyertakan maklumat pencukaian di dalam bahagian "Negara
untuk tujuan pencukaian".
2 Tax Identification Number (TIN). / Nombor cukai.
3 It is mandatory to provide relevant supporting document. / Adalah wajib untuk menyertakan dokumen
sokongan.
12. Date of Birth / Tarikh Lahir 31/08/2020 16/05/1982
13. Country of Birth Malaysia Malaysia
Negara Kelahiran
14. Age / Umur 1 15. Age Admitted / Umur Diakui No 40 15. Age Admitted / Umur Diakui No
16. Sex / Jantina Female Female
17. Citizenship / Nationality Malaysian Malaysian
Kewarganegaraan /
Warganegara
18. U.S. Citizen
Warganegara U.S.
19. U.S. Permanent Resident
or Green card holder
Penduduk Tetap atau
Pemegang 'Green card'
U.S.
20. Country of dual / additional
Citizenship
Negara bagi
kewarganegaraan duaan /
tambahan
21. Marital Status Single Married
Taraf Perkahwinan No of Children /Bilangan Anak No of Children /Bilangan Anak 4
22. Height / Tinggi 80 cm / sm 23. Weight / Berat 11 kg / kg 163 cm / sm 23. Weight / Berat 50 kg / kg
24. Have you smoked or used No No
any tobacco or nicotine Sticks per day / Batang sehari Sticks per day / Batang sehari
products in the past 12

months? / Dalam tempoh
12 bulan yang lalu, adakah
anda merokok atau
menggunakan produk
tembakau atau nikotin?
25. Do you drink alcohol more No No
than one time per week? If Beer / Bir small bottle(s)/can(s) / Beer / Bir small bottle(s)/can(s) /
"Yes", please specify botol kecil/tin botol kecil/tin
quantity consumed. /
Wine / Win glass(es) / gelas Wine / Win glass(es) / gelas
Adakah anda minum
minuman keras lebih Whiskey / Brandy / Others / pegs/shots / pegs/shots Whiskey / Brandy / Others / pegs/shots / pegs/shots
daripada satu kali Wiski / brandi Wiski / brandi
seminggu?
8 0 0 5 7 6 7 4 2 4
26. Relationship of Life Assured to Applicant / Hubungan Orang Diinsuranskan dengan Pemohon Daughter
27. Occupation / Child Teacher
Pekerjaan
28. Annual Income 29. Occupation Class/ 2 120,000.00 29. Occupation Class/ 1
Pendapatan Tahunan Kelas Pekerjaan Kelas Pekerjaan
30. Name and address of Not Applicable SMK SACRED HEART
Employer
Nama dan Alamat
Majikan
Postcode / Poskod Postcode / Poskod
Country of Incorporation / Malaysia Country of Incorporation / Malaysia
Negara Diperbadankan Negara Diperbadankan
31. Nature of Business / Non-Income Earner Education/ Training/ Tuition
Jenis Perniagaan
32. E-Document Option / Yes / PHOENIXCHIA@HOTMAIL.COM
Email
Opsyen E-Dokumen /
Emel
33. Residential Address / NO.6F, NO.6F,
Alamat Rumah LORONG OLD OYA 8M, LORONG OLD OYA 8M,
(Registered address SIBU SARAWAK. SIBU SARAWAK.
for entitiy customer / Postcode / Poskod 96000 Postcode / Poskod 96000
Alamat pendaftaran Country of residence / Malaysia Country of residence / Malaysia
untuk pelanggan Negara Kediaman Negara Kediaman
entiti)
34. Correspondence/ Applicant's Residence / Kediaman Applicant's Employer/Business / Majikan/Perniagaan Pemohon
mailing address / Pemohon
Alamat surat- Postcode / Poskod
menyurat Country of mailing / Negara Surat Menyurat Malaysia
35. Country of Not Applicable / Malaysia (if Country of residence is Malaysia) /
Residence Tidak berkenaan Malaysia (jika negara tempat tinggal adalah Malaysia)
for Tax Purpose* /
Negara mastautin Malaysia (if Country of residence is NOT Malaysia) / Malaysia (jika negara tempat tinggal BUKAN Malaysia)
untuk
Reason*1/ Sebab*1 Other reason. Please specify. / Sebab lain. Tolong
tujuan pencukaian*
nyatakan.
(more than 1 Other country (please specify) / Negara lain (tolong nyatakan)
selection
is allowed / Pilihan Country 1/ Negara 1
lebih dari satu Country */ Negara *
adalah dibenarkan)
TIN*2 / Nombor
cukai*2
Reason*1/ Sebab*1 Other reason. Please specify. / Sebab lain. Tolong nyatakan.
Country 2 (if applicable) / Negara 2 (Jika berkenaan)
Country */ Negara *
TIN*2 / Nombor
cukai*2
Reason*1/ Sebab*1 Other reason. Please specify. / Sebab lain. Tolong nyatakan.
*Mandatory / *Mandatori
1 It is mandatory to provide relevant supporting document eg. working visa, student visa, confirmation letter from
employer/ education institution, business registration, Certificate of residence etc. / Adalah wajib untuk
menyertakan dokumen sokongan yang relevan, contoh: visa bekerja, visa pelajar, surat pengesahan dari
majikan, pendaftaran perniagaan, Sijil taraf mastautin dan lain-lain.
2 Tax Identification Number (TIN). / Nombor cukai.
8 0 0 5 7 6 7 4 2 4
Contact Number (Country Code for Malaysia is 60) / Nombor Perhubungan (Kod Negara Malaysia 60)
36(a). Tel. No. (House) / No.
Tel. (Rumah)
36(b). Tel. No. (Office) /No.
Tel. (Pejabat)
36(c). Fax No. / No. Faks.
37(a). Mobile Phone No. / No. 60-19-8596267 60-19-8596267
Tel. Bimbit
37(b). Mobile Phone No. 2 /
No. Tel. Bimbit 2
Section 2 : Personal Particulars of Joint Life Assured / Seksyen 2 : Butir-butir Orang Diinsuranskan Bersama
38. Title / Gelaran
39. Name (as per NRIC/BC) /
Nama (seperti di dalam
KP/SK)
40. NRIC No. (New) / 41. NRIC No. (Old) / Passport No. /
No. KP (Baru) BC No. /No. KP (Lama) / No.
Pasport / No. SK
42. Passport No. / No. Pasport 43. Passport Expiry Date / Tarikh
Luput Pasport
44. Date of Birth / Tarikh Lahir 45. Age / Umur
46. Sex / Jantina 47. Age Admitted /Umur Diakui
48. Country of Birth /Negara 49. Citizenship/Nationality /
Kelahiran Kewarganegaraan/Warganegara
50. Marital Status / Taraf No. of Children /Bilangan Anak
Perkahwinan
51. Height / Tinggi 52. Weight / Berat
53. Have you smoked or used Sticks per day / Batang sehari
any tobacco or nicotine
products in the past 12
months? / Dalam tempoh
12 bulan yang lalu, adakah
anda merokok atau
menggunakan produk
tembakau atau nikotin?
54. Do you drink alcohol more
than one time per week? If
Beer / Bir small bottle(s)/can(s) / botol kecil/tin
"Yes", please specify
quantity consumed. / Wine / Win glass(es) / gelas
Adakah anda minum Whiskey / Brandy / Others / Wiski / pegs/shots / pegs/shots
minuman keras lebih brandi
daripada satu kali
seminggu?
55. Relationship to Applicant /
Hubungan dengan
Pemohon
56. Occupation / Pekerjaan
57. Annual Income / 58. Occupation Class / Kelas
Pendapatan Tahunan Pekerjaan
59. Name and address of
Employer / Business
Nama dan alamat Majikan /
Perniagaan
Postcode / Poskod
Country / Negara
60. Nature of Business /Jenis
Perniagaan
Section 3 : Payor Details / Seksyen 3 : Maklumat Pembayar

61(a). Payor's Name / CHIA SWEE YEE

Nama Pembayar
61(b). Payor's NRIC No. 820516-05-5218 61(c). Business Registration No. / No.
(New)/Passport No. / Pendaftaran Perniagaan
No. KP (Baru) / No.
Pasport Pembayar
61(d). Sex / Jantina Female 61(e). Age Admitted / Umur Diakui No
61(f). Date of Birth / Tarikh Lahir 16/05/1982 61(g). Mobile Phone No. / No. 60-19-8596267
Tel.Bimbit
61(h). Country of Birth /Negara Malaysia 61(i). Citizenship/Nationality / Malaysian
Kelahiran Kewarganegaraan/Warganegara
61(j). Occupation /Pekerjaan Teacher
61(k). Relationship to Applicant / Self 61(l). Annual Income / Pendapatan 120,000.00
Hubungan dengan Tahunan
Pemohon
8 0 0 5 7 6 7 4 2 4
Section 3 : Payor Details / Seksyen 3 : Maklumat Pembayar
61(m). Name of Employer / Nama SMK SACRED HEART
Majikan
61(n). Nature of Business / Jenis Education/ Training/ Tuition
Perniagaan
61(o). Source of Funds / Sumber Salary/Business Income 61(p). Source of Wealth / Sumber Salary/Business Income
Dana Kekayaan
61(q). Address / Alamat NO.6F,
LORONG OLD OYA 8M,
SIBU SARAWAK.
Postcode / Poskod 96000
Country / Negara Malaysia
61(r). Is Payor insured? If YES, please state total insured amount for inforce policies: / YES / YA
Adakah si pembayar pemegang mana-mana insurans hayat? Jika YA, nyatakan jumlah insurans yang masih NO /
berkuatkuasa: TIDAK
LIFE / HAYAT : 50,000.00
ACCIDENT / KEMALANGAN : 50,000.00
CRITICAL ILLNESS / PENYAKIT KRITIKAL : 50,000.00
Section 4 : Proposed Policy Particulars / Seksyen 4 : Butir-butir Polisi Yang Dicadangkan
62. Basic Plan Term Insured Amount Premium 63.Fund Apportionment / Pengagihan Dana
Pelan Asas Tempoh Jumlah Diinsurans (RM) Premium Fund/ Percentage/
PLK10 99 50,000.00 2,592.00 Dana Peratusan
Managed Fund / Dana 50 %
Rider Term Insured Amount Premium
Terurus
Faedah Tambahan Tempoh Jumlah Diinsurans (RM) Premium
Equity Fund / Dana Ekuiti 0%
UHCPR03 99 50,000.00 0.00
Dynamic Growth Fund / 50 %
UMI+00K101 99 UMI+150 0.00
Dana Pertumbuhan
USCRT03 30 2,592.00 0.00 Dinamik
Equity Income Fund / 0%
Dana Pendapatan Ekuiti
Bond fund / Dana Bon 0%
Dana Padu / Dana Padu 0%
Amanah Dana ikhlas / 0%
Dana Ikhlas Amanah
ASEAN Plus / ASEAN 0%
Plus
Total Return Asian Equity 0%
Fund / Dana Ekuiti Asia
Total Return
Global Income Fund / 0%
Dana Pendapatan Global
Total / Jumlah 100 %
Note / Nota : The fund apportionment for
each fund must be in multiples of 5%. The
total percentage of all funds must be 100%. If
no fund apportionment has been indicated,
100% of Managed Fund will be chosen by
Service Tax 6% / Cukai Perkhidmatan 6% 0.00 default. / Pengagihan dana untuk setiap dana
Total premium inclusive of Service Tax, if any / Jumlah 2,592.00 mestilah dalam gandaan 5%. Jumlah
premium termasuk Cukai Perkhidmatan, jika ada peratusan untuk semua dana mestilah 100%.
Sekiranya pengagihan dana tidak

dinyatakan, 100% Dana Terurus akan
digunakan.
64. Mode of payment / Frekuensi Pembayaran Annual
65. Type of Payment / Cara pembayaran Cash
Note 1: Service Tax : According to the statutory requirement, Service Tax will be charged at the prevailing rate on the applicable portion of
your premium/fee/charges for the period of insurance coverage. / Nota 1: Cukai Perkhidmatan: Selaras dengan keperluan perundangan,
Cukai Perkhidmatan akan dikenakan pada kadar semasa ke atas bahagian premium/yuran/caj anda yang berkenaan untuk tempoh
perlindungan insurans.
Note 2: Your agent is NOT AUTHORISED to collect premiums on behalf of ALIM. Please opt for hassle-free payment method that is
available such as credit card or auto debit. /Nota 2: Ejen anda TIDAK DIBENARKAN untuk mengutip premium bagi pihak ALIM. Sila pilih
cara pembayaran mudah yang tersedia seperti kad kredit atau auto debit.
8 0 0 5 7 6 7 4 2 4
Important Notice for Cash Before Cover / Tunai Sebelum Lindungan
1. I hereby acknowledge that ALIM will deduct the premium from my credit card while the application is being processed. However, Life Assured
will be entitled for accidental coverage as per the Terms, Conditions and Limitations contained in ALIM's Conditional Interim Cover Receipt
(CICR). / Saya dengan ini mengakui bahawa ALIM akan memotong premium daripada kad kredit saya semasa permohonan saya masih
diproses. Bagaimanapun, Orang Diinsuranskan akan layak untuk perlindungan kemalangan berdasarkan Terma, Syarat dan Had yang
terkandung di dalam Resit Lindungan Sementara Bersyarat ALIM.
2. I hereby request and authorize ALIM to debit my credit card account as indicated below for the amount of premium due as advised by ALIM
from time to time under my insurance policy(ies) mentioned above. / Saya dengan ini meminta dan memberi kebenaran kepada ALIM untuk
mendebitkan akaun kad kredit saya seperti yang dinyatakan di bawah bagi jumlah premium yang perlu dijelaskan seperti yang dimaklumkan
oleh ALIM dari masa ke semasa ke atas polisi insurans yang dinyatakan di atas.
3. In the event that the money is refunded by ALIM for any reason, ALIM is authorized to refund the money without interest by crediting the said
sum into my credit card account and shall thereafter be discharged from all obligations pertaining to the same./ Jika terdapat sebarang
pemulangan balik sebarang wang oleh ALIM atas sebab, ALIM diberikuasa untuk memulangkan wang tersebut tanpa faedah dengan
mengkreditkan jumlah tersebut ke dalam akaun kad kredit saya dan seterusnya dilepaskan dari semua kewajipan yang berkaitan dengan
perkara tersebut.
4. ALIM shall not be held responsible or liable for any claim, loss, damages, costs and / or expenses arising from the successful and / or
unsuccessful processing of the debit due to exceeding credit limit, malfunction of the system, electricity failure and / or other factors beyond
ALIM's control./ ALIM tidak akan bertanggungjawab dan tidak tertakluk kepada mana-mana tuntutan, kerugian, kerosakan, kos dan / atau
perbelanjaan yang timbul dari kejayaan dan / atau kegagalan di dalam pemprosesan debit yang disebabkan oleh melebihi had kredit, system
yang pincang tugas, kegagalan elektrik dan / atau lain-lain faktor-faktor yang berada di luar jangkaan ALIM.
Section 5 : Credit Card Particulars / Seksyen 5 : Butir-butir Kad Kredit
Name of Cardholder / Nama Pemegang Kad
Type of Credit Card / Jenis Kad Kredit
Card No. / No. Kad
Card Expiry Date / Tarikh Luput Kad
1 Issuing Bank / Bank Pengeluar
2Card holder relationship to Applicant /
Hubungan Pemegang Kad kepada Pemohon
Signature of Cardholder (as on card) / Date /
Tandatangan Pemegang Kad (seperti di atas kad) Tarikh
1 Must be a financial institution in Malaysia. / Mestilah satu institusi kewangan di Malaysia.

2 Premium payment through credit card is allowed if the cardholder is paying for his/her own policy or the policy of his/her immediate family
member namely his/her spouse, parents or children. / Bayaran premium melalui kad kredit dibenarkan sekiranya pemegang kad membayar
untuk polisinya sendiri atau polisi keluarga terdekatnya iaitu suami/ isteri, ibu bapa atau anak.
Section 6 : Backdating / Seksyen 6 : Pengunduran Tarikh
66. Is backdating3 required? If YES, please state backdated policy date (up to a maximum of 6 months only). / Adakah No
pengunduran3 tarikh diperlukan? Jika YA, sila catatkan tarikh pengunduran (sehingga maksimum 6 bulan sahaja).
dd / mm / yyyy / 3 not applicable to medical plan and investment-linked policy / bukan untuk polisi pelan
hh bb tttt perubatan dan berkaitan-pelaburan
Section 7 : General Information / Seksyen 7 : Maklumat Umum

NOTE / NOTA : PLEASE DO NOT TICK APPLICANT /JOINT LIFE ASSURED COLUMN IF THERE IS NO Life Assured Applicant / Joint Life
ATTACHMENT OF PAYOR /SPOUSE RIDERS /JANGAN TANDA PADA BAHAGIAN PEMOHON /ORANG / Orang Pemohon Assured /
DIINSURANSKAN BERSAMA JIKA TIADA FAEDAH TAMBAHAN PEMBAYAR /PASANGAN Diinsurans Orang
Diinsuranskan
Bersama
1. Do you engage or intend to engage in any dangerous activities? (Example: racing, diving, No No
mountain climbing or flying other than as a fare paying passenger on a regularly scheduled
airline, etc) / Adakah anda terlibat atau dijangka terlibat dalam sebarang aktiviti yang berbahaya?
(Contoh: perlumbaan, penyelaman, pendakian gunung atau penerbangan selain daripada
sebagai penumpang yang membayar tambang untuk penerbangan berjadual, dan lain-lain)
2. Have you resided overseas for more than 1 month in the past 1 year or do you intend to live / No No
travel overseas for a period of more than 1 month? / Pernahkah anda menetap di luar negara
melebihi 1 bulan dalam tempoh 1 tahun yang lepas atau adakah anda bercadang untuk menetap
/ mengembara ke luar negara melebihi 1 bulan?
3. Have you ever used any illicit drugs, recreational drugs, narcotics or drugs which are not No No
prescribed by a doctor? / Pernahkah anda mengambil dadah yang diharamkan, dadah rekreasi,
narkotik atau dadah yang tidak dipreskripsikan oleh doctor?
4. Have any of your biological parents, brothers or sisters, been diagnosed with any of the following No No
before the age of 60:
Multiple Sclerosis, Alzheimer’s, Parkinson’s, Huntington’s disease, motor neuron disease,
polycystic kidney disease, heart disease, stroke, hypertension, diabetes mellitus, cancer
including carcinoma-in-situ or any other inherited or genetic diseases? /

Pernahkah sesiapa di antara ibu bapa atau adik-beradik anda menghidap sebarang penyakit
yang berikut sebelum umur 60 tahun:
Multiple Sclerosis, penyakit Alzheimer, Parkinson, Huntington, penyakit motor neuron, penyakit
buah pinggang polisistik, penyakit jantung, strok/angin ahmar, tekanan darah tinggi, kencing
manis, kanser/barah termasuk karsinoma-insitu atau sebarang penyakit yang diwarisi atau
genetik?
5. Do you have any existing insurance coverage or are you currently applying for coverage with any No No
other insurance companies? / Adakah anda memiliki sebarang perlindungan insurans sedia ada
atau adakah anda sedang memohon perlindungan insurans dengan syarikat insurans lain?
(a) Life/ Death Coverage / Perlindungan Hayat / Kematian
(b) Critical Illness Coverage / Perlindungan Penyakit Kritikal
(c) Personal Accident Coverage / Perlindungan Kemalangan Diri
(d) Hospitalization and Surgical Coverage / Perlindungan Penghospitalan dan Pembedahan
(e) Income Replacement or Hospital Cash Benefit Coverage / Perlindungan Penggantian
Pendapatan atau Faedah Tunai Hospital
8 0 0 5 7 6 7 4 2 4
Section 8 : Replacement Of Policy / Seksyen 8 : Penggantian Polisi
IMPORTANT NOTICE / NOTIS PENTING : It may not be advantageous to replace an existing life Life Assured Applicant / Joint Life
insurance policy with a new one. If you intend to do so, we recommend that you consult your present / Orang Pemohon Assured /
insurer before making a final decision. / Anda tidak digalakkan mengganti polisi insurans hayat yang Diinsurans Orang
sedia ada dengan polisi yang baru. Jika anda ingin berbuat demikian, kami cadangkan anda Diinsuranskan
berbincang dengan pihak insurans berkenaan sebelum membuat sebarang keputusan. Bersama
1. Do you intend to surrender, lapse, terminate or change any of your existing life insurance policies No No
with this application? / Adakah anda bercadang untuk mengembalikan atau meluputkan atau
membatalkan atau mengubah sebarang polisi insurans hayat anda yang sedia ada dengan
permohonan polisi baru ini?
(a) Is there any party who has influenced you to surrender or lapse or terminate or change any
of your existing life insurance policies? / Adakah anda dipengaruhi oleh sesiapa supaya
mengembalikan atau meluputkan atau membatalkan atau mengubahkan sebarang polisi
insurans hayat anda yang sedia ada?
Please note that by terminating your existing policies: / Sila perhatikan dengan bahawa pembatalan insurans hayat yang sedia ada:
(a) You will not receive any guaranteed cash value if the policies have been purchased for less than 3 years, or / anda tidak berhak menerima
nilai pengembalian jika pembelian insurans hayat anda kurang dari 3 tahun, atau
(b) You will be entitled to a surrender value which may be lesser than the total amount of paid premium for 3 years / anda berhak menerima nilai
pengembalian di mana nilainya kurang dari jumlah pembayaran premium yang dibuat selama 3 tahun atau lebih.
Section 9 : Health Questions / Seksyen 9 : Soalan-Soalan Kesihatan
ATTACHMENT OF PAYOR /SPOUSE RIDERS / JANGAN TANDA PADA BAHAGIAN PEMOHON /ORANG / Orang Pemohon Assured /
Diinsuranskan
Bersama
1. Have you ever, for any illness (other than common cold), injury, growth, cyst, lump, disease, No No
disorder, physical disability or impairment (including hereditary, congenital, genetic,
mental/psychiatric conditions),
Been investigated or diagnosed and/or received any treatment or medication; or
Been advised to undergo follow-up, periodic monitoring or observation; or
Consulted any medical practitioner or any alternative health practitioner?
Please indicate “Yes” if ANY of the above applies
Pernahkah anda, bagi sebarang penyakit (selain daripada selesema), kecederaan, ketumbuhan,
sista, masalah, gangguan, kecacatan fizikal atau kecacatan (termasuk keadaan yang diwarisi,
kongenital, genetik, mental/psikiatri),
Disiasat atau didapati menghidap dan/atau menerima sebarang rawatan atau perubatan;
atau
Dinasihat mendapat rawatan susulan, pemantauan secara berkala atau pemerhatian;
atau
Dirawat oleh pengamal perubatan atau pengamal kesihatan alternatif?
Sila nyatakan"Ya" jika SEBARANG yang di atas berkenaan
Notes / Nota:
i. If your answer to Question 1 is "No", you have confirmed that you DO NOT have any of the
conditions in the list of medical sub-questions (a) to (l) / Jika jawapan anda kepada Soalan 1
adalah "Tidak", anda mengesahkan anda TIDAK mempunyai mana-mana keadaan atau
penyakit dalam senarai soalan susulan (a) hingga (l)
ii. If your answer to Question 1 is "Yes", please answer if you have any of the following
conditions in the list of sub-questions (a) to (l) / Jika jawapan anda kepada Soalan 1 adalah
"Ya", sila jawab jika anda mempunyai mana-mana keadaan atau penyakit dalam senarai
soalan susulan (a) hingga (l)
List of medical sub-questions (a) – (l) / Senarai soalan kesihatan susulan (a) – (l):
(a) Endocrine System
(Diabetes Mellitus, Raised blood sugar, Sugar in urine, Thyroid disorders, Goiter, Adrenal
gland disorders, Pituitary gland disorders, Parotid gland disorders) /
Sistem Endokrin
(Kencing Manis, Gula dalam darah yang tinggi, Gula dalam air kencing, Penyakit Tiroid,
Goiter, Penyakit Kelenjar Adrenal, Penyakit Kelenjar Pituitary, Penyakit Kelenjar Parotid)
(b) Cardiovascular or Blood or Autoimmune System
(Hypertension, Raised Cholesterol, Heart Attack, Coronary Heart Disease, Palpitation, Heart
Valve Disease, Heart Murmur, Congenital Heart Disease, Heart Failure, Rheumatic Fever,
Deep Vein Thrombosis, Anaemia, Thalassaemia, Systemic Lupus Erythematous, Rheumatoid
Arthritis, Idiopathic thrombocytopenic purpura (ITP), Abnormal platelet count) /
Kardiovaskular atau Darah atau Sistem Autoimun
(Tekanan Darah Tinggi, Kolesterol Tinggi, Serangan Jantung, Penyakit Arteri Koronari,
Palpitasi, Penyakit Injap Jantung, Deruan Jantung, Penyakit Jantung Kongenital, Kegagalan
Jantung, Demam Reumatik, Thrombosis Vena Dalam, Anemia, Thalasemia, Sistemik Lupus
Erythematosus, Arthritis Rheumatoid, Idiopathic Thrombocytopenic Purpura, Kiraan platelet
yang tidak normal)

(c) Respiratory System or Eyes, Ears, Nose and Throat
(Asthma, Tuberculosis, Bronchitis, Rhinitis, Pneumonia, Sinusitis, Tonsillitis , Chronic
Obstructive Pulmonary Disease (COPD), Obstructive Sleep Apnea (OSA), Cataract,
Glaucoma, Blindness, Impaired hearing, Impaired speech, Vertigo) /
Sistem Pernafasan atau Mata, Telinga, Hidung dan Tekak
(Asma/Lelah, Penyakit Tibi, Bronkitis, Rinitis, Radang Paru-paru, Resdung, Tonsillitis,
Penyakit Kronik Pulmonari Obstruktif, Obstructive Sleep Apnea, Katarak, Glaukoma, Buta,
Pendengaran terjejas, Percakapan terjejas, Vertigo)
(d) Gastrointestinal System
(Gastritis, Gastroesophageal Reflux Disease, Peptic Ulcer, Colitis, Ulcerative Colitis, Crohn’s
Disease, Piles or Hemorrhoids, Fistula, Hepatitis or Hepatitis carrier, Jaundice, Fatty Liver,
Hernia, Gallstone, Liver Cirrhosis) /
Sistem Gastrousus
(Gastrik, Penyakit Refluks Gastroesophageal, Peptik Ulser, Colitis, Ulcerative Colitis,
Penyakit Crohn, Buasir, Fistula, Hepatitis atau pembawa hepatitis, Jaundis, Hati Berlemak,
Hernia, Batu Hempedu, Sirosis Hati)
8 0 0 5 7 6 7 4 2 4
Diinsuranskan
Bersama
(e) Genital-Urinary System
(Urinary Stone, Kidney Stone, Protein in urine, Blood in urine, Polycystic Kidney Disease
(PKD), Nephrotic syndrome, Glomerular disease, Hydronephrosis, Impaired kidney function,
Benign Prostate Hypertrophy) /
Sistem Genitor-Urinari
(Batu karang dalam sistem kencing, Batu karang dalam buah pinggang, Protein dalam air
kencing, Darah dalam air kencing, Penyakit Buah Pinggang Polisistik, Sindrom Nephrotik,
Penyakit Glomerular, Hydronephrosis, Fungsi buah pinggang terjejas, Hipertropi Kelenjar
Prostate)
(f) Congenital or Hereditary Disorders
(Down's Syndrome, Congenital defect, Muscular Dystrophy, Huntington's disease, Glucose-
6-phosphate dehydrogenase (G6PD) deficiency) /
Masalah Kongenital atau Penyakit Keturunan
(Sindrom Down, Kecacatan kongenital, Distrofi Otot, Penyakit Huntington, Penyakit
kekurangan enzim Glucose-6-phosphate dehydrogenase (G6PD))
(g) Nervous System or Psychiatric Diseases
(Epilepsy, Paralysis, Stroke, Transient ischemic attack (TIA), Encephalitis, Meningitis,
Multiple sclerosis, Dementia, Cerebral Palsy, Depression, Anxiety, Schizophrenia, Suicide
Attempt, Parkinson’s Disease, Psychiatric disorder, Panic attack, Insomnia, Bipolar Disorder,
Learning disability, Attention Deficit Hyperactivity Disorder (ADHD), Autism, Alzheimer
disease) /
Sistem Saraf atau Penyakit Psikiatri
(Epilepsi/Sawan, Lumpuh, Strok/Angin ahmar, Serangan Iskemia Sementara, Encephalitis,
Meningitis, Multiple Sclerosis, Dimensia, Palsi Serebral, Kemurungan, Keresahan,
Schizophrenia, Cubaan membunuh diri, Penyakit Parkinson, Penyakit Psikiatri, Serangan
Panik, Insomnia, Gangguan Bipolar, Masalah pembelajaran, Perhatian Defisit Gangguan
Hiperaktif, Autisme, Penyakit Alzheimer)
(h) Tumor, Cyst, Cancer, Growth, Lymphatic System
(Cyst, Tumour, Lump, Polyps, Hodgkin’s Disease, Enlarge Lymph Glands, Cancer, Leukemia,
Haemangioma, Lesions, Bone Marrow Disorders) /
Tumor, Sista, Kanser, Ketumbuhan, Sistem Limfa
(Sista, Tumor, Ketumbuhan, Polip, Penyakit Hodgkin, Pembesaran Kelenjar Limfa,
Kanser/Barah, Leukemia, Haemangioma, Lesi, Gangguan Sumsum Tulang)
(i) Sexual Transmitted Disease, AIDS or HIV Infection
(Syphilis, Venereal Disease, Gonorrhoea, Infection of HIV, AIDS, Herpes, HPV infection) /
Penyakit Kelamin Berjangki, AIDS or Jangkitan HIV
(Sifilis, Penyakit Kelamin, Gonorea, Jangkitan HIV, AIDS, Penyakit Herpes, Jangkitan HPV)
(j) Musculoskeletal System
(Gout, Hyperuricemia, Arthritis, Osteoarthritis, Prolapsed Intervertebral Disc (PID),
Spondylosis, Scoliosis, Ligament Disorder, Muscle Disorder, Joint Disorder, Spine Disorder,
Backache, Knee Disorder, Psoriasis, Poliomyelitis, Rheumatism, Severe Skin Infection,
Eczema, Burns) /
Sistem Rangka Otot
(Gout, Hiperuricemia, Artritis, Osteoarthritis, Diska Tergelincir, Spondylosis, Scoliosis,
Gangguan Ligamen, Gangguan Otot, Gangguan Sendi, Gangguan Tulang Belakang, Sakit
belakang, Gangguan Sendi Lutut, Psoriasis, Poliomyelitis, Penyakit Sendi, Jangkitan kulit
yang teruk, Ekzema, Melecur)
(k) FEMALE ONLY / PEREMPUAN SAHAJA
Female Reproductive System
(Fibroids, Ovarian Cysts, Endometriosis, Polycystic Ovarian Disease (POD), Cervicitis,
Breast Disorder, Pelvic inflammatory disease (PID), Cervical intraepithelial neoplasia (CIN),
Pregnancy/childbirth complications) /
Sistem Pembiakan Perempuan
(Fibroid, Sista Ovari, Endometriosis, Penyakit Polisistik Ovari, Cervicitis, Penyakit Payudara,
Penyakit radang pelvik, Neoplasia intraepithelial serviks, Komplikasi semasa hamil dan/atau
ketika bersalin)
(l) Other health conditions that are not listed above /
Masalah kesihatan yang tidak disenaraikan di atas
2. Other than the conditions you have disclosed above, have you ever been hospitalized, or No No
undergone any medical procedure (including surgeries and endoscopes) on a day-care or
outpatient basis? /
Selain daripada keadaan kesihatan yang anda telah dedahkan di atas, pernahkah anda dirawat
di hospital, atau menjalani sebarang prosedur perubatan (termasuk pembedahan dan prosedur
endoskopi) secara rawatan harian atau rawatan pesakit luar?
(a) Is your hospitalization due to the following cause:
Appendicitis, dengue fever, viral fever, food poisoning or accidental injury? /
Adakah rawatan hospital disebabkan oleh:
Radang apendik, demam denggi, demam akibat jangkitan virus, keracunan makanan atau
kecederaan akibat kemalangan?
8 0 0 5 7 6 7 4 2 4
Diinsuranskan
Bersama
3. Other than the conditions you have disclosed above, have you ever had, or been advised to No No
perform any medical test?
Example:
Blood/urine/stool test
HIV screening
X-Ray, Ultrasound, CT/MRI/PET scan
Mammogram, Pap Smear
Electrocardiogram (ECG), Treadmill ECG, Angiogram, Echocardiogram (ECHO)
Biopsy, Fine-needle aspiration
Endoscopy, Laparoscopy
/ Selain daripada keadaan kesihatan yang anda telah dedahkan di atas, pernahkah anda
menjalani atau dinasihatkan untuk menjalani sebarang ujian perubatan?
Contoh:
Ujian darah/air kencing/najis
Ujian HIV
X-Ray, Ultrasound, CT Scan/ Pengimejan Resonans Magnetik/ PET scan
Mammogram, Pap smear
Elektrokardiogram (ECG), Treadmill ECG, Angiogram, Echocardiogram (ECHO)
Biopsi, Aspirasi jarum halus
Endoskopi, Laparoskopi
4. Other than the conditions you have disclosed above, have you experienced any of the following No No
signs or symptoms in the past 6 months?
Vomiting blood, prolonged cough, persistent nose bleed, blood in urine/stool/phlegm
Fainting spells, recurrent severe headache, blurring of vision, fits
Persistent fever, persistent and unexplained fatigue, weight loss
Irregular heartbeat, chest pain, numbness
Lump/growth/cyst/swelling of any part of the body, ascites, unusual skin lesions
Abnormal vaginal discharge, abnormal uterine bleeding
Persistent diarrhea or abdominal pain, enlarged lymph nodes or spleen
Joint pain, meniscus or ligament injury / tear
/ Selain daripada keadaan kesihatan yang anda telah dedahkan di atas, pernahkah anda
mengalami sebarang tanda atau gejala dalam tempoh 6 bulan yang lalu?
Muntah darah, batuk berpanjangan, hidung berdarah berterusan, darah dalam air
kencing/najis/kahak
Pening, sakit kepala teruk berulang, kabur, sawan
Demam berpanjangan, kelesuan berpanjangan dan tidak dapat diterangkan, kesusutan
berat
Degupan jantung tidak teratur, sakit dada, kebas
Badan benjolan/pertumbuhan/sista/bengkak, ascites, lesi kulit luar biasa
Keputihan atau pendarahan rahim abnormal
Diarea atau sakit perut berterusan, pembesaran nodus limfa atau limpa
Sakit sendi, kecederaan / terkoyak meniskus atau ligamen
5. FEMALE ONLY / PEREMPUAN SAHAJA No
Are you pregnant currently? /
Adakah anda sedang mengandung?
6. Is the child born with low birth weight (less than 2.5kg) or premature or pre-term or less than 37 No
weeks gestation? /
Adakah anak dilahirkan dengan berat lahir yang rendah (kurang daripada 2.5kg) atau pramatang
atau kurang daripada 37 minggu?
7. Any special care needed after birth and/or has the child had any physical defects or shown any No
sign of slow physical or mental development? /
Adakah penjagaan khas diperlukan selepas kelahiran dan/atau pernahkah anak mempunyai
kecacatan fizikal atau menunjukkan sebarang tanda pertumbuhan fizikal atau mental yang
lambat?
8. Any medical report to be submitted to Allianz? / No No
Adakah anda mempunyai sebarang laporan perubatan yang hendak dikemukakan kepada
Allianz?
Note / Nota: If there is insufficient space, kindly use the Amendment Form / Sila gunakan Borang Pindaan sekiranya ruang tidak mencukupi.
Section 10 : Declaration By Life Assured, Applicant And Joint Life Assured / Seksyen 10 : Pengisytiharan Oleh Orang
Diinsuranskan, Pemohon Dan Orang Diinsuranskan Bersama
I/We hereby declare that / Dengan ini saya/kami mengisytiharkan bahawa :
a) Where I/We apply for this contract of insurance wholly for purposes unrelated to My/Our trade, business or profession, I/We agree and
declare that: / Di mana Saya/Kami memohon untuk kontrak insurans sepenuhnya bagi tujuan yang tidak berkaitan dengan perdagangan,
perniagaan atau profesion Saya/Kami, Saya/Kami bersetuju dan mengisytiharkan bahawa:
I/We shall take reasonable care not to make any misrepresentation when answering the questions in this Application Form and in any
required medical examination, questionnaire or amendment and any other relevant document in connection with this application
("collectively referred to as "the Information"); / Saya/Kami akan mengambil penjagaan munasabah supaya tidak membuat salah
nyataan semasa menjawab soalan-soalan di dalam Borang Permohonan ini dan di dalam sebarang pemeriksaan perubatan yang
dikehendaki, soal selidik and sebarang dokumen yang berkaitan dengan permohonan ini (kesemuanya dirujuk sebagai "Maklumat
tersebut");
the Information that I/We have provided is full and accurate otherwise it may result in the contract being avoided, a claim denied or
reduced, terms changed or varied, or the contract terminated; / Maklumat tersebut yang diberikan oleh Saya/Kami adalah lengkap
dan benar, sekiranya tidak benar ia mungkin akan menyebabkan kontrak dibatalkan, tuntutan ditolak atau dikurangkan, terma dipinda
atau diubah, atau kontrak akan ditamatkan.
I/We shall inform ALIM of any change to the Information after I/We have submitted the Information but before the contract is entered
into, varied or renewed with ALIM. / Saya/Kami akan memberitahu ALIM tentang sebarang perubahan terhadap Maklumat tersebut
selepas Saya/Kami menyerahkan Maklumat tersebut tetapi sebelum kontrak dimasuki, diubah atau diperbaharui dengan ALIM.
b) I/We have given to the agent no other information, except as written in this application or attached to this form. / Saya/Kami tidak memberi
maklumat-maklumat lain kepada ejen tuan kecuali apa yang tertulis di dalam permohonan ini atau yang disertakan bersama borang
permohonan ini.
8 0 0 5 7 6 7 4 2 4
Section 10 : Declaration By Life Assured, Applicant And Joint Life Assured / Seksyen 10: Pengisytiharan Oleh Orang
Diinsuranskan, Pemohon Dan Orang Diinsuranskan Bersama
c) Where I/We apply for this contract of insurance for purposes related to My/Our trade, business or profession, I/We agree and declare that: /
Di mana Saya/Kami memohon kontrak insurans ini bagi tujuan berkaitan dengan perdagangan, perniagaan atau profesion Saya/Kami,
Saya/Kami bersetuju dan mengisytiharkan bahawa:-
the Information that I/We provided is full and accurate and shall be the basis of the contract of insurance with ALIM; / Maklumat yang
diberikan oleh Saya/Kami adalah lengkap dan benar dan akan membentuk asas kontrak insurans dengan ALIM;
I/We shall inform ALIM of any change to the Information after I/We have submitted the Information but before the contract is entered
into, varied or renewed with ALIM. / Saya/Kami akan memberitahu ALIM tentang sebarang perubahan terhadap Maklumat tersebut
selepas Saya/Kami menyerahkan Maklumat tersebut tetapi sebelum kontrak dimasuki, diubah atau diperbaharui dengan ALIM.
d) I/We undertake to inform ALIM of any medical consultation, examination or admission or any changes to my/our health from the date of this
declaration or medical examination prior to the issuance of the Policy. / Saya/Kami bersetuju untuk memaklumkan kepada ALIM segala
maklumat pemeriksaan kesihatan atau kemasukan wad atau sebarang perubahan kesihatan yang berlaku pada pengisytiharan ini, sebelum
penguatkuasaan Polisi.
e) I/We hereby authorize any physician, hospital, clinic, insurance company or other organization, institution or person, that has any record or
knowledge of me/us or my/our health, to disclose to ALIM or its representative any and all information about me/us with reference to my/our
health and medical history and any hospitalization, advice, treatment, disease or ailment and a photocopy of this authorization shall be
effective and valid as the original. / Dengan ini saya/kami membenarkan mana-mana pakar perubatan, hospital, klinik, syarikat insurans atau
organisasi lain, institusi atau individu yang mempunyai rekod atau pengetahuan tentang diri saya/kami atau kesihatan saya/ kami yang
membekalkan kepada ALIM atau wakilnya sebarang dan semua maklumat tentang saya/kami berhubung kesihatan dan sejarah perubatan
atau apa-apa tempoh rawatan atau penyakit dan salinan fotokopi pemberian kebenaran ini akan dikuatkuasakan dan sah sebagai salinan
asalnya.
f) I/We agree to pay to ALIM the total medical fees incurred for this application should I/we decide to cancel or withdraw this application before
Policy issuance. / Saya/ Kami bersetuju untuk membayar kepada ALIM keseluruhan yuran perubatan bagi permohonan ini sekiranya
saya/kami ingin membatalkan atau menarik balik permohonan sebelum Polisi diterbitkan.
g) The insurance herein applied for shall not take effect unless and until the Policy is issued and the first premium thereon is paid in full during
my/our lifetime and provided I/we am/are in good health. / Insurans yang dipohon tidak akan dikuatkuasakan kecuali dan sehingga Polisi
dikeluarkan dan premium pertama yang telah dibayar sepenuhnya semasa hayat saya/kami dan berada dalam keadaan kesihatan yang
baik.
h) I confirm that I am a person of sound mind who has attained the age of 18 years and is not a nominee under this Application and hereby act
as a witness to the nomination made by the above named Applicant/ Life Assured submitted via e-submission in my presence. / Saya
mengesahkan bahawa saya adalah orang yang sempurna akal yang telah mencapai umur 18 tahun dan bukan penama Permohonan ini dan
dengan ini bertindak sebagai saksi kepada penamaan yang dibuat oleh Pemohon /Orang yang Diinsuranskan di atas melalui e-
penghantaran di hadapan saya.
i) Where I am an individual applying for this contract of insurance, I hereby declare that I am not acting on behalf of a third party. / Sekiranya
saya adalah individu yang memohon kontrak insurans ini, saya dengan ini mengisytiharkan bahawa saya tidak bertindak bagi pihak ketiga.
The following declarations are applicable to regular premium investment-linked insurance plan. / Pengisytiharan berikut untuk
premium tetap pelan insurans berkaitan pelaburan sahaja.
j) I/We understand that the premium paid for the Policy will be used to purchase units depending on the allocation rate for the premium year.
Units, determined by Bid Price, will be deducted monthly to pay for insurance and service charges applicable to the basic plan and
supplementary contracts attached, if any. / Saya/Kami memahami iaitu premium yang dibayar untuk Polisi ini akan digunakan untuk membeli
unit berpandukan pemberian bahagian premium tahunan. Unit, ditentukan oleh Harga Bida akan ditolak bulanan untuk membayar insurans
dan caj perkhidmatan yang dikenakan kepada pelan asas dan kontak tambahan pilihan yang disertakan, jika ada.
k) In the event of non-payment of the regular premium, I/we agree and authorize ALIM to automatically use the Account Value to pay for the
insurance and service charges of the basic plan and supplementary contracts. / Sekiranya pembayaran tidak dilakukan, saya/kami bersetuju
dan membenarkan ALIM untuk menggunakan nilai akaun untuk membuat pembayaran insurans dan caj perkhidmatan untuk pelan asas dan
kontrak faedah tambahan pilihan.
l) I/we understand that when the value of the balance of units in the Policy is insufficient to pay the Policy Charges when due, a grace period of
thirty one (31) days will be granted during which the Policy shall remain in force. However, the Policy shall lapse at the end of the grace
period if any Policy Charges shall remain unpaid at the end of its grace period. / Saya/kami memahami apabila nilai baki Unit dalam Polisi ini
tidak mencukupi untuk membayar Caj Polisi apabila perlu dibayar, tempoh tenggang selama tiga puluh satu (31) hari akan dibenarkan dalam
mana Polisi akan kekal berkuatkuasa. Walau bagaimanapun, Polisi akan luput pada akhir tempoh tenggang sekiranya mana-mana Caj Polisi
masih kekal tidak berbayar pada akhir tempoh tenggang.
m) I/We understand and agree that the number of units to be credited to the Policy shall be determined by the Bid Price established on the
Valuation Date upon the issuance of Policy by ALIM. / Saya/Kami memahami dan bersetuju bahawa bilangan unit-unit yang dikreditkan
kepada Polisi akan ditentukan dengan Harga Bida yang ditetapkan pada Tarikh Penilaian ketika pengeluaran Polisi oleh ALIM.
Signed at / Malaysia this / 06 day of / 01 month / 2022 year /
Ditandatangani di pada haribulan bulan tahun
4 5 Signature of Witness
Signature of Life Assured Signature of Applicant

Tandatangan Orang Diinsuranskan Tandatangan Pemohon Tandatangan Saksi
Name of Witness / Nama Saksi
NRIC No. of Witness / No. KP Saksi
Signature of Joint Life Assured / Tandatangan

OrangDiinsuranskan Bersama
4 Except for the 3rd party application where the Life Assured is a child with attained age below 16 years. / Kecuali permohonan pihak ketiga dimana Orang
Diinsuranskan ialah kanak-kanak berumur di bawah 16 tahun.
5 For Business Insurance application, Company's rubber stamp is required and the Applicant's column must be completed by an authorized personnel who is
not the Life Assured. / Untuk permohonan Insurans Perniagaan, cop Syarikat diperlukan dan bahagian Pemohon hendaklah diisi oleh personel bertauliah
yang bukan merupakan Orang Diinsuranskan.
8 0 0 5 7 6 7 4 2 4
Section 11 : Consent Of Parent/Legal Guardian / Seksyen 11 : Persetujuan Ibu bapa/Penjaga Sah
I / Saya (6 parent/legal guardian of the Life Assured / ibu bapa/penjaga sah Orang Diinsuranskan) NRIC No. /No. KP hereby consent to / dengan
ini membenarkan to be the owner of this policy / menjadi pemunya polisi ini.
Signature of 6 parent/legal guardian / Tandatangan ibu bapa/penjaga sah

6 Consent/Declaration for Life Assured who has attained the age of 10 years but is below 16 years. / Persetujuan/pengisytiharan Orang
Diinsuranskan yang berumur 10 tahun tetapi kurang dari 16 tahun.
Section 12 : Declaration on the Verification of an Insured in Compliance with section 16(2) of the Anti-Money Laundering,
Anti-Terrorism Financing and Proceeds of Unlawful Activities Act 2001 / Seksyen 12:Pengisyitiharan Pengesahan ke atas
Pihak Diinsuranskan selaras dengan Pematuhan Seksyen 16(2) Akta Pencegahan Penggubahan Wang Haram, Pencegahan
Pembiayaan Keganasan dan Hasil daripada Aktiviti Haram 2001
I, hereby agree that pursuant to the Anti-Money Laundering, Anti-Terrorism Financing and Proceeds of Unlawful Activities Act 2001, the below
mentioned documents of the proposed applicant were sighted and verified by me at the point of sale. / Saya, dengan ini bersetuju bahawa
selaras dengan Akta Pencegahan Pengubahan Wang Haram, Pencegahan Pembiayaan Keganasan dan Hasil daripada Aktiviti Haram 2001,
dokumen-dokumen seperti yang dinyatakan di bawah berkaitan milik pemohon yang dicadangkan telah disemak dan disahkan oleh saya ketika
urusniaga ini dijalankan.
Hence, whereby the applicant is an individual, I have sighted the original NRIC/Passport or other identification document and have verified the
identity and details of the proposed insured/applicant OR, whereby the applicant is a body corporate/ trust/ club/ society/charity, I have sighted
the original Business Registration Certificate/ Memorandum of Association/ Article of Association or other relevant constituent identification
documents, and have taken reasonable measures to identify and verify authentication of the beneficial owners and details of the proposed
insured/applicant. / Iaitu, bagi pemohon individu, saya mengesahkan bahawa saya telah menyemak Kad Pengenalan asal/ Pasport atau
dokumen rasmi lain berkaitan pemohon dan mengesahkan telah mengenal pasti identiti dan butiran milik pihak diinsuranskan/ pemohon ATAU,
sekiranya pemohon adalah badan korporat/badan amanah /persatuan/ badan amal, saya mengesahkan telah menyemak dokumen asal Sijil
Pendaftaran Perniagaan/Memorandum Persatuan/Perkara-Perkara Persatuan atau dokumen konstituen lain yang berkaitan, serta telah
mengambil langkah-langkah yang munasabah untuk mengenal pasti dan mengesahkan ketulenan identiti pemunya benefisial serta butiran
berkaitan pihak diinsuranskan/pemohon.
I hereby confirm that the relevant documents were sighted and verified by me and at the time of verification the insured is not suspected of
money laundering or financing of terrorism until any event or circumstances that may render it otherwise, I shall be subjected to disclose the
matter to Allianz. / Saya dengan ini mengesahkan bahawa dokumen-dokumen berkaitan telah disemak dan disahkan ketulenannya oleh saya
dan ketika pengesahan ini dilakukan, pihak yang diinsuranskan tidak disyaki menjalani aktiviti pengubahan wang haram atau pembiayaan
keganasan sehinggalah terdapatnya sebarang perkara yang bertentangan, saya hendaklah tertakluk untuk mendedahkan perkara tersebut
kepada Allianz.
LAI SIEW CHING 870128-52-5412 06/01/2022
Signature Of Agent / Tandatangan Ejen NRIC No / No. Kad Pengenalan Date / Tarikh
Section 13 : Nominees & Trustee /Seksyen 13 : Penama-penama & Pemegang Amanah

IMPORTANT NOTICE / NOTIS PENTING
Pursuant to Schedule 10 of Financial Services Act 2013 ("FSA 2013") / Selaras dengan Jadual 10 Akta Perkhidmatan Kewangan 2013
("FSA 2013"):
A policy owner who has attained the age of sixteen (16) years may nominate a natural person to receive policy moneys payable under his life
policy upon his death. / Pemunya polisi yang telah mencapai umur enam belas (16) tahun boleh menamakan sesiapa sahaja untuk menerima
wang polisi yang akan dibayar di bawah polisi hayat tersebut atas kematiannya.
It is advisable to appoint at least one nominee and keep the nominee informed of the appointment in order to facilitate the payment of policy
moneys payable upon death of the Life Assured. Failure to make a nomination may delay the payment of the policy moneys become payable. /
Dengan ini dinasihatkan untuk melantik sekurang-kurangnya seorang penama dan pastikan penama tersebut dimaklumkan akan lantikan
tersebut bagi memudahkan pembayaran wang polisi yang akan dibayar atas kematian Orang Yang Diinsuranskan. Kegagalan untuk membuat
penamaan boleh melambatkan pembayaran wang polisi tersebut.
If you are a non-Muslim policy owner, when you appoint your spouse, child or parent (if you have no spouse or child living at the date of making
the nomination) as the nominee, you will create a trust of policy moneys payable upon your death in favor of the nominee. You are advised to
appoint a trustee for the policy moneys and in the event of failure to do so, the competent nominee shall be the trustee. For a policy with such
trust created, written consent of the trustee is required before you change the nomination, vary, surrender, assign or pledge the policy. / Jika
anda seorang pemunya polisi bukan Islam, apabila anda melantik suami atau isteri, anak atau ibu bapa (jika anda tidak mempunyai suami atau
isteri, atau anak yang masih hidup pada tarikh penamaan itu dibuat) sebagai penama, penamaan tersebut akan mewujudkan suatu amanah
terhadap wang polisi yang akan dibayar. Anda dinasihatkan untuk melantik seorang pemegang amanah bagi wang polisi tersebut dan sekiranya
gagal berbuat demikian, penama yang kompeten itu akan bertindak sebagai pemegang amanah. Bagi polisi yang telah mewujudkan amanah di
bawahnya, maka kebenaran bertulis daripada pemegang amanah adalah diperlukan sebelum anda membuat pindaan ke atas penamaan,
manfaat, membatalkan atau serah hak polisi.
Any nominee who is other than the spouse, child or parent (if there is no spouse or child living at the date of nomination) of a non-Muslim policy
owner, shall receive the policy moneys payable upon death of the policy owner as an executor. If the Policy owner's intention is for such nominee
to receive the policy moneys solely as a beneficiary i.e. not as an executor, then the policy owner must assign the benefits of the policy to such
nominee. / Mana-mana penama selain daripada suami atau isteri, anak atau ibu bapa (jika tidak mempunyai suami atau isteri, atau anak yang
masih hidup pada tarikh penamaan) bagi pemunya polisi yang bukan Islam, penama sedemikian akan menerima wang polisi dan bertindak
sebagai wasi. Sekiranya pemunya polisi ingin penama tersebut menerima wang pemunya sebagai benefisiari dan bukan sebagai wasi, maka
pemunya polisi mesti serah hak manfaat polisi kepada penama itu.
Section 13 : Nominees & Trustee /Seksyen 13 : Penama-penama & Pemegang Amanah
Nominee 1 / Penama 1
Name / Nama
NRIC No. (New) / No. KP (Baru) NRIC No. (Old) / No. KP (Lama)
Passport No. / No. Pasport (For Passport Expiry Date / Tarikh Luput
Foreigner only / untuk Pasport
warganegara asing sahaja)
Country of Birth / Negara Kelahiran
Sex / Jantina Citizenship/Nationality /
Kewarganegaraan/Warganegara
Date of Birth / Tarikh Lahir Relationship to Life Assured /
Hubungan kepada orang
diinsuranskan
% of share / % bahagian
Address / Alamat
Postcode / Poskod Country / Negara
Name / Nama
diinsuranskan
Address / Alamat
Name / Nama

diinsuranskan
Address / Alamat

8 0 0 5 7 6 7 4 2 4
Name / Nama
diinsuranskan
Address / Alamat
Appointment Of Trustee /Pelantikan Pemegang Amanah

IMPORTANT NOTICE: This section is only applicable if you are a non-Muslim policy owner and you have appointed your spouse, child or parent
(if you have no spouse or child living at the date of making the nomination) as the nominee. Policy Owner is not allowed to appoint
himself/herself as the Trustee./NOTA PENTING: Sila isi bahagian ini hanya jika anda seorang pemegang polisi bukan Islam dan anda telah
menamakan isteri atau suami, anak atau ibubapa (sekiranya anda tiada suami atau isteri atau anak pada tarikh penamaan) sebagai penama.
Pemunya polisi tidak dibenarkan untuk melantik diri sendiri sebagai Pemegang Amanah.
I hereby appoint the following Trustee(s)/additional Trustees to receive such money payable under this policy upon my death and the receipt by
the Trustee(s) shall be a complete discharge to the Company for all liability in respect of the policy moneys so paid to them. I reserve the right to
revoke and reappoint Trustee(s) at any time at my sole discretion without the consent of the Trustee(s). / Saya dengan ini melantik
Pemegang(Pemegang-pemegang) Amanah/ Pemegang(Pemegang-pemegang) Amanah tambahan seperti berikut untuk menerima wang
berkenaan yang dibayar di bawah polisi ini di atas kematian saya dan penerimaannya oleh Pemegang(Pemegang-pemegang) Amanah akan
melepaskan sepenuhnya Syarikat daripada semua liabiliti berkenaan dengan wang polisi yang dibayar kepada mereka. Saya berhak untuk
membatalkan dan melantik semula Pemegang(Pemegang-pemegang) Amanah pada bila-bila masa dan pada budi bicara saya tanpa kebenaran
Pemegang(Pemegang-pemegang) Amanah.
Trustee / Pemegang Amanah
Name / Nama
diinsuranskan
Address / Alamat

I/We hereby agree to act as Trustee(s) and my/our appointment is subject to the abolute right of revocation of my/our appointment by the policy
owner of the above mentioned policy. / Saya/Kami dengan ini bersetuju untuk bertindak sebagai Pemegang(Pemegang-pemegang) Amanah dan
perlantikan saya/kami adalah tertakluk kepada kuasa mutlak pemunya polisi untuk membatalkan perlantikan saya/kami untuk polisi seperti yang
dinyatakan di atas.
06/01/2022
Signature of Trustee / Tandatangan Pemegang Amanah Date / Tarikh
8 0 0 5 7 6 7 4 2 4
Section 14 : Data Privacy And Disclosure Of Personal Information / Seksyen 14 : Pendedahan Maklumat Peribadi Dan
Privasi Data
1. Data Privacy / Data Privasi
Allianz Life Insurance Malaysia Berhad ("Company") will process your personal information strictly in accordance with the Personal Data
Protection Act 2010, other related legislation, the Company's and/or its Group's own strict internal policy. / Allianz Life Insurance Malaysia
Berhad ("Syarikat") akan memproses maklumat peribadi anda secara tegasnya mengikut Akta Perlindungan Data Peribadi 2010, undang-
undang lain yang berkaitan dan polisi dalaman Syarikat dan/ atau Kumpulannya sendiri yang ketat.
2. Processing of Personal Data / Pemprosesan Data Peribadi
When you apply for, update, modify or renew an insurance policy, the personal information including policy information, financial information
and Sensitive Personal Data pertaining to you ("Personal Data") will be collected, held on computer and/or in documents, used, disclosed and
otherwise processed by the Company and its employees, representatives, reinsurers, agents and affiliates to facilitate the performance and
administration of the Company's functions as an insurance company. / Apabila anda memohon, mengemaskini, mengubah atau
memperbaharui suatu polisi insurans, maklumat peribadi termasuk maklumat polisi, maklumat kewangan dan Data Peribadi Sensitif yang
berkaitan dengan anda ("Data Peribadi") akan dikutip, disimpan dalam komputer dan/atau dalam dokumen, digunakan, didedahkan atau
sebaliknya diproses oleh Syarikat dan pekerja-pekerjanya, wakil-wakil, penanggung-penanggung insurans semula, agen-agen dan sekutu-
sekutu Syarikat untuk memudahkan pelaksanaan dan pentadbiran fungsi Syarikat sebagai sebuah syarikat insurans.
The Personal Data in relation to you may include copies and other details of identity documents, proof of address and other contact details,
information concerning age, marital status, creditworthiness, physical or mental health or medical condition ("Sensitive Personal Data"). /
Data Peribadi berkenaan anda mungkin termasuk salinan dan butir-butir dokumen identiti lain, bukti alamat dan maklumat berhubung lain,
maklumat berkenaan umur, taraf perkahwinan, kelayakan kredit, kesihatan fizikal atau mental atau keadaan kesihatan ("Data Peribadi
Sensitif").
The Company may obtain your Personal Data from other sources, such as bureaus or agencies established or to be established by regulatory
authorities, operators of registers or databases available to the insurance industry, government departments, agencies or authorities, any
party who has, does or will provide products or services to you and to whom you have granted consent, our commercial partners, insurance
intermediaries, reinsurers, third party administrators and/or service providers, other insurance companies, your attending doctors, hospitals,
clinics, other medical professionals, facilities or pharmacies, laboratories, your lawyers, agents, proposed assignees, group policyholders,
benefit plan administrators and employer, or related persons or organizations where such information would be essential for the purposes
stated herein. / Syarikat mungkin memperoleh Data Peribadi anda daripada sumber lain, seperti biro atau agensi-agensi yang ditubuhkan
atau akan ditubuhkan oleh pihak berkuasa kawal selia, operator rekod atau pangkalan data yang tersedia kepada industri insurans, jabatan
kerajaan, agensi atau pihak berkuasa, mana-mana pihak yang telah, sedang atau akan membekalkan produk atau khidmat kepada anda dan
kepada siapa yang anda telah memberikan persetujuan, rakan-rakan komersil kami, pihak perantara insurans, pihak penanggung insurans
semula, pengurus dan/atau pembekal perkhidmatan pihak ketiga, syarikat insurans yang lain, doktor perawat anda, hospital, klinik, ahli
profesional perubatan yang lain, kemudahan atau farmasi perubatan yang lain, makmal, peguam anda, agen, pemegang serah hak yang
dicadangkan, pemunya polisi berkumpulan, pihak pengurusan pelan manfaat dan majikan anda, atau orang-orang atau organisasi yang
berkaitan di mana maklumat sebegitu adalah penting untuk tujuan yang dinyatakan di sini.
3. Impact resulting from failure to supply information / Akibat daripada kegagalan untuk memberikan maklumat
You may choose whether or not to provide your Personal Data to the Company. If you choose not to do so, the Company may be unable to
provide you with the services and/or products requested. Hence, it is obligatory for you to provide the Company with your Personal Data when
you choose to apply for insurance cover with the Company. / Anda boleh memilih sama ada hendak memberikan Data Peribadi anda kepada
Syarikat. Sekiranya anda memilih untuk tidak memberikan Data Peribadi anda, Syarikat mungkin tidak dapat menyediakan kepada anda
khidmat dan/atau produk yang diminta. Dengan itu, adalah menjadi obligasi anda untuk membekalkan kepada Syarikat Data Peribadi anda
apabila anda memilih untuk membuat permohonan untuk perlindungan insurans dengan Syarikat.
4. Purposes of Collecting and Using Your Personal Data / Tujuan Mengumpul dan Menggunakan Data Peribadi Anda
Your Personal Data will be collected, used and otherwise processed by the Company for the following purposes: / Data Peribadi anda akan
dikutip, digunakan dan sebaliknya diproses oleh Syarikat untuk tujuan-tujuan berikut:
(a) to better understand your insurance situation, provide quotes, enter into and execute your insurance contract, and to set up and administer
your policy; / untuk lebih memahami keadaan insurans anda, memberi sebut harga, memasuki dan melaksanakan kontrak insurans anda,
dan untuk menyediakan dan menguruskan polisi anda;
(b) for underwriting, risk assessment, handling and settling of claims and audit purposes; / untuk pengunderaitan, penilaian risiko, pengurusan
dan penyelesaian tuntutan dan tujuan audit;
(c) for detection and prevention of criminal activity or fraud in connection with an insurance transaction; / untuk mengesan dan mengelakkan
aktiviti jenayah atau penipuan berkaitan dengan suatu transaksi insurans;
(d) to manage and service the Company's relationship with you and provide you with better customer service including marketing and
promoting of other products and services by the Company and/or its Group; / untuk menguruskan dan menyelenggarakan hubungan
Syarikat dengan anda dan menyediakan khidmat pelanggan yang lebih baik kepada anda termasuk pemasaran dan promosi produk dan
perkhidmatan lain Syarikat dan/atau Kumpulannya;
(e) to maintain and develop our business systems and infrastructure; / untuk mengekalkan dan membangunkan sistem dan infrastruktur
bisnes kami;
(f) for data transfer, and sharing with, the Company and its Group and/or third parties acting on our behalf, including those located outside
Malaysia. / untuk pemindahan data, dan berkongsi dengan, Syarikat dan Kumpulannya dan/atau pihak ketiga bertindak bagi pihak kami,
termasuk yang lokasinya berada di luar Malaysia.
8 0 0 5 7 6 7 4 2 4
Section 14 : Data Privacy And Disclosure Of Personal Information / Seksyen 14 : Pendedahan Maklumat Peribadi Dan
Privasi Data
5. Disclosure of Your Personal Data / Pendedahan Data Peribadi Anda
The Company may share your Personal Data with your employer and its representatives, agents and affiliates (where, for example, you are
insured under a group insurance policy obtained through your employer), other insurers, brokers, credit organizations, underwriters,
reinsurers, group policyholders, benefit plan administrators, those to whom the Company outsource certain business operations, commercial
partners of the Company, regulatory authorities, bureaus or agencies established or to be established by regulatory authorities, operators of
registers or databases available to the insurance industry, professionals working on behalf of the Company and/or its Group such as loss
adjusters, lawyers, auditors, persons conducting actuarial or research studies, accountants, consultants, surveyors, external claims data
collectors, investigators and medical professionals, and any other contractors or sub-contractors as required or permitted by law or as we may
determine to be necessary or appropriate. / Syarikat mungkin berkongsi Data Peribadi anda dengan majikan anda dan wakil, agen dan
sekutunya (di mana, contohnya, anda diinsuranskan di bawah polisi insurans berkumpulan yang diperolehi melalui majikan anda), syarikat
insurans yang lain, broker, organisasi kredit, pihak pengunderait, pihak penanggung insurans semula, pemunya polisi berkumpulan, pihak
pengurusan pelan manfaat, mereka kepada mana Syarikat telahmenyumber luar operasi bisnes kami yang tertentu, rakan-rakan komersil
Syarikat, pihak berkuasa kawal selia, biro atau agensi yang telah atau akan ditubuhkan oleh pihak berkuasa kawal selia, operator rekod atau
pangkalan data yang tersedia kepada industri insurans pihak profesional yang bertugas bagi pihak Syarikat dan/atau Kumpulannya seperti
penyelaras kerugian, peguam, juruaudit, mereka yang melaksanakan penyelidikan aktuari atau kaji selidik, akauntan, pakar runding, peninjau,
pemungut data tuntutan luar, penyiasat dan profesional perubatan dan mana-mana kontraktor atau sub-kontraktor lain yang diperlukan atau
dibenarkan oleh undang-undang atau yang diputuskan oleh kami sebagai perlu atau bersesuaian.
6. Data Transfer and Sharing / Pemindahan dan Perkongsian Data
Where the Company considers it necessary or appropriate for the purposes of data storage or processing or human resource management,
the Company may transfer your Personal Data to another member of the Group or third party service or product providers within or outside
Malaysia, under conditions of confidentiality and similar levels of security safeguards. / Di mana Syarikat fikir adalah perlu atau sesuai untuk
tujuan penyimpanan data atau pemprosesan atau pengurusan sumber manusia, Syarikat mungkin memindahkan Data Peribadi anda kepada
ahli Kumpulan yang lain atau pemberi khidmat atau produk pihak ketiga di dalam atau di luar negara Malaysia, di bawah syarat-syarat
kesulitan dan tahap usaha penjagaan yang serupa.
7. Your Rights of Access to Your Personal Data / Hak Anda Untuk Akses Kepada Data Peribadi Anda
You have the right to request in writing, access to and correction of your Personal Data held by the Company and you may make any
enquiries or complaints in respect of your Personal Data by contacting the Company's Customer Service Officer at 1300-88-1028, from 8.45
a.m. to 5.45 p.m., Monday to Friday or email at customer.service@allianz.com.my or via our Fax No. 03-2264 8499. You also have the right to
request in writing for the Company to cease processing your Personal Data including for marketing purposes. / Anda berhak untuk meminta
secara bertulis akses kepada dan membetulkan Data Peribadi anda yang disimpan oleh Syarikat dan anda boleh membuat pertanyaan atau
aduan berkaitan Data Peribadi anda dengan menghubungi Pegawai Perkhidmatan Pelanggan Syarikat di 1300-88-1028, daripada 8.45 pagi
hingga 5.45 petang, Isnin hingga Jumaat atau emel kepada customer.service@allianz.com.my atau melalui No. Faks 03-22648499. Anda
juga berhak untuk membuat permintaan secara bertulis kepada Syarikat untuk berhenti memproses Data Peribadi anda termasuk untuk
tujuan pemasaran.
8. Information About Another Person / Maklumat Berkaitan Orang Lain
When you give the Company, information about another person, you confirm that they have appointed you to act for them, to consent to the
processing of their personal data and to receive on their behalf, any data privacy notices. / Apabila anda memberi Syarikat maklumat
berkaitan orang lain, anda mengesahkan bahawa mereka telah melantik anda untuk bertindak bagi pihak mereka untuk bersetuju dengan
pemprosesan data peribadi mereka dan untuk menerima bagi pihak mereka apa-apa notis data privasi.
The Company reserves the right to update and amend this Privacy Notice or its Privacy Policy from time to time. The Company will notify you of
any amendments to this Privacy Notice or its Privacy Policy via announcements on the Company’s website (www.allianz.com.my) or other
appropriate means. If the Company amends this Privacy Notice or its Privacy Policy, the amendment will only apply to Personal Data collected
after the Company has posted the revised Privacy Notice or Privacy Policy. In the event of any inconsistencies or discrepancies between the
English version and the Bahasa Malaysia version, the English version shall prevail. /Syarikat berhak untuk mengemaskini dan meminda Notis
Privasi ini atau Polisi Privasi Syarikat dari semasa ke semasa. Sebarang perubahan atau pemindahan kepada Notis Privasi ini atau Polisi Privasi
Syarikat akan dimaklumkan melalui pengumuman di laman web Syarikat (www.allianz.com.my) atau melalui cara yang bersesuaian. Jika
Syarikat meminda Notis Privasi ini atau Polisi Privasi Syarikat, pindaan itu hanya akan berkuat-kuasa untuk Data Peribadi yang dikumpul
selepas Syarikat memaparkan Notis Privasi atau Polisi Privasi yang terpinda. Sekiranya terdapat sebarang ketidakseragaman atau
percanggahan di antara versi Bahasa Inggeris dan Bahasa Malaysia, versi Bahasa Inggeris akan digunapakai.
In certain cases, Allianz may also share your information with a third party outside its financial group for marketing purposes provided always
that you have expressly consented to our doing so. Please indicate below if you consent to such disclosure. / Adakalanya, Allianz mungkin juga
akan berkongsi maklumat yang telah anda berikan dengan pihak ketiga di luar kumpulan kewangannya bagi tujuan pemasaran tetapi hanya
dengan keizinan nyata anda. Sila tandakan persetujuan anda jika anda membenarkan pendedahan maklumat seperti diatas.
I consent to Allianz disclosing my information to a third party outside its financial group for marketing Yes / Ya
campaign purposes. / Saya bersetuju untuk Allianz berkongsi maklumat peribadi saya kepada pihak ketiga di
No / Tidak
luar kumpulan kewangannya bagi tujuan kempen pemasaran.
8 0 0 5 7 6 7 4 2 4
Section 15 : Consent To Process And Disclose Personal Data / Seksyen 15 :Persetujuan Untuk Memproses Dan Mendedah
Data Peribadi
I have fully read and understood this Data Privacy Notice. I hereby confirm that I give explicit consent, in accordance with the provisions of the
Personal Data Protection Act 2010, on behalf of myself and any family members, dependants, beneficiaries, trustees, personal representatives,
nominees, assignees or other persons (collectively referred to as "other persons"), to the Company and/or its Group to collect, use, disclose,
transfer, share or otherwise process my Personal Data and the Personal Data of the other persons including Sensitive Personal Data for the
abovementioned purposes. I confirm that where I have provided Personal Data about the other persons, I have obtained the consent of the
individual(s) concerned to enable the Company to use their Personal Data, including any Sensitive Personal Data. I also confirm that I have
brought the Data Privacy Notice to the attention of the other persons who have confirmed that they understand, agree and authorize the
Company and/or its Group to deal with their Personal Data in accordance with the declaration above./ Saya telah membaca dan memahami
sepenuhnya Notis Data Privasi ini. Saya di sini mengesahkan bahawa saya memberi persetujuan yang nyata, mengikut peruntukan Akta
Perlindungan Peribadi 2010 bagi pihak saya dan mana-mana ahli keluarga, tanggungan, benefisiari, pemegang amanah, wakil peribadi,
penama, pemegang serah hak atau sesiapa yang lain (secara kolektifknya dirujuk sebagai "orang-orang lain"), kepada Syarikat dan/atau
Kumpulannya untuk mengutip, mengguna, mendedahkan, memindahkan, berkongsi atau sebaliknya memproses Data Peribadi saya dan Data
Peribadi orang-orang lain termasuk Data Peribadi Sensitif untuk tujuan-tujuan yang dinyatakan di atas. Saya mengesahkan bahawa di mana
saya telah memberikan Data Peribadi berkenaan dengan orang-orang lain, saya telah memperoleh persetujuan individu yang berkaitan untuk
membolehkan Syarikat dan/atau Kumpulannya menggunakan Data Peribadi mereka, termasuk apa-apa Data Peribadi Sensitif. Saya juga
mengesahkan bahawa saya telah membawa Notis Data Privasi ini kepada perhatian orang-orang lain yang telah mengesahkan bahawa mereka
memahami, bersetuju dan memberi kuasa kepada Syarikat dan/atau Kumpulannya untuk berurus dengan Data Peribadi mereka mengikut
deklarasi di atas.
06/01/2022
Signature of Applicant / Tandatangan Pemohon Date / Tarikh
Full Name / Nama Penuh : CHIA SWEE YEE NRIC No. / No. Kad Pengenalan : 820516-05-5218
Section 16 : Declaration To Comply With Relevant Requirements / Seksyen 16 : Pengisytiharan Bagi Pematuhan Keperluan
Berkaitan
I agree to disclose and allow the transfer of my personal and contact information including nationality, tax status or tax residencies ("Relevant
Information") kept with the Company to any local and foreign regulatory or self-regulatory persons in any jurisdiction, or foreign government
authorities ("Relevant Authorities") that the Company is obliged to comply with or choose to comply in its absolute discretion or to meet the
requirements of the laws, regulations, guidelines or terms of an agreement with such Relevant Authorities that is in force or may be declared to
be in force and as amended from time to time ("Relevant Requirements"). / Saya bersetuju bagi mendedahkan dan membenarkan pemindahan
maklumat peribadi dan butir-butir perhubungan termasuk kewarganegaraan, status cukai atau cukai bagi pemastautin ("Maklumat Berkaitan")
yang disimpan oleh pihak Syarikat kepada mana-mana badan kawal selia tempatan dan asing atau individu dalam mana-mana bidang kuasa,
atau pihak berkuasa kerajaan asing ("Pihak Berkuasa yang Berkenaan") di mana pihak Syarikat perlu mematuhi atau memilih bagi mematuhi di
dalam budi bicara sepenuhnya atau bagi memenuhi keperluan undang-undang, peraturan, garis panduan atau terma-terma perjanjian dengan
Pihak Berkuasa yang Berkenaan yang masih berkuatkuasa atau boleh diisytiharkan berkuatkuasa dan sepertimana dipinda dari semasa ke
semasa ("Keperluan Berkaitan").
I also agree to cooperate with the Company to provide any information or documents as may be requested by the Company from time to time
that is required for disclosure by the Company to any Relevant Authorities, in a timely manner and within a reasonable period of time. I
undertake that I must promptly update the Company of any changes to the Relevant Information stated under this application. / Saya juga
bersetuju untuk berkerjasama dengan pihak Syarikat bagi menyediakan sebarang maklumat atau dokumen-dokumen sepertimana diminta oleh
pihak Syarikat dari semasa ke semasa yang diperlukan untuk pendedahan oleh pihak Syarikat kepada Pihak Berkuasa yang Berkenaan dalam
waktu yang bersesuaian dan tempoh yang munasabah. Saya berjanji bahawa saya akan dengan segera mengemaskinikan sebarang
perubahan terhadap Maklumat Berkaitan yang tertera di dalam permohonan ini dengan pihak Syarikat.
I further agree and accept that in case I fail to disclose or update any change to the Relevant Information or submit any requested documents,
the Company may, to the extent permitted under applicable law, take any step to ensure the Company's compliance with the Relevant
Requirements including withholding payment of any amount due to me or my personal representatives under my policy in compliance with the
Relevant Requirements and/or pay such amount withheld to the Relevant Authorities. / Saya seterusnya bersetuju dan menerima bahawa
sekiranya saya gagal untuk mendedahkan atau mengemaskinikan sebarang perubahan terhadap Maklumat Berkaitan atau menyerahkan
sebarang dokumen yang diperlukan, pihak Syarikat boleh, setakat mana yang dibenarkan undang-undang, mengambil sebarang langkah bagi
memastikan pihak Syarikat mematuhi Keperluan Berkaitan termasuklah menyekat bayaran sebarang jumlah yang tertunggak kepada saya atau
wakil-wakil peribadi di bawah polisi saya bagi mematuhi Keperluan Berkaitan dan/atau membayar jumlah tersebut kepada Pihak Berkuasa yang
Berkenaan.
The Company is also entitled to claim, to the extent permitted by law, compensation for any loss, liability or damage which the Company may
suffer as a result of my default as declared above. / Pihak Syarikat juga berhak untuk membuat tuntutan setakat mana yang dibenarkan undang-
undang, pampasan ganti rugi terhadap sebarang kerugian, liabiliti atau kehilangan yang dialami pihak Syarikat akibat kelalaian yang
disytiharkan seperti di atas.
06/01/2022
Signature of Applicant / Tandatangan Pemohon Date / Tarikh
Full Name / Nama Penuh : CHIA SWEE YEE NRIC No. / No. Kad Pengenalan : 820516-05-5218
Allianz Customer Service Center :
Jalan Stesen Sentral 5, Kuala Lumpur Sentral , 50470 Kuala Lumpur
Appendix
Life Assured
Section: Health Questions
Health Question 9: Are you taking any medication(s) regularly? / Adakah anda mengambil sebarang ubat secara berkala?
Health Question 9 answer: No
Section: Occupation, Nationality
Q1 Child
Q2 Malaysian
Applicant
Section: Health Questions
Health Question 9: Are you taking any medication(s) regularly? / Adakah anda mengambil sebarang ubat secara berkala?
Health Question 9 answer: No
Section: Occupation, Nationality
Q1 Teacher
Q2 Malaysian
--------------------------------------------------------------------------------- End of Disclosure --------------------------------------------------------------------------------
I certify that there has been no change in my health condition and that I have not received any medical attention, consultation or examination
whatsover, since the date of my application in e-submission and I agree that this statement shall form part of my application. / Saya mengesahkan
bahawa tidak ada perubahan mengenai kesihatan saya dan saya tidak menerima sebarang perubatan khusus, penerangan atau pemeriksaan
dan sebagainya, semenjak tarikh permohonan dalam sistem e-submission ini saya bersetuju bahawa penyataan ini akan menjadi sebahagian dari
permohonan saya.
Signed at / Malaysia this / 06 day of / 01 month / 2022 year /
Ditandatangani di pada haribulan bulan tahun
4Signature of Life Assured Signature of Witness

Tandatangan Orang Diinsuranskan Tandatangan Saksi

Name of Witness / Nama Saksi
NRIC No. of Witness / No. KP Saksi
Signature of Joint Life Assured / Tandatangan 5Signature of Applicant

OrangDiinsuranskan Bersama Tandatangan Pemohon
Allianz Customer Service Center :

Jalan Stesen Sentral 5, Kuala Lumpur Sentral, 50470 Kuala Lumpur
(Dilesen di bawah Akta Perkhidmatan Kewangan 2013 dan diatur oleh Bank Negara Malaysia)
Customer Fact Find Form

Borang Carian Fakta Pelanggan
Important Notice To Customers (Read Carefully And Understand Fully The Customer Fact Find Form Before Proceeding)
Notis Penting Kepada Pelanggan (Sila Baca Dengan Teliti Dan Fahami Sepenuhnya Kandungan Borang Carian Fakta Pelanggan
Ini)
Your agent must have sufficient information before making a suitable recommendation. The information that you provide will be the basis on
which advice will be given. / Ejen anda mestilah mempunyai maklumat yang cukup sebelum memberi pengesyoran yang sesuai. Nasihat
yang akan diberikan adalah berdasarkan kepada maklumat yang anda berikan.
If you choose not to provide all relevant information requested, your agent may not be able to provide you suitable advice and as a result,
you may risk making a financial commitment to a life insurance policy inappropriate to your needs. / Sekiranya anda memilih untuk tidak
memberi kesemua maklumat yang dikehendaki, ejen anda mungkin tidak akan dapat memberikan nasihat yang sesuai dan akibatnya, anda
mungkin akan mengambil risiko dengan komitmen kewangan pada polisi insurans hayat yang tidak sesuai dengan keperluan anda.
Your agent is required to preserve the confidentiality of information disclosed by you and restrict the use of such information only for the
purpose of recommending life insurance products. / Ejen anda dikehendaki menjaga kesulitan maklumat yang anda berikan dan
menghadkan penggunaan maklumat hanya untuk tujuan mengesyorkan produk insurans hayat.
You must ensure that important information regarding the policy is disclosed to you and that you understand the information disclosed.
Where there is ambiguity, you should seek an explanation from the agent or the insurer. / Anda mestilah memastikan bahawa maklumat
penting tentang polisi tersebut didedahkan dan anda memahami maklumat tersebut. Sekiranya terdapat sebarang keraguan, anda haruslah
mendapatkan penjelasan daripada ejen atau penanggung insurans.
Prior to making a decision to purchase any life insurance policy, you must satisfy yourself that the policy best meets your insurance needs
and resources. / Sebelum membuat keputusan untuk membeli sebarang polisi insurans hayat, anda mestilah memastikan bahawa polisi
tersebut memenuhi keperluan dan keadaan kewangan anda.
Disclosure Of Agent's Status / Pendedahan Status Ejen
I am an insurance agent who represents Allianz Life Insurance Malaysia Berhad and can advise you on Traditional Life Plan/Medical & Health
Plan/Investment-Linked plan, etc. of Allianz Life Insurance Malaysia Berhad (*Delete whichever not applicable). / Saya adalah ejen insurans
yang mewakili Allianz Life Insurance Malaysia Berhad dan boleh memberi nasihat tentang Polisi Insurans Hayat Biasa/Perubatan &
Kesihatan/Berkaitan-Pelaburan, dll. daripada Allianz Life Insurance Malaysia Berhad (*Potongkan mana yang tidak berkenaan).
I receive remuneration from Allianz Life Insurance Malaysia Berhad for providing advice on/selling of their insurance products. / Saya menerima
imbuhan daripada Allianz Life Insurance Malaysia Berhad untuk menyediakan nasihat mengenai/menjual produk insurans mereka.
Client's Choice / Pilihan Pelanggan
Please tick (✓) whichever appropriate. / Sila tandakan (✓) yang berkenaan.
(1) I/We wish to disclose all information requested for in this Form.
(All sections are required to be completed except the sections on "Record of Advice" and "Agent's Declaration and
Acknowledgement".)
Saya/Kami ingin mendedahkan kesemua maklumat yang dikehendaki di dalam Borang ini.
(Semua bahagian perlu diisikan kecuali "Rekod Nasihat" dan "Pengisytiharan dan Pengakuan Ejen".)
(2) I/We wish to disclose partially information requested for in this Form.
(To complete "Potential Areas for Discussion" and any other sections except the sections on "Record of Advice" and "Agent's
Declaration and Acknowledgement".)
Saya/Kami ingin mendedahkan sebahagian maklumat yang dikehendaki di dalam Borang ini.
(Dikehendaki mengisi bahagian "Perkara Berpotensi Untuk Dibincangkan" dan seksyen-seksyen lain kecuali bahagian "Rekod
Nasihat" dan "Pengisytiharan dan Pengakuan Ejen".)
(3) I/We wish to receive product information only and do not wish to disclose any information requested for in this Form.
(Only required to complete the section on Client's Acknowledgement.)
Saya/Kami ingin menerima maklumat tentang produk sahaja dan tidak mahu mendedahkan sebarang maklumat yang dikehendaki
di dalam Borang ini.
(Hanya bahagian Pengakuan Pelanggan perlu dilengkapkan.)
06/01/2022
SDD / CFF / Nov2019 1/8
Signature of Client / Tandatangan Pelanggan Date / Tarikh
Allianz Customer Service Center

Allianz Arena, Ground Floor, Block 2A, Plaza Sentral, Jalan Stesen Sentral 5, Kuala Lumpur Sentral, 50470 Kuala Lumpur
Allianz Contact Center: 1 300 22 5542 Email: customer.service@allianz.com.my AllianzMalaysia allianz.com.my
Potential Areas For Discussion / Perkara Berpotensi Untuk Dibincangkan
Already
Possible Needs Planned To Discuss / Review Priority
Keperluan Yang Berkemungkinan Sudah Untuk Dibincang / Dikaji Semula Keutamaan
Dirancang
Protecting you and your family against loss of income in the
event of death, emergency and yourself against disability and
critical illness
1 Yes 1
Melindungi anda dan keluarga anda daripada kehilangan
pendapatan apabila berlaku kematian, kecemasan dan untuk
diri anda sekiranya hilang upaya dan penyakit kritikal
Planning for old age / retirement /

2 No
Perancangan untuk umur tua / persaraan
Planning for children's education /

3 No
Perancangan untuk pendidikan anak-anak
Regular savings for the future /

4 No
Simpanan berkala untuk masa depan
Lump sum investment /

5 No
Pelaburan sekaligus
Health and Medical plans /
6 No
Pelan Kesihatan dan Perubatan
Others /
7 No
Lain-lain
Personal Details / Maklumat Peribadi

Client / Pelanggan Partner / Spouse /
Pasangan
Title and Name / Madam CHIA SWEE YEE
Gelaran dan Nama
NRIC No. /Passport No. / 820516-05-5218
No. KP/Paspot
1.1 Children and Dependants / Anak-anak dan Tanggungan
Name Relationship Date of Birth / Age Sex Years to Support
Nama Hubungan Tarikh Lahir / Umur Jantina Bilangan Tahun
Tanggungan
1.2 Preference / Keutamaan Anda

Investment Preference (Please place an "X" on the scale to give an indication of your risk-return profile)
Keutamaan Pelaburan (Sila tanda "X" pada skala untuk menandakan profil pulangan risiko anda)
Low Risk / Risiko Rendah High Risk / Risiko Tinggi
SDD / CFF / Nov2019 2/8
Low Potential Return / Potensi Pulangan Rendah High Potential Return / Potensi Pulangan Tinggi
1 2 3 X 4 5
My Financial Statement / Penyata Kewangan Saya
1. My Existing Insurance Plans / Pelan Insurans yang sedia ada

Life Assured / Participant
Policy Owner Company Since Inception Type of Plan
Orang Yang Diinsurankan
Pemunya Polisi Syarikat Tarikh Permulaan Jenis Pelan
/ Peserta
Death Benefit Disability Benefit Critical Illness Other Benefits Premium Contribution
Maturity Date
Faedah Kematian Faedah Ketidakupayaan Penyakit Kritikal Faedah Lain Bayaran Pemium
Tarikh Matang
(RM) (RM) (RM) (RM) (RM)
2. Your Financial Analysis / Analisis Keperluan Kewangan Anda
2.1 Income Protection / Perlindungan Pendapatan
Annual Income needed in the event of death or disability RM

Pendapatan Tahunan yang diperlukan sekiranya berlaku kematian atau kecacatan
Years needed for this annual income to be protected

Tahun yang diperlukan untuk pendapatan tahunan ini dilindungi
(-) Existing Life Insurance

RM
(-) Insurans Hayat Sedia Ada
Amount of insurance protection needed

RM
Jumlah perlindungan insurans diperlukan
2.2 Medical/Healthcare Planning / Perubatan/Perancangan Kesihatan
Amount needed for treatment of critical illness

RM
Amaun yang diperlukan untuk rawatan penyakit kritikal
Amount needed for medical / hospitalisation

RM
Amaun yang diperlukan untuk perubatan / kemasukan ke hospital
(-) Existing critical illness protection

RM
(-) Perlindungan penyakit kritikal sedia ada
(-) Existing medical/hospitalisation plan
RM
(-) Pelan perubatan / hospital sedia ada
Amount of critical illness needed

RM
Jumlah penyakit kritikal yang diperlukan
Amount of medical/hospitalisation needed

RM
Amaun perubatan / kemasukan ke hospital diperlukan
SDD / CFF / Nov2019 3/8
2.3 Debt Cancellation / Pembatalan Hutang
Outstanding Loan RM
Pinjaman Tertunggak
No. of years left for loan settlement

Bilangan tahun yang tinggal untuk penyelesaian pinjaman
(-) Existing debt cancellation

RM
(-) Pembatalan hutang sedia ada
Amount needed for debt cancellation

RM
Amaun yang diperlukan untuk pembatalan hutang
Would you like to include critical illness protection? If yes, how much?
RM
Adakah anda ingin menyertakan perlindungan penyakit kritikal? Jika ya, berapa banyak?
2.4 Savings and Investments / Simpanan dan Pelaburan
Investment time frame

Jangka masa pelaburan
Expected annual % returns
Jangka pulangan % tahunan
Amount to be allocated for investment per month

RM
Amaun yang diperuntukkan untuk pelaburan sebulan
2.5 Children's Education / Pendidikan anak-anak
Amount Needed
Years to Existing Children
for Education
Current Age TertiaryEducation Education Fund
Name of Child Amaun yang
No. Umur Tahun ke Dana Pendidikan
Nama Kanak-Kanak Diperlukan
semasa Pendidikan Kanak-Kanak
untuk
Tinggi yang sedia ada
Pendidikan
10
2.6 Retirement Income / Pendapatan Persaraan
No. of years to retirement

Bilangan tahun untuk bersara
Annual amount needed for retirement

RM
Jumlah tahunan yang diperlukan untuk persaraan
No. of years to receive this income

Bilangan tahun untuk menerima pendapatan ini
Existing retirement income

RM
Pendapatan persaraan sedia ada
Amount needed for retirement

SDD / CFF / Nov2019 4/8
RM
Amaun yang diperlukan untuk persaraan
What other sources of income do you expect to rely on during retirement?

Apakah sumber pendapatan lain yang anda harapkan untuk bergantung pada masa persaraan?
3. Your Financial Planning / Perancangan Persaraan Anda
Amount available for Financial Planning:

RM / month / sebulan
Amaun yang tersedia untuk Perancangan Kewangan:
Do you expect your income to change?

No
Adakah anda mengharapkan pendapatan anda berubah?
If so, please indicate the approximate amount

Jika ya, sila nyatakan jumlah anggaran
Record Of Advice / Rekod Nasihat
4.1 Recommendations and Reasons for Recommendation

Pengesyoran dan Tujuan Bagi Pengesyoran Tersebut
Recommended Solution – Priority 1 Reasons for recommending Priority 1
Penyelesaian Pengesyoran – Keutamaan 1 Tujuan bagi mengesyorkan Keutamaan 1
Type of Plan : PLK10 Income Protection - protecting your family against loss of income in the event
Jenis Pelan : of death and yourself against disability and critical illness. /
Frequency of Payment : Annual Perlindungan Pendapatan - melindungi keluarga anda daripada kehilangan
Kekerapan Pembayaran : pendapatan sekiranya berlaku kematian dan diri anda terhadap
Payment Mode : Cash ketidakupayaan dan penyakit kritikal.
Cara Pembayaran : Medical/ Healthcare Planning / Perubatan / Perancangan Kesihatan
Sum Assured/ Participated : 50,000.00
Debt Cancellation – planning for loan settlement / Pembatalan Hutang -
Jumlah Diinsuranskan / Penyertaan :
perancangan penyelesaian hutang
Savings and Investments / Simpanan dan Pelaburan
Children's Education / Pendidikan Kanak-Kanak

Additional Benefits : UMI+00K101, UHCPR, USCRT
Faedah Tambahan : Retirement Income / Pendapatan Persaraan
Others: / Lain-lain:
Recommended Solution – Priority 2 Reasons for recommending Priority 2

Penyelesaian Pengesyoran – Keutamaan 2 Tujuan bagi mengesyorkan Keutamaan 2
Type of Plan : Income Protection - protecting your family against loss of income in the event
Jenis Pelan : of death and yourself against disability and critical illness. /
Frequency of Payment : Perlindungan Pendapatan - melindungi keluarga anda daripada kehilangan
Kekerapan Pembayaran : pendapatan sekiranya berlaku kematian dan diri anda terhadap
Payment Mode : ketidakupayaan dan penyakit kritikal.
Cara Pembayaran : Medical/ Healthcare Planning / Perubatan / Perancangan Kesihatan
Sum Assured/ Participated :
Debt Cancellation – planning for loan settlement / Pembatalan Hutang -
Jumlah Diinsuranskan / Penyertaan :
perancangan penyelesaian hutang
Savings and Investments / Simpanan dan Pelaburan
Children's Education / Pendidikan Kanak-Kanak

Additional Benefits :
Faedah Tambahan : Retirement Income / Pendapatan Persaraan
Others: / Lain-lain:
Action Taken If Different From Recommendations And The Reasons

Tindakan Yang Diambil Sekiranya Berbeza Daripada Saranan Dan Tujuanya
SDD / CFF / Nov2019 5/8
4.2 Agent's Declaration and Acknowledgement / Pengisytiharan dan Pengakuan Ejen
I declare that I will treat the information provided to me in the Customer Fact Find Form with strict confidence and I will use it only for the
purpose of fact finding in the process of recommending suitable insurance products and shall not use it for any other purposes.
The above analysis/advice is based on the facts furnished in the Form. I have taken reasonable steps to ensure that the advice is suitable for
the client, having regard to the facts disclosed and other relevant facts which are made available to me. I also explained to the client about the
features of the product recommended and have given sufficient information to enable the client to make an informed decision.
Saya mengaku akan menjadikan maklumat yang diberikan kepada saya di dalam Borang Carian Fakta Pelanggan sebagai sulit dan saya
hanya akan menggunakannya untuk tujuan carian fakta di dalam proses mengesyorkan produk insurans yang sesuai dan tidak akan
menggunakannya untuk tujuan lain.
Analisa/nasihat di atas adalah berdasarkan fakta yang disediakan di dalam Borang. Saya telah mengambil langkah yang sewajarnya untuk
memastikan bahawa nasihat tersebut adalah bersesuaian untuk pelanggan, dengan mengambilkira fakta yang diberikan dan lain-lain fakta
berkaitan yang diberikan kepada saya. Saya juga telah menjelaskan kepada pelanggan mengenai ciri-ciri produk yang disyorkan dan telah
memberikan maklumat yang mencukupi untuk membolehkan pelanggan membuat keputusan berasas.
LAI SIEW CHING LAI SIEW CHING 06/01/2022

Signature of Agent / Tandatangan Ejen Name of Agent / Nama Ejen Date / Tarikh
Address of Agent / Alamat Ejen:
4.3 Supervisor's Declaration (applicable to agent who has been contracted for one year and below)
Pengisytiharan Penyelia (untuk ejen yang telah dikontrak selama satu tahun dan ke bawah)
I declare that I have reviewed this Customer Fact Find form and to my best belief and knowledge, the advice and recommendation given by
the agent is sound and appropriate.
Saya mengaku bahawa saya telah menyemak borang Carian Fakta Pelanggan ini dan setakat pengetahuan dan kepercayaan terbaik saya,
nasihat dan pengesyoran yang diberikan oleh ejen adalah wajar dan sesuai.
Signature of Supervisor / Tandatangan Penyelia Name of Supervisor / Nama Penyelia Date / Tarikh
4.4 Client's Acknowledgement / Pengakuan Pelanggan

I/We acknowledge that the agent has provided me /us with a copy of the Customer Fact Find Form.
Saya / Kami mengaku bahawa ejen telah memberikan saya/ kami satu salinan Borang Carian Fakta Pelanggan.
I/We acknowledge that the agent has shown me/us the contents of the completed Customer Fact Find form in softcopy and I/we agree
that a soft copy/ physical copy of the same Form will be provided to me/us before the issuance of the policy contract.
Saya/Kami mengakui bahawa ejen telah menunjukkan kepada saya / kami kandungan borang Carian Fakta Pelanggan yang lengkap
dalam bentuk softcopy dan saya / kami bersetuju bahawa satu salinan salinan / salinan fizikal Borang yang sama akan diberikan kepada
saya / kami sebelum kontrak polisi dikeluarkan.
I/We acknowledge that the intermediary has shown or provided me/us the web address of the Insurance.
Saya / Kami mengakui bahawa ejen telah menunjukkan atau memberikan saya / kami alamat web Panduan Perkhidmatan Insurans.
CHIA SWEE YEE 06/01/2022

Signature of Client / Tandatangan Pelanggan Name of Client / Nama Pelanggan Date / Tarikh
This Form should be attached with the application form(s). / Borang ini hendaklah dilampirkan bersama borang permohonan.
A Confirmation of Advice will be sent to you together with the issuance of life insurance policy contract by your insurer.
Pengesahan nasihat akan dihantar kepada anda bersama dengan kontrak polisi insurans hayat anda yang dikeluarkan oleh syarikat insurans
SDD / CFF / Nov2019 6/8
anda.
4.5 Additional Comments and Notes / Komen dan Nota Tambahan

Policy Number /
Nombor Polisi : 8 0 0 5 7 6 7 4 2 4

Level 29, Menara Allianz Sentral, 203, Jalan Tun Sambanthan, Kuala Lumpur Sentral, 50470 Kuala Lumpur
Confirmation of Advice / Pengesahan Nasihat
given to / diberikan kepada
(Name of Client / Nama Pelanggan)
CHIA SWEE YEE
By / Oleh LAI SIEW CHING (Name of Agent / Nama Ejen)
Based on the information provided in the Customer Fact Find form, we have concluded the prioritized financial goals of CHIA SWEE YEE (name of
client) are as follows: / Berdasarkan kepada maklumat yang telah diberikan di dalam Borang Carian Fakta Pelanggan, kami merumuskan
bahawa matlamat kewangan utama untuk CHIA SWEE YEE (nama pelanggan) adalah seperti berikut :
Please Tick (✓) Financial Goals Priority
Sila Tanda (✓) Matlamat Kewangan Keutamaan
1. Protecting you and your family against loss of income in the event of death, emergency and yourself against disability
✓ and critical illness / Melindungi anda dan keluarga anda daripada kehilangan pendapatan apabila berlaku kematian, 1
kecemasan dan untuk diri anda sekiranya hilang upaya dan penyakit kritikal
2. Security in retirement / Jaminan semasa persaraan
3. Provision for your children's education / Peruntukan untuk pendidikan anak-anak anda
4. Regular savings for the future / Simpanan berkala untuk masa hadapan
5. Lump sum investment / Pelaburan sekaligus
6. Health and medical plans / Pelan kesihatan dan perubatan
7. Others / Lain-lain
In order to meet these goals, the following products have been recommended for CHIA SWEE YEE (name of client) to purchase.
Untuk memenuhi matlamat tersebut, produk berikut telah disyorkan kepada CHIA SWEE YEE (nama pelanggan) untuk dibeli.
Mode of Payment
Product (Annual/Half-Yearly/Quarterly/ Sum Bought
Name of Life Assured (Yes/No)
Type Term Premium Monthly/Single) Assured Additional Benefits
Nama Orang
Jenis Tempoh Premium Kekerapan Jumlah Faedah Tambahan Beli
Diinsuranskan
Pelan (Tahunan/Setengah Tahun/Suku Diinsurans (Ya/Tidak)
Tahun/Bulanan/Tunggal)
SIEW EUNG YUE PLK10 99 2592.00 Annual 50,000.00 UMI+00K101, UHCPR, USCRT Yes
Name of Agent / Nama Ejen : LAI SIEW CHING

LAI SIEW CHING NRIC No. / No. KP : 870128-52-5412
Signature of Agent / Tandatangan Ejen Date / Tarikh : 06/01/2022
You may cancel your life insurance policy by returning the policy to your insurance company within 15 days after the delivery of the policy
and your premium contribution will be refunded immediately to you.
Anda boleh membatalkan polisi insurans hayat anda dengan mengembalikan polisi tersebut kepada penanggung insurans anda dalam masa
15 hari selepas anda menerima dokumen polisi tersebut. Premium yang telah anda bayar ditolak apa-apa perbelanjaan perubatan yang
ditanggung akan dipulangkan kepada anda serta merta.
This statement should be attached with the insurance contract and a copy will be kept by the insurance company and the agent.
Kenyataan ini mestilah dilampirkan bersama dengan kontrak polisi insurans dan satu salinan akan disimpan oleh penanggung insurans dan
ejen.
SDD / CFF / Nov2019 7/8

Allianz Contact Center: 1 300 22 5542 Email: customer.service@allianz.com.my AllianzMalaysia allianz.com.my
A Personalised Life Insurance Solution For
Name
CHIA SWEE YEE
Plan
Allianz PowerLink
Presented By
LAI SIEW CHING
Date
06-01-2022

Website: www.allianz.com.my
SI001
Allianz PowerLink
DUTY OF DISCLOSURE
General Important Notice:
1. Consumer Insurance Contract

Pursuant to Paragraph 5 Schedule 9 of the Financial Services Act 2013, if you are applying for this insurance wholly for purposes
unrelated to your trade, business or profession, you have a duty to take reasonable care not to make a misrepresentation in answering the
questions required when applying to Allianz Life Insurance Malaysia Berhad ("ALIM") and in addition disclose any other matter that you
know to be relevant to ALIM's decision in accepting the risks and determining the rates and terms to be applied.
2. Non-Consumer Insurance Contract

Pursuant to Paragraph 4(1) Schedule 9 of the Financial Services Act 2013, if you are applying for this insurance for purposes related to
your trade, business or profession, you have a duty to disclose any matter that you know to be relevant to ALIM's decision in accepting the
risks and determining the rates and terms to be applied and any matter a reasonable person in the circumstances could be expected to
know to be relevant.
3. This duty of disclosure for Consumer and Non-Consumer Insurance Contract shall continue until the time the contract is entered into,
varied or renewed.
4. It is important to notify ALIM of any change in contact details, including the mailing address, mobile phone no., the nominee and/or trustee.
Printed by : LAI SIEW CHING 06-01-2022 @ 09:33:00 Pg. 2

ALIM Imagine 7.4.0 Copyright © 2021 Allianz Life Insurance Malaysia Berhad This Sales Illustration is for pre-sale purpose only
Allianz PowerLink
CLIENT PARTICULARS
Client's Name : SIEW EUNG YUE Sex : Female
Age Nearest Birthday :1 Smoker : Non-Smoker
Premium Mode : Annual Occupation Class :2
Basic Sum Assured (RM) : 50,000.00
Loading : No
PAYOR PARTICULARS
Payor's Name : CHIA SWEE YEE Sex : Female
Age Nearest Birthday : 40 Smoker : Non-Smoker
Loading : No
BENEFITS AND PREMIUMS
Basic/Riders Term Of Sum Assured Annually Half Yearly Quarterly Monthly

Coverage (RM)/Benefit
(RM) (RM) (RM) (RM)
BASIC - PLK10 99 50,000.00
Insurance 2,592.00 1,296.00 648.00 216.00
Investment 0.00 0.00 0.00 0.00
Sub Total Basic Premium 2,592.00 1,296.00 648.00 216.00
Unit Cancellation Riders*
UHCPR 99 50,000.00
UMI+00K101 99 UMI+150
USCRT 30 2,592.00
TOTAL PREMIUM 2,592.00 1,296.00 648.00 216.00
Please add 6% service tax if the policy owner is a business organization or where the policy is absolutely assigned to a business organization.
* No explicit premiums are payable for providing the benefits of unit cancellation riders. The cost for providing the benefits i.e. cost of insurance
(COI) for the unit cancellation riders is levied via cancellation of units directly from the Account Value. COI is automatically deducted on every
COI due date until the policy matures or there is insufficient Account Value. COI will continue to be deducted during non-payment of regular
premium of the policy. Unit cancellation rider COI will be deducted with your consent as per the declaration section in the application form.

Allianz PowerLink
READ Is investment-linked policy right for you? Are you aware of the costs, benefits and risks?
Name of Insurer: Allianz Life Insurance Malaysia Berhad Client's Name: SIEW EUNG YUE
Product Name: Allianz PowerLink Sex: Female
Type of Policy: Regular Premium Investment-Linked Insurance Smoker: Non-Smoker
Ratio of Fund(s) Chosen: 50% in Allianz Life Managed Fund Age: 1
50% in Allianz Life Dynamic Growth Fund
Do you know that ... Have you been advised of ... Have you been told ...
It is flexible but you bear the investment risk? How your premiums will be used?
It is an insurance product that is tied to the performance of the
investment fund(s) which you selected.
Premium paid (a)
Benefits
Unallocated
Premium allocated into Unit Fund (b)
Flexibility to vary your premium amount or coverage if your financial needs premium
change.
Choice of funds depending on the level of risk you are comfortable with. Used to purchase units in
To pay:-
the investment fund(s)
Insurer's own
Risks expenses
The coverage you
You bear the investment risk entirely including poor returns. Commission
Deduct fees & charges: will receive
If your fund performs poorly or your insurer increases your charges to agent/
You may lose your insurance cover; or broker/
financial Insurance charges (c) - to
Your account value may be adversely affected. pay for your insurance cover Sum assured (f)
You may need to increase your premiums or reduce the level of insurance adviser (h)
protection to avoid losing your insurance cover. Minimum amount
Other charges (d) e.g. received on
monthly service charges death/total and
Other products that could better meet your needs? permanent
disability*
Non-participating products: The benefits and coverage period are
guaranteed as long as you pay premiums. Fund management charge
Participating products: In addition to receiving guaranteed benefits and (e)
Note: Upon death,
having a guaranteed coverage period, you can share in the profits (non- the total of the sum
guaranteed) of the participating life fund. assured and
What you may receive account value are
payable
Non-guaranteed account
value (g) - Amount received
on surrender/death/maturity
Fees and charges taken out of your investment fund(s) which reduce the
amount available for investment:-
monthly service charges, fund management charge, Ad Hoc top-up charge,
switching fee, withdrawal penalty and surrender penalty.
*TPD benefit is payable prior to the policy anniversary when the Life Assured
attains age 71 years old, and it is subject to a maximum sum assured of RM8
million (per Life Assured).

Allianz PowerLink

Table 1: Allianz PowerLink (For illustration purposes only. This may not be the benefits that you will receive)
The numbers in the table below illustrate the possible movements of cash flows of the policy, including how fees and charges could impact account values. In order to show the impact of different investment returns on the cash flows, two rates of
return have been chosen, 2% (Scenario X) and 5% (Scenario Y).The actual return rates may be higher or lower than the chosen rates, or even be negative.
Actual returns of the fund will fluctuate (i.e. rise or fall) each year based on the performance of the assets the fund(s) invested in.
Please see the attached fund fact sheet(s) for the past actual annual investment returns.
You should only purchase the riders you need as

The amount you At maturity or upon early cancellation, you may
the cost of the riders will be borne by you. Riders
need to pay receive this amount (amount is not guaranteed)
are optional
Non-Guaranteed Account Value

Allocated Premium Insurance Charges1 (RM) Fund Management Charge (RM)
(RM) Non-Guaranteed Death Benefits3 Commission
End (b) Other (e) (h)
Premium Paid (c) Sum Assured (g) (RM)
of
(RM) Charges1 (RM)
Policy Unit (RM)
(a) Basic (f)
Year RM % cancellation (d) Scenario X Scenario Y Scenario X Scenario Y Scenario X Scenario Y RM %
policy
rider(s)2
1 2,592.00 1,555.20 60.00% 24 1,368 96 10 11 20,000 57 73 20,071 20,091 1,036.80 40.00%
2 2,592.00 1,555.20 60.00% 35 1,372 96 11 12 30,000 101 136 30,127 30,170 1,036.80 40.00%
3 2,592.00 1,555.20 60.00% 47 1,377 96 12 13 40,000 165 233 40,165 40,233 648.00 25.00%
4 2,592.00 2,073.60 80.00% 59 1,385 96 19 21 50,000 705 814 50,705 50,814 648.00 25.00%
5 2,592.00 2,073.60 80.00% 59 918 96 30 32 50,000 1,716 1,888 51,716 51,888 388.80 15.00%
6 2,592.00 2,073.60 80.00% 59 927 96 44 47 50,000 2,722 2,986 52,722 52,986 388.80 15.00%
7 2,592.00 2,462.40 95.00% 59 936 96 63 68 50,000 4,113 4,511 54,113 54,511 - -
8 2,592.00 2,462.40 95.00% 59 945 96 82 89 50,000 5,503 6,076 55,503 56,076 - -
9 2,592.00 2,462.40 95.00% 59 952 96 101 111 50,000 6,891 7,683 56,891 57,683 - -
10 2,592.00 2,462.40 95.00% 59 913 96 121 133 50,000 8,325 9,380 58,325 59,380 - -
15 2,592.00 2,592.00 100.00% 59 1,054 96 227 266 50,000 15,979 19,142 65,979 69,142 - -
20 2,592.00 2,592.00 100.00% 59 1,242 96 324 410 50,000 22,996 29,686 72,996 79,686 - -
30 2,592.00 2,592.00 100.00% 59 1,179 96 510 755 50,000 36,590 55,304 86,590 105,304 - -
40 2,592.00 2,592.00 100.00% 62 1,623 96 694 1,217 50,000 49,826 89,352 99,826 139,352 - -
50 2,592.00 2,592.00 100.00% 154 2,441 96 790 1,739 50,000 56,438 127,686 106,438 177,686 - -
60 2,592.00 2,592.00 100.00% 390 4,664 96 715 2,255 50,000 49,898 164,927 99,898 214,927 - -
70 2,592.00 2,592.00 100.00% 1,181 7,233 96 229 2,496 50,000 12,848 181,382 62,848 231,382 - -
80 2,592.00 2,592.00 100.00% 3,038 11,694 96 - 2,116 50,000 - 150,308 - 200,308 - -
90 - - - - - - - - - - - - - - -
99 - - - - - - - - - - - - - - -
1 The illustrated insurance and other charges are not guaranteed and may be varied from time to time by giving three (3) months notice to policy owners, for example, charges for medical riders may increase due to rising medical costs.
2 Please refer to the table "Insurance Charges for Unit Cancellation Rider(s)" for the breakdown of the insurance charges, if applicable.
3 The death benefit payable is the total of the sum assured and account value.
Where "-" is shown in the non-guaranteed portion, it means that your unit fund is no longer able to pay for your insurance cover. However, the insurance cover can be maintained by increasing the premium.

Allianz PowerLink
Insurance Charges for Unit Cancellation Rider(s)
Insurance Charges (RM)

End of Policy Year Total (RM)
UHCPR USCRT UMI+
1 42 135 1,192 1,368
2 42 138 1,192 1,372
3 42 144 1,192 1,377
4 42 151 1,192 1,385
5 42 159 717 918
6 42 168 717 927
7 42 178 717 936
8 42 187 717 945
9 42 193 717 952
10 42 200 672 913
15 42 279 734 1,054
20 42 351 850 1,242
30 69 91 1,019 1,179
40 144 - 1,479 1,623
50 248 - 2,193 2,441
60 894 - 3,770 4,664
70 1,395 - 5,838 7,233
80 2,650 - 9,044 11,694
90 - - - -
99 - - - -

Allianz PowerLink
Table 2: Rider(s) (Optional)

1. A rider can provide additional protection or enhance existing benefits payable under your basic policy.
2. Riders can be in the form of:
(i) Unit cancellation, where the cost of the rider has been incorporated into the premiums for your basic policy. The rider is therefore funded by deducting charges from your unit fund;
(ii) Premium-paying, where the cost of the rider has not been incorporated into the premiums for your basic policy. Separate premiums to fund the cost of the rider will be required; and
(iii) Top-up, where the premium will enhance the potential investment returns and sustainability of your policy.
Riders Type Annual Premium Paid (RM) Sum Assured (RM)/Benefit Coverage Period (Years)
UMI+00K101 - MediSafe Infinite+ Unit Cancellation Rider Not applicable UMI+150 99
UHCPR03 - HealthCover Plus Unit Cancellation Rider Not applicable 50,000.00 99
USCRT03 - SecureCover (Term) Unit Cancellation Rider Not applicable 2,592.00 30

Product Disclosure Sheet - Allianz PowerLink
PRODUCT DISCLOSURE SHEET

(Read this Product Disclosure Sheet before You decide to take up Allianz PowerLink. Be sure to also read the general terms and conditions.)
Financial Service Provider : Allianz Life Insurance Malaysia Berhad ("Us"/"We"/"Our")
Product Name : Allianz PowerLink
1. What is this product about?

This is a non-participating regular premium investment-linked insurance plan (ILIP) which offers a combination of insurance protection and
investment. If You die or are total and permanently disabled (TPD)* during the term of the Policy, this plan pays a lump sum benefit plus the
value of the investment units at the time of claim. Upon survival of the Life Assured at Policy maturity, You will receive one hundred percent
(100%) of the Account Value established on the Valuation Day immediately after the Maturity or Expiry Date.
The Account Value of the ILIP depends on the price of the underlying units, which in turn depends on the performance of Your chosen
fund.
* Prior to Life Assured attains age seventy one (71) years old (nearest birthday) on the Policy Anniversary and subject to a maximum
Insured Amount of RM8 million per life. Payment of TPD benefit will reduce the basic insured Amount.
2. What are the covers/benefits provided?

(i) The plan covers:
Coverage Benefits (Amount Payable)
Death; or (a) RM 50,000.00 (Insured Amount); plus
(b) 100% of Account Value
TPD; or (a) RM 50,000.00 (Insured Amount); plus
(b) 100% of Account Value
Maturity Benefit (a) 100% of Account Value.
Other Benefits
In Force Guarantee
The Policy Charges for the first three (3) policy years will be deferred (subsequently called the "Deferred Policy Charges") so that this
Policy will not lapse in the event the value of balance of Units in this Policy is insufficient to pay the Policy Charges when due
provided all Premiums due under this Policy are paid no later than thirty-one (31) days from the Premium Due Date and no Units are
withdrawn from this Policy for this duration (subsequently called "the In Force Guarantee feature"). The In Force Guarantee feature
will be forfeited if the total Premium due under this Policy is not paid or paid after the expiry of thirty-one (31) days from the Premium
Due Date.
The Deferred Policy Charges will be deducted from the Account Value when the Account Value becomes sufficient or from the
Insured Amount/Benefits payable under the Basic Policy and Supplementary Contract (if any).
(ii) Fund Chosen

Fund Invested: % Invested
Allianz Life Equity Fund 0
Allianz Life Managed Fund 50%
Allianz Life Dynamic Growth Fund 50%
Allianz Life Equity Income Fund 0
Allianz Life Bond Fund 0
Allianz Life Dana Padu Fund 0
Allianz Life Amanah Dana Ikhlas Fund 0
Allianz Life ASEAN Plus Fund 0
Allianz Life Total Return Asian Equity Fund 0
Allianz Life Global Income Fund 0
100%
(iii) The coverage term for this Plan is 99 years.
Reminder: Please read the sales literature and fund brochure which includes product benefits and objectives of the investment-linked fund.
It is important to select a plan or a combination of funds that suit Your financial goals and risk profile.
3. How much premium do I have to pay?

(i) The total premium that You have to pay and the Policy terms may vary depending on Our underwriting requirements.
(ii) The estimated total premium that You have to pay based on standard risks is:
Annually Half Yearly Quarterly Monthly
RM 2,592.00 RM 1,296.00 RM 648.00 RM 216.00
Please add 6% service tax if the policy owner is a business organization or where the policy is absolutely assigned to a business
organization.
(iii) The premium payment period for this Plan is 99 years.
We will allocate a portion of the premium to purchase units in the investment-linked fund that You have chosen. Any unallocated amount
will be used to pay commissions to agents and Our other expenses. You are advised to refer to the allocation rates given in the sales
illustration.

4. What are the fees and charges that I have to pay?

(a) Insurance charges are deducted monthly from the value of Your units to pay for Your insurance coverage. The insurance charges
may vary by Your attained age, sex, occupation, smoking status and medical rating (if any). The insurance charges will increase
as You grow older.
(b) Monthly Service Charges
A RM 8.00 monthly service charge will be levied every month via cancellation of units.
(c) Fund Management Charge

Each of the Allianz Life Investment-Linked Fund is subject to a Fund Management Charge. The maximum Fund Management
Charge for each of the Fund is as follows. The actual Fund Management Charge will vary according to the actual asset mix of the
fund and will be reviewed by us no less frequent than quarterly basis.
Allianz Life Equity Fund up to 1.50% per annum
Allianz Life Managed Fund up to 1.25% per annum
Allianz Life Dynamic Growth Fund up to 1.50% per annum
Allianz Life Equity Income Fund up to 1.35% per annum
Allianz Life Bond Fund up to 0.75% per annum
Allianz Life Dana Padu Fund up to 1.50% per annum
Allianz Life Amanah Dana Ikhlas Fund up to 1.35% per annum
Allianz Life ASEAN Plus Fund up to 1.50% per annum
Allianz Life Total Return Asian Equity Fund* up to 1.50% per annum
Allianz Life Global Income Fund* up to 1.25% per annum
* The Fund Management Charge as set out above includes fund management fee of the Target Fund. There will be no additional
fee that is charged to you other than the Fund Management Charge above.
(d) Ad Hoc Top-Up Charges

RM 25.00 per request.
(e) Switching Fees

Five (5) free switches are available every policy year. Any subsequent switches will be charged a fee of RM 10.00.
(f) Withdrawal Penalty
A Withdrawal Penalty will be imposed on the withdrawal amount upon withdrawal of units from any fund(s).
Withdrawal Penalty
Policy Year
(% of withdrawal amount)
1 20.00%
2 20.00%
3 and above 0.00%
(g) Surrender Penalty

A Surrender Penalty will be imposed on the Account Value upon surrender of this Policy.
Surrender Penalty
Policy Year
(% of Account Value)
1 20.00%
2 20.00%
3 and above 0.00%
The fees and charges stated above are the current charges and are not guaranteed. We reserve the right to vary the rates above by
giving You at least three (3) months written notice prior to the next Policy Anniversary.

5. What are some of the key terms and conditions that I should be aware of?
(i) Importance of disclosure - You must disclose all material facts such as medical condition and state Your age correctly. You should also
provide sufficient and accurate information to enable Us to advise You on the suitability of the plan, taking into consideration the
appropriateness of the plan to Your needs and circumstances.
(ii) Free-look period - You may cancel Your Policy by giving Us a written request and by returning this Policy to Us within fifteen (15) days or
such longer period as may be specified by Bank Negara Malaysia, from the date of receipt of the Policy by You. We will refund to You the
unallocated premiums, the value of units that have been allocated (if any) at unit price at the next valuation date and any insurance charge
and Monthly Service Charge that have been deducted less any medical fee incurred.
(iii) Account Value - the Account Value of the ILIP depends on the performance of the investment-linked funds selected. The higher the level of
insurance coverage selected, the more units will be absorbed to pay for the insurance charges and the fewer units will remain to
accumulate Account Value under Your Policy.
(iv) In Force Guarantee - The policy charges for the first three (3) policy years will be deferred (subsequently called the "Deferred Policy
Charges") so that this Policy will not lapse in the event the Account Value is insufficient to pay the policy charges when due provided all
premiums due under this Policy are paid no later than thirty-one (31) days from the premium due date and no withdrawal from Account
Value for this duration (subsequently called "the In Force Guarantee feature"). The In Force Guarantee feature will be forfeited if the total
premium due under this Policy is not paid or paid after the expiry of thirty-one (31) days from the premium due date. The Deferred Policy
Charges will be deducted from the Account Value when the Account Value becomes sufficient or from the Insured Amount/benefits
payable under this Policy.
(v) After the In Force Guaranteed period, if the Account Value of the ILIP is insufficient to pay for the insurance and other charges for both the
basic policy and all unit deducting Riders attached to the basic policy when due, You will be given a grace period of thirty one (31) days to
pay Your premium, during which the ILIP will remain in force. However, the ILIP shall lapse at the end of the grace period if any insurance
and other charges shall remain unpaid at the end of the grace period.
(vi) Policy Lapse - The ILIP will lapse when the value of investment units is insufficient to pay for the insurance and other charges.
(vii) Reinstatement - If the ILIP is lapsed due to non-payment of premium, You may upon obtaining Our written consent reinstate it any time
from the due date of the premium. You may refer to the Policy Contract for the terms and conditions of reinstatement.
(viii) Policy Sustainability - The Account Value of this Policy must be projected to be sufficient to pay for the Policy Charges of this Policy,
including any rider(s), up to the Maturity Date. The financial projection of the Policy cashflows, including the Account Value and Policy
Charges, is carried out by Us from time to time as required using Our predefined financial assumptions. In the event that the financial
projection of the Account Value of this Policy is insufficient to pay for the Policy Charges of this Policy and the respective rider(s), if any, up
to the Maturity Date of the Policy, We reserve the right to increase the Premium to ensure that the Account Value is projected to be
sufficient for the deduction of Policy Charges of this Policy and the respective rider(s), if any, up to the Maturity Date.
(ix) Option to Purchase New Plan upon Maturity - You have the option to purchase a new plan upon the Maturity Date or Expiry Date of this
Policy (“Option”) without further health underwriting and provided that the following conditions are met:
(a) The Life Assured meets the eligibility age of the new plan;
(b) You must notify Us of your decision to exercise this Option no earlier than ninety (90) days before the Maturity Date or Expiry Date
by giving Us a written notice to such effect;
(c) The new policy shall be issued in the name of the same Life Assured of this Policy; and
(d) The Insured Amount for the new policy shall not exceed the Insured Amount of this Policy.
Note: This list is non-exhaustive. Please refer to the Policy Contract for the complete terms and conditions under this Plan.
6. What are the major exclusions and limitations under this Plan?
(i) Where the age of the Life Assured is less than forty nine (49) months at the time of death/TPD, the amount payable under this Plan shall
be as follows:-
Age of Life Assured at the Time of Death/TPD % of Insured Amount Payable
13 - 24 months 40%
25 - 36 months 60%
37 - 48 months 80%
* If the Life Assured's age is less than fifteen (15) days old:
We shall pay You the Account Value calculated in the same manner as if the Units are to be cancelled together with unallocated Premium,
Policy Charges and any revision of it, if any, of the premium less the percentage of the premium granted as bonus unit and any expenses
incurred for medical examination.
(ii) This Plan shall not cover suicide within twelve (12) months from the Issue Date or any Reinstatement Date, whichever is later.
If death was due to suicide within twelve (12) months, the amount payable is one hundred percent (100%) of the Account Value together
with the total cost of insurance charged from the Issue Date or Reinstatement Date, whichever is later.
(iii) This Plan shall not cover TPD caused directly or indirectly, wholly or partly, by any one (1) or more of the following events:
(a) attempted self-destruction or self-inflicted injuries while sane or insane;
(b) war, invasion, act of foreign enemy, hostilities or warlike operations (whether declared or undeclared), strike, riot and/or civil
commotion, mutiny, civil war assuming the proportions of or amounting to a popular uprising, rebellion, revolution, insurrection,
military uprising, military or usurped power, martial law, state of siege, terrorist activity or any of the events or causes which
determine the proclamation or maintenance of martial law or state of siege;
(c) accidental events that are directly or indirectly related to the use of atomic, biological or chemical weapons as well as radioactive,
biological or chemical warfare agents or substances;

(d) service in the armed forces in time of declared or undeclared war while under orders for warlike operations or restoration of public
order;
(e) entering, exiting, operating, servicing, or being transported by any aerial device or conveyance except when the Life Assured is a
passenger on a commercial passenger airline on a regular passenger trip over its established passenger route;
(f) any congenital defect which has manifested or was diagnosed before the Life Assured attains seventeen (17) years of age and of
which We were not aware at the Issue Date;
(g) an opportunistic infection or a malignant neoplasm if at the time of disability, there is present in the Life Assured Acquired
Immunodeficiency Syndrome. An opportunistic infection includes but is not limited to Pneumocystis carini pneumonia, organism of
chronic enteritis, virus and/or disseminated fungi infection. A malignant neoplasm includes but is not limited to Kaposi's sarcoma,
central nervous system lymphoma, hairy-cell leukemia and/or other malignancies now known or which become known as immediate
cause of disability or death in the presence of Acquired Immunodeficiency Syndrome; or
(h) pre-existing conditions unless declared by you/the Life Assured and accepted by Us, on or prior to the Issue Date or Reinstatement
Date of your policy, whichever is later.
Note: This list is non-exhaustive. Please refer to the Policy Contract for the complete terms and conditions under this Plan.
7. Can I cancel my Policy?

You may cancel Your Policy by giving a written notice to Us. Buying a regular premium ILIP is a long-term financial commitment. It is not
advisable to hold this Policy for a short period of time in view of the high initial costs. If You find that the fund that You have chosen is no
longer appropriate, You have the flexibility to switch fund. You are allowed five (5) switches per Policy year without any fee. For additional
switches within a Policy year, You will be charged a fee of RM10.00 per switch.
8. What do I need to do if there are changes to my contact details?

It is important that You inform Us of any change in Your contact details including Your address or the address of Your nominee and/or
trustee, if any, to ensure that all correspondences reach You or Your nominee and/or trustee in a timely manner.
9. How do I make a claim?

You may visit www.allianz.com.my for the claims guide. You are advised to submit Your claim (if any) to Us as soon as possible.
10. Where can I get further information?

Should You require additional information about investment-linked insurance, please refer to the insurance info booklet on "Investment-
Linked Insurance", available at all Our branches or You can obtain a copy from the insurance agent or visit www.insuranceinfo.com.my.
If You have any enquiries, please contact Us at:

(licensed under the Financial Services Act 2013 and regulated by Bank Negara Malaysia)
Allianz Arena
Ground Floor, Block 2A
Plaza Sentral, Jalan Stesen Sentral 5
Kuala Lumpur Sentral
50470 Kuala Lumpur
Customer Contact Center : 1 300 22 5542
Email : customer.service@allianz.com.my
11. Other similar types of cover available?

Please contact Us if You wish to know any other similar types of cover that We offer.
IMPORTANT NOTE:
THIS IS AN INSURANCE PRODUCT THAT IS TIED TO THE PERFORMANCE OF THE UNDERLYING ASSETS, AND IS NOT A PURE
INVESTMENT PRODUCT SUCH AS UNIT TRUSTS. YOU MUST EVALUATE YOUR OPTIONS CAREFULLY AND SATISFY YOURSELF
THAT THE INVESTMENT-LINKED INSURANCE PLAN CHOSEN MEET YOUR RISK APPETITE, AND THAT YOU CAN AFFORD THE
PREMIUM THROUGHOUT THE POLICY DURATION. TO INCREASE INVESTMENT VALUE AT ANY TIME, IT IS ADVISABLE THAT YOU
PAY THE ADDITIONAL PREMIUMS AS 'AD HOC TOP-UP'. RETURN ON ANY INVESTMENT-LINKED FUND IS NOT GUARANTEED.
Other Important Notice:

1. You should consider the following before You purchase an ILIP to ensure the Plan suits Your financial needs and goals:
(a) You should satisfy Yourself that this Plan would best serve Your needs and that the premium payable under this Plan is affordable.
(b) Whether the allocation of Insurance Premiums towards protection and investment meets Your financial circumstances;
(c) Whether the investment-linked fund chosen match Your investment objectives and risk appetites;
(d) Whether You understand the financial risk and potential losses that may arise from investing the ILIP;
2. It is advisable for You to nominate a nominee for Your Policy and ensure the nominee is aware of the Policy that You have purchased.
Failure to make a nomination shall cause the delay in paying the Policy moneys to Your beneficiary.
3. You may change the ownership of the Policy by an assignment by giving Us a written notice. The change of ownership of the Policy shall
be effective only after We receive the written notice.
4. Insurance protection shall only be provided effective from the date of issue of the Policy.
5. You are advised to keep the receipt as proof of payment of premiums.
6. The standard time frame required for Us to issue a Policy will be six (6) working days from the submission date of the Application Form
for Life Assurance subject to full documentation received and We are satisfied that no further investigation is necessary.
7. This Plan may qualify for tax relief subject to Inland Revenue Board's approval.
8. It may not be advantageous to replace an existing life insurance Policy with a new one. If You intended to do so, We recommend that You
consult Your present insurer before making a final decision.
9. Surrender value of the Policy is the Account Value less Surrender Penalty (if any). If You surrender Your Policy in the early years, You
may receive an amount which is much lesser than the premiums paid.

10. If premium remains unpaid on the premium due date, the Policy shall be kept in force by effecting a premium holiday. However, there
would be a possibility of the Policy lapsing if the required charges such as cost of insurance and Policy Fee/Monthly Service Charge
including rider charges exceed the value of investment-linked funds units available.
11. You may vary the level of death benefit and premium and switch investment-linked fund. You may also perform Ad Hoc Top-Up at any
time to enhance the investment portion of Your Policy without any change in the insurance coverage. Please refer to the Policy Contract
for the conditions for each of the options.
12. In the event that any sales and services tax, value added tax or any similar tax and any other duties, taxes, levies or imposts (collectively
"Applicable Tax") whatsoever are introduced by any authority and are payable under the laws of Malaysia in connection with any supply
of goods and/or services made or deemed to be made under this Policy, We will be entitled to charge any Applicable Tax as allowed by
the laws of Malaysia. Such Applicable Tax payable shall be paid in addition to the applicable premiums and other charges. All provisions
in this Policy on payment of premiums and default hereof shall apply equally to the Applicable Tax.
This information provided in this Product Disclosure Sheet is valid as at 06-01-2022.

Product Disclosure Sheet - HealthCover Plus

(Read this Product Disclosure Sheet before You decide to take up HealthCover Plus. Be sure to also read the general terms and conditions.)
Financial Service Provider: Allianz Life Insurance Malaysia Berhad ("Us"/"We"/"Our")

Product Name: HealthCover Plus

This is a unit deducting Rider which is attachable to the regular premium investment-linked insurance plan (ILIP). This Rider provides
Critical Illnesses coverage. It pays a lump sum Critical Illness benefit if the Life Assured is diagnosed with Critical Illnesses prior to the
expiry of the Rider.
The total Critical Illness benefit payable shall not exceed one hundred percent (100%) of the Rider Insured Amount. Once one hundred
percent (100%) of the Rider Insured Amount has been paid, this Rider shall then terminate.

(i) This Rider covers:
Insured Amount: RM 50,000.00

List of Critical Illnesses cover:
1. Heart Attack - of specified severity 32. Terminal Illness
2. Coronary Artery Bypass Surgery 33. Motor Neuron Disease - Permanent Neurological Deficit
3. Serious Coronary Artery Disease with Persisting Clinical Symptoms
4. Angioplasty and Other Invasive Treatments for Coronary 34. Loss of Independent Existence
Artery Disease* 35. Brain Surgery
5. Cancer - of specified severity and does not cover very 36. Full-Blown AIDS
early cancers 37. Occupationally Acquired Human Immunodeficiency Virus
6. Heart Valve Surgery (HIV) Infection
7. Surgery to Aorta 38. Deafness - Permanent and Irreversible
8. Primary Pulmonary Arterial Hypertension - of specified 39. Blindness - Permanent and Irreversible
severity 40. Severe Eisenmenger's Syndrome
9. Cardiomyopathy - of specified severity 41. Infective Endocarditis
10. Stroke - resulting in Permanent Neurological Deficit with 42. Poliomyelitis
Persisting Clinical Symptoms 43. Progressive Scleroderma
11. Paralysis of Limbs 44. Chronic Rheumatoid Arthritis
12. Multiple Sclerosis 45. Crohn's Disease with Fistula
13. Alzheimer's Disease/ Severe Dementia 46. Ulcerative Colitis with Total Colectomy
14. Coma - resulting in Permanent Neurological Deficit with 47. Myasthenia Gravis
Persisting Clinical Symptoms
48. Progressive Muscular Atrophy
15. Parkinson's Disease - resulting in Permanent inability to
49. Progressive Supranuclear Palsy
perform Activities of Daily Living
50. Chronic Autoimmune Hepatitis
16. Bacterial Meningitis - resulting in Permanent inability to
perform Activities of Daily Living 51. Chronic Adrenal Insufficiency
17. Benign Brain Tumour - of specified severity 52. Osteogenesis Imperfecta
18. Encephalitis - resulting in Permanent inability to perform 53. Meningeal Tuberculosis
Activities of Daily Living 54. Accidental Fracture of Spinal Column
19. Major Head Trauma - resulting in Permanent inability to 55. Apallic Syndrome
perform Activities of Daily Living 56. Cerebral Aneurysm Requiring Brain Surgery
20. End Stage Lung Disease 57. Multiple Root Avulsions of Brachial Plexus
21. End Stage Liver Failure 58. Stroke Requiring Carotid Endarterectomy Surgery
22. Chronic Aplastic Anaemia - resulting in Permanent Bone 59. Surgery for Idiopathic Scoliosis
Marrow Failure 60. Chronic Relapsing Pancreatitis
23. Fulminant Viral Hepatitis 61. Elephantiasis
24. Third Degree Burns - of specified severity 62. Kawasaki Disease with Heart Complications
25. Kidney Failure - requiring dialysis or kidney transplant 63. Acute Necrohemorrhagic Pancreatitis
26. Major Organ/Bone Marrow Transplant 64. Cerebral Metastasis
27. Muscular Dystrophy 65. Creutzfeldt - Jakob Disease (Mad Cow Disease)
28. Systemic Lupus Erythematosus with Severe Kidney 66. Ebola Hemorrhagic Fever
Complications 67. Pheochromocytoma
29. HIV Infection Due To Blood Transfusion 68. Severe Relapsing Nephrotic Syndrome
30. Loss of Speech 69. Wilson's Disease
31. Medullary Cystic Disease 70. Hydrocephalus
Additional coverage for juvenile:

71. Systemic Arthritis Chronic Child (Still's Disease) 75. Severe Hemophilia
72. Severe Dengue Haemorrhagic Fever 76. Spinal Amyotrophy Children with Type I
73. Insulin-Dependent Diabetes Mellitus 77. Rheumatic fever with Heart Valve Disorders
74. Hand, Foot, Mouth Disease with severe complications
(life threatening)

The additional coverage for juvenile (Critical Illness category 71 to 77 in the table above) expires on the policy anniversary when the
Life Assured attains age nineteen (19) nearest birthday.
*The benefit payable for Angioplasty and Other Invasive Treatments for Coronary Artery Disease shall be fifteen percent (15%) of the
Rider Insured Amount or RM30,000, whichever is lower. This benefit is payable once only. Thereafter, the Rider Insured Amount will
be reduced by the amount paid.
(ii) The coverage term for this Rider is 99 years.

No explicit premiums are payable for this Rider as this is a unit deducting Rider. However, the Cost of Insurance for providing the
insurance coverage for this Rider is not guaranteed and will be charged from the value of Your units. We reserve the right to revise the
Cost of Insurance.
The Cost of Insurance that will be charged and the Rider terms and conditions may vary depending on Our underwriting requirement.

The insurance coverage charges for this Rider are deducted monthly from the value of Your units. The insurance charges will increase as
You grow older. Details of insurance charges for this Rider are given in the sales illustration.
(i) Importance of disclosure - You must disclose all material facts such as medical condition and state Your age correctly. You should
also provide sufficient and accurate information to enable Us to advise You on the suitability of the Rider, taking into consideration
the appropriateness of the Rider to Your needs and circumstances.
(ii) Free-look period - You may cancel Your Rider by giving Us a written request and by returning this Supplementary Contract to Us
within fifteen (15) days or such longer period as may be specified by Bank Negara Malaysia, from the date of receipt of the
Supplementary Contract by You. The amount refunded under this Rider shall be the Cost of Insurance deducted for this Rider, less
any expenses incurred for medical examination.
(iii) When the Account Value of the basic Policy is insufficient to pay for the insurance and other charges for both the basic Policy and
all unit deducting Riders attached to the basic Policy when due, You will be given a grace period of thirty one (31) days to pay Your
premium, during which the basic Policy and this Rider will remain in force. However, the basic Policy and this Rider shall lapse at
the end of the grace period if any insurance and other charges shall remain unpaid at the end of the grace period.
(iv) Waiting period:
(a) the eligibility for Critical Illnesses benefit under the Supplementary Contract of this Rider (except Critical Illness no. 1, 2, 3, 4
and 5 as stated in the list of Critical Illnesses above) will only start thirty (30) days from the Issue Date or date of last
reinstatement, whichever is later.
(b) the eligibility for Critical Illness no. 1, 2, 3, 4 and 5 as stated in the list of Critical Illnesses above under the Supplementary
Contract of this Rider will only start sixty (60) days from the Issue Date or date of last reinstatement, whichever is later.
(v) This Rider is guaranteed renewable. The Cost of Insurance is not guaranteed and We reserve the right to revise the Cost of
Insurance by giving the policyholder three months written notice prior to the next policy anniversary. The adjustment in Cost of
Insurance, if any, will aim to reflect Our claim experience. The Cost of Insurance may also be revised under other justified
circumstances. Such changes, if any, shall be applicable to all Policy Owners irrespective of their claim experience.
Note: This list is non-exhaustive. Please refer to the Supplementary Contract for the complete terms and conditions under this
Rider.
6. What are the major exclusions under this Rider?

(i) Juvenile Lien
Where the age of the Life Assured is less than forty-nine (49) months at the time of diagnosis of a Critical Illness, the benefit payout
under this Supplementary Contract shall be based on the following:
Attained Age of Life Assured at the time of diagnosis % of Benefit Payable
13 months - 24 months 40%
(ii) Survival Period

The Insured Amount will not be payable if the Life Assured dies within thirty (30) days from the date of diagnosis of any one (1) of
the Critical Illnesses.
(iii) This Rider does not cover any Critical Illness caused directly or indirectly, wholly or partly, by any one (1) of the following
occurrences::
(a) any illness or surgery other than diagnosis of or surgery for a Critical Illness as defined herein;
(b) the signs or symptoms of the Critical Illness has manifested prior to or within the Waiting Period;
(c) the Critical Illness arises directly or indirectly from a Pre-Existing Condition as defined, and which has existed prior to the Issue
Date or Reinstatement Date of the Supplementary Contract, whichever is later;
(d) the Critical Illness, where in Our opinion, was caused directly or indirectly by the existence of Acquired Immune Deficiency
Syndrome (AIDS) or by the presence of any Human Immunodeficiency Virus (HIV) infection. We reserve the right to require the
Life Assured to undergo a blood test for HIV as a condition precedent to acceptance of any claim. This exclusion does not
apply to HIV Infection due to Blood Transfusion or Occupationally Acquired Human Immunodeficiency Virus (HIV) Infection as
defined in the Supplementary Contract. For the purpose of the Supplementary Contract,

1. the definition of AIDS shall be that used by the World Health Organization in 1987, or any subsequent revision by the World
Health Organization of that definition.
2. an infection shall be deemed to have occurred where in Our opinion, the blood or other relevant test(s) indicate either the
presence of any Human Immunodeficiency Virus or Antibodies to such a Virus.
(e) any Critical Illness which was diagnosed to be due, directly or indirectly, to a congenital defect or disease, which was
manifested or was diagnosed before the Life Assured attains seventeen (17) years of age;
(f) any Critical Illness caused by a self-inflicted injury;
(g) any Critical Illness resulting directly from alcohol or drug abuse; or
(h) the Life Assured did not survive for at least thirty (30) days after the diagnosis Critical Illness.
Rider.
7. Can I cancel my Rider?

If You find that this Rider is no longer appropriate, You may cancel it by giving Us a written notice.



Should You require additional information about medical and health insurance, please refer to the insurance info booklet on "Medical and
Health Insurance", available at all Our branches or You can obtain a copy from the insurance agent or visit www.insuranceinfo.com.my.

Allianz Arena
50470 Kuala Lumpur
11. Other similar types of cover available.

Please contact Us if You wish to know any other similar types of cover that we offered.
IMPORTANT NOTE:
YOU SHOULD SATISFY YOURSELF THAT THIS RIDER WILL BEST SERVE YOUR NEEDS. YOU SHOULD READ AND UNDERSTAND
THE INSURANCE RIDER AND DISCUSS WITH THE AGENT OR CONTACT US DIRECTLY FOR MORE INFORMATION.

1. You should satisfy Yourself that this Rider will best serve Your needs and that the Cost of Insurance under this Rider is affordable.
2. Insurance protection shall only be provided effective from the date of issue of the Supplementary Contract of this Rider.
For Life Assurance subject to full documentation received and We are satisfied that no further investigation is necessary.
5. It may not be advantageous to replace an existing life insurance Policy with a new one. If You intend to do so, We recommend that You
6. This plan may qualify for tax relief subject to Inland Revenue Board's approval.
"Applicable Tax") whatsoever are introduced by any authority and are payable under the laws of Malaysia in connection with any supply of
goods and/or services made or deemed to be made under this Policy, We will be entitled to charge any Applicable Tax as allowed by the
laws of Malaysia. Such Applicable Tax payable shall be paid in addition to the applicable premiums and other charges. All provisions in

Product Disclosure Sheet - MediSafe Infinite+ and Optional Benefit

(Read this Product Disclosure Sheet before You decide to take up MediSafe Infinite+ and Optional Benefit. Be sure to also read the general
terms and conditions)

Product Name: MediSafe Infinite+ and Optional Benefit

This is a unit deducting investment-linked plan Rider which provides hospitalisation and surgical and specified out-patient treatment
benefits. No Overall Lifetime Limit is imposed for this rider.
This rider comes with options of zero deductible (Base Plan) or a series of deductible amount (ie: RM 5,000, RM 10,000 and RM 30,000).
For deductible plan, this Rider also provides for Retirement Option to convert the current deductible plan to a Base Plan when the Life
Assured attains age sixty (60) nearest birthday on the Policy Anniversary without further underwriting or to continue with the current
deductible level. The Retirement Option must be selected upon application.
"Deductible" means that portion of Eligible Expenses for which You are liable before any benefits are payable under this Rider. The
applicable Deductible amount is set forth in the Policy Schedule. The Eligible Expenses are accumulated on Policy Year basis.
Besides, this Rider also offers optional Hospital Income Benefit which You can attach to enjoy a more comprehensive hospital and
surgical coverage.

You have selected the following:
Plan type: Plan 150
Deductible Option: 0
Retirement Option: No
Hospital Income Benefit: No
(i) Table of Benefits

Plan Type
Overall Annual Limit 850,000 1,500,000 1,600,000 1,700,000 1,800,000 2,000,000 2,500,000
Overall Lifetime Limit No limit
zero deductible (Base Plan); or
Deductible Option
RM5,000, RM10,000 or RM30,000 per Policy Year with Retirement Option at age 60
A) Hospitalisation & Surgical Benefit
Hospital Room & Board (subject to a
1 maximum of one hundred and fifty (150) days 150 200 250 300 350 400 500
per Any One (1) Disability)
Intensive Care Unit (subject to a maximum of
2 one hundred and fifty (150) days per As charged. Subject to Reasonable & Customary Charges*
confinement)
Lodger Benefit (subject to a maximum of one
3 hundred and fifty (150) days per Any One (1) 75 100 125 150 175 200 250
Disability)
4 Hospital Supplies and Services
5 Surgical Fees
6 Anaesthetist Fees
7 Operating Theatre Fees
In-Hospital Physician Visit (subject to a
8
maximum of two (2) visits per day)
Pre-Hospitalisation Diagnostic Tests (within
9
ninety (90) days prior to hospitalisation)
Pre-Hospitalisation Consultation (within ninety
(90) days prior to hospitalisation – maximum
10 As charged. Subject to Reasonable & Customary Charges*
of two (2) General Practitioner and one (1)
Specialist consultations)
11 Organ Transplant
Post Hospitalisation Treatment (within one
12 hundred and eighty (180) days following
discharge from hospital)
Home Nursing Care (subject to a maximum of
13 one hundred and eighty (180) days per
lifetime)
14 Ambulance Fees
15 Day-Care Surgery
As charged.
16 Medical Report Fees Reimbursement Up to a maximum of RM200 per admission for In-Patient treatment or per Disability for Out-
Patient treatment.

B) Out-Patient Treatment Benefits

Emergency Accidental Out-Patient Treatment &
1 thirty (30) days follow up treatment (Annual Up to 1,500 Up to 2,000 Up to 2,500 Up to 3,000 Up to 3,500 Up to 4,000 Up to 5,000
Limit)
Out-Patient Kidney Dialysis Treatment (includes
2 consultation, examination tests and prescribed
take-home drugs)
Out-Patient Dengue or Enteric Fever Treatment As charged. Subject to Reasonable & Customary Charges*
3 (includes consultation, examination tests and
prescribed take-home drugs)
C) Cancer Treatment Benefit
Out-Patient Cancer Treatment (radiotherapy,
chemotherapy, targeted therapy, hormonal
1 therapy or immunotherapy including As charged. Subject to Reasonable & Customary Charges*
consultation, examination tests and prescribed
take-home drugs)
2 Genomic Test for Cancer (per lifetime)
10,000 15,000 20,000 25,000 30,000 35,000 40,000
D) Other Benefits
Reimbursement of the claimable cost, subject to Reasonable and Customary Charges*
1 Second Medical Opinion
(up to a maximum of RM2,000 per annum).
As charged. Subject to Reasonable and Customary Charges*
(limited to one (1) visit per day)
Reimbursement for Alternative Treatment fees
(post Hospitalisation Out-Patient benefit, within Limit per day
2
thirty (30) days following discharge from 150 200 250 300 350 400 500
hospital) Maximum per annum
1,500 2,000 2,500 3,000 3,500 4,000 5,000
3 Intraocular Lens As charged. Subject to Reasonable & Customary Charges*
E) No Claim Benefit
10% increase in the initial rate of Hospital Room and Board Benefit every 3 years,
1 No Claim Reward provided that no claim is made in the previous 3 years and the increased amount
shall not exceed 150% of the initial rate of Hospital Room and Board Benefit.
No Claim Refund
No Claim Period (% of Cost of Insurance Paid** of Preceding
Policy Year)
2 No Claim Refund 1 consecutive Policy Year 10%
* Reasonable and Customary Charges based on Private HealthCare Facilities and Services (Private Hospitals and Other Private HealthCare
Facilities) Regulation 2006 of Malaysia, including any subsequent amendment(s) or enactment of it.
** Cost of Insurance paid does not include Hospital Assistance Fee.
Value Added Service
International Second Medical Opinion
The International Second Medical Opinion is a value added service provided by a third party which gives the Life Assured access to top experts
from around the world to facilitate the medical decision making. A licensed doctor will be assigned to conduct a thorough clinical conversation,
collect all available medical information and identify top experts to provide independent assessment.
If You wish to utilise this service, kindly contact Us for further arrangements.
We reserve the right to amend the terms and provisions of this service or terminate this service by giving you a written notice three (3) months
prior to the revisions.
NOTE:
1. You shall bear the difference in the Hospital Room and Board charges if the Life Assured is hospitalised at a Room and Board which is higher
than his/her eligible benefit.
(ii) You may extend this Rider to opt for the following benefit as shown in the table below. This benefit will be charged by additional unit
deductions.
Plan Type
F) Optional Benefit
Hospital Income Benefit (daily benefit per day of
1 hospitalisation) (maximum thirty (30) days per 75 100 125 150 175 200 300
Disability)
(iii) The coverage term for MediSafe Infinite+ is until Policy Anniversary when the Life Assured attains age one hundred (100) years old
nearest birthday, or until the Basic plan expires, lapses, terminated or surrendered, whichever is the earliest.
(iv) The coverage term for Hospital Income Benefit is until Policy Anniversary when the Life Assured attains age eighty one (81) years old
nearest birthday, or until the Basic plan expires, lapses, terminated or surrendered, whichever is the earliest.


No explicit premiums are payable for this Rider as this is a unit deducting Rider. However, the Cost of Insurance for providing the insurance
coverage for this Rider is not guaranteed and will be charged from the value of Your units.
The Cost of Insurance that will be charged and the Rider terms may vary depending on Our underwriting requirement.
The Cost of Insurance is not guaranteed and We reserve the right to revise the Cost of Insurance.

(i) The insurance coverage charges for this Rider are deducted monthly from the value of Your units. The insurance charges will increase
as You grow older. Details of insurance charges for this Rider are given in the sales illustration.
(ii) Hospital Assistance Fee is charged at RM23.00 per annum by way of cancellation of units. We reserve the right to revise the Hospital
Assistance Fee by giving three (3) months written notice prior to the next Policy Anniversary.
(i) Important of disclosure - You must disclose all material facts such as medical condition, if required, and state Your age correctly. You
should also provide sufficient and accurate information to enable Us to advise You on the suitability of the Rider, taking into
consideration the appropriateness of the Rider to Your needs and circumstances.
Supplementary Contract by You. We will refund to You the insurance charge for this Rider less any expenses incurred for medical
examination.
(iii) When the Account Value of the Basic Policy is insufficient to pay for the insurance and other charges for both the Basic Policy and all
unit deducting Riders attached to the Basic Policy when due, You will be given a grace period of thirty one (31) days to make sufficient
premium payment, during which the Basic Policy and this Rider will remain in force. However, the Basic Policy and this Rider shall
lapse at the end of the grace period if any insurance and other charges shall remain unpaid at the end of the grace period.
(iv) Waiting Period - The eligibility for benefits under this Rider will only start thirty (30) days after the Issue Date, Reinstatement Date or
the date of birth of the Life Assured, whichever is later except for a covered Accident occurring after the effective date of coverage.
For Specified Illnesses, the Waiting Period is one hundred and twenty (120) days. Specified Illnesses shall mean the following
Disabilities and its related complications:
a) Hypertension, diabetes mellitus and cardiovascular diseases;
b) All tumours, Cancers, cysts, nodules, polyps, stones of the urinary system and biliary system;
c) All ear, nose (including sinuses) and throat conditions;
d) Hernias, haemorrhoids, fistulae, hydrocele, varicocele;
e) Endometriosis including disease of the reproduction system;
f) Vertebro-spinal disorders (including disc) and knee conditions.
(v) The Waiting Period for Hospital Income Benefit is thirty (30) days.
(vi) The Cost of Insurance at the time of renewal is not guaranteed and subject to review in future. We reserve the right to revise the Cost
of Insurance by giving three (3) months written notice prior to the next Policy Anniversary. The adjustment in Cost of Insurance, if any,
will aim to reflect Our claim experience, cost of medical treatment, medical inflation and advancement in medical technology. This list
is not exhaustive and the Cost of Insurance rates may also be revised under other justified circumstances. Such changes, if any, shall
be applicable to all Policy Owners irrespective of their policy duration and claim experience.
(vii) In the event the actual daily charge for Hospital Room & Board is below the initial rate of Room & Board Benefit's daily entitlement,
fifty percent (50%) of the balance ("Unutilised Benefit") shall be payable provided that:
a) the total Unutilised Benefit amount payable for each period of Hospital confinement shall not be less than RM50; and
b) the total Unutilised Benefit amount payable for each Policy Year shall not exceed RM5,000.
(viii) We shall review the claims experience for this Supplementary Contract every three (3) years commencing from the Issue Date of this
Supplementary Contract ("Review"). If no claim is made or paid for the three (3) year period prior to each Review, We shall increase
the amount of the Hospital Room and Board Benefit entitlement for the period after each Review by ten percent (10%) of the initial
rate of the Hospital Room and Board Benefit entitlement PROVIDED ALWAYS THAT the increased amount shall not exceed one
hundred and fifty percent (150%) of the initial rate of the Hospital Room and Board Benefit entitlement as per the Issue Date of this
(ix) We shall review the claims experience for this Supplementary Contract every year. If no eligible claim event is registered for the
preceding Policy Year, We shall refund the Cost of Insurance paid in the preceding Policy Year based on the schedule below ("No
Claim Refund"). The refunded amount will be credited into Your Account Value.
No Claim Refund
No Claim Period
(% of Cost of Insurance Paid* of Preceding Policy Year)
* Cost of Insurance paid does not include Hospital Assistance Fee.
If, after a No Claim Refund has been credited into Your Account Value, an eligible claim event from the preceding Policy Year(s) is
subsequently registered, the No Claim Period shall reset based on claim event date and the appropriate amount of No Claim Refund
for the corresponding year(s) shall be debited from Your Account Value.
(x) If the Life Assured elects to or is referred by the attending Physician to be treated outside Malaysia, the benefits in respect of the
treatment shall be limited to the Reasonable and Customary Charges that are Medically Necessary for such equivalent local treatment
in Malaysia and shall exclude the cost of transport to the place of treatment.
For avoidance of doubt, if there is no equivalent local treatment in Malaysia, then the benefits in respect of any treatment outside
Malaysia shall be limited to the cost of the current available alternative treatment in Malaysia for the Life Assured's condition as
recommended by the attending Physician.

(xi) No benefit whatsoever shall be payable for any medical treatment received by the Life Assured outside Malaysia apart from Singapore
and Brunei, if the Life Assured resides or travels outside Malaysia, Singapore and Brunei for more than ninety (90) consecutive days
from the day the Life Assured leaves Malaysia.
Rider.
6. What are the major exclusions under this Rider?

(i) This Rider and its Optional Benefit shall not pay any benefit arising from or accelerated, directly or indirectly, wholly or partly by:
a) Pre-Existing Conditions.
b) Specified Illnesses occurring during the first one hundred and twenty (120) days of continuous cover, whether or not caused by
Accident.
c) Any medical or physical conditions arising during the Waiting Period except for Accidental Injuries.
d) Surgery and/ or treatment related to plastic/ cosmetic purposes, circumcision, eye examination, glasses and refraction or surgical
correction of nearsightedness (Radial Keratotomy or Lasik) and the use or acquisition of external prosthetic, external appliances
or corrective devices such as artificial limbs, hearing aids, pacemakers and prescriptions thereof.
e) Dental conditions including dental treatment or oral surgery except as necessitated by Accidental Injuries to sound natural teeth
occurring wholly during the period of cover.
f) Private nursing, rest cures or sanitaria care, illegal drugs, intoxication, sterilisation, venereal disease and its sequelae, AIDS
(Acquired Immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV related diseases, and any communicable
diseases requiring quarantine by law.
g) Any treatment or surgical operation for Congenital Conditions or deformities including hereditary conditions which was manifested
or was diagnosed before the Life Assured attains seventeen (17) years of age.
h) Pregnancy, child birth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care and surgical, mechanical
or chemical contraceptive methods of birth control or treatment pertaining to infertility, erectile dysfunction and tests or treatment
related to impotence or sterilisation.
i) Hospitalisation primarily for investigatory purposes, diagnosis, X-ray examination, general physical or medical examinations, not
incidental to treatment or diagnosis of a covered Disability or any treatment which is not Medically Necessary and any preventive
treatments, preventive medicines or examinations carried out by a Physician, and treatments specifically for weight reduction or
gain.
j) Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
k) War or any act of war, declared or undeclared, criminal or terrorist activities, active duty in any armed forces, direct participation in
strikes, riots and civil commotion or insurrection.
l) Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from
any nuclear weapons material.
m) Expenses incurred for donation of any body organ by the Life Assured and costs of acquisition of the organ including all costs
incurred by the donor during organ transplant and its complications.
n) Investigation and treatment of sleep and snoring disorders, hormone replacement therapy and alternative therapy (other than the
Alternative Treatment specified in Reimbursement For Alternative Treatment Fees provisions) such as treatment, medical service
or supplies, including but not limited to acupressure, reflexology, bonesetting, herbalist treatment, massage or aroma therapy or
other alternative treatment.
o) Care or treatment for which payment is not required or to the extent which is payable by any other insurance or indemnity
covering the Life Assured and Disabilities arising out of duties of employment or profession that is covered under a Workman's
Compensation Insurance Contract.
p) Psychotic, psychiatric, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic
manifestations).
q) Costs/expenses of services of a non-medical nature, such as television, telephones, telex services, radios or similar facilities,
admission kit/pack and other ineligible non-medical items.
r) Sickness or Injury arising from racing of any kind (except foot racing), hazardous sports such as but not limited to skydiving, water
skiing, underwater activities requiring breathing apparatus, winter sports, professional sports and illegal activities.
s) Private flying other than in any commercial scheduled airlines licensed to carry passengers over established routes.
t) Expenses incurred for sex changes.
u) Experimental Treatments which security and reliability have not been recognised by the medical authority (Ministry of Health) in
Malaysia.
Rider.

If You find that this Rider is no longer appropriate, You may cancel it by giving Us a written notice.




Should You require additional information about medical and health insurance, please refer to the insurance info booklet on "Medical and
Health Insurance", available at all Our branches or You can obtain a copy from the insurance agent or visit www.insuranceinfo.com.my.

Allianz Arena
50470 Kuala Lumpur

Please contact Us if You wish to know any other similar types of cover that We offered.
IMPORTANT NOTE:
Other Important Notices:

1. You should satisfy Yourself that this Rider will best serve Your needs and that the Cost of Insurance under this Rider is affordable.
2. Insurance protection shall only be provided effective from the Issue Date of the Supplementary Contract of this Rider.
4. The standard time frame required for Us to issue a Policy will be six (6) working days from the submission date of the Application Form for
Life Assurance subject to full documentation received and We are satisfied that no further investigation is necessary.
5. It may not be advantageous to replace an existing life insurance Policy with a new one. If You intend to do so, We recommend that You
consult Your present insurer before making the final decision.
laws of Malaysia. Such Applicable Tax payable shall be paid in addition to the applicable premiums and other charges. All provisions in this
Policy on payment of premiums and default hereof shall apply equally to the Applicable Tax.

Product Disclosure Sheet - SecureCover (Term)

(Read this Product Disclosure Sheet before You decide to take up SecureCover (Term). Be sure to also read the general terms and conditions.)

Product Name: SecureCover (Term)

This is a unit deducting Rider which is attachable to the regular premium investment-linked insurance plan (ILIP). If You die, suffer Total
and Permanent Disability (TPD) prior to age sixty five (65) or is diagnosed with any one(1) of the specified thirty six (36) critical illnesses
(as listed below) prior to the expiry of the Rider, We shall contribute on behalf of You the modal premiums of the basic Policy, to purchase
units until the expiry of the Rider term or upon termination of the basic Policy or death of the Life Assured of the basic Policy, whichever is
earlier.

(i) This Rider covers:
Death: RM 2,592.00; or
TPD: RM 2,592.00; or
Critical Illness: RM 2,592.00
List of Critical Illnesses cover:

1. Stroke - resulting in permanent neurological deficit with 19. Major Organ / Bone Marrow Transplant
persisting clinical symptoms 20. Loss of Speech
2. Heart Attack - of specified severity 21. Brain Surgery
3. Kidney Failure - requiring dialysis or kidney transplant 22. Heart Valve Surgery
4. Cancer - of specified severity and does not cover very 23. Terminal Illness
early cancers 24. Bacterial Meningitis - resulting in permanent inability to
5. Coronary Artery By-Pass Surgery perform Activities of Daily Living
6. Serious Coronary Artery Disease 25. Major Head Trauma - resulting in permanent inability to
7. Paralysis of Limbs perform Activities of Daily Living
8. End-Stage Liver Failure 26. Chronic Aplastic Anemia - resulting in permanent Bone
9. Fulminant Viral Hepatitis Marrow Failure
10. Coma - resulting in permanent neurological deficit with 27. Motor Neuron Disease - permanent neurological deficit
persisting clinical symptoms with persisting clinical symptoms
11. Benign Brain Tumour - of specified severity 28. Parkinson's Disease - resulting in permanent inability to
12. Deafness - Permanent and Irreversible perform Activities of Daily Living
13. Third Degree Burns - of specified severity 29. Alzheimer's Disease / Severe Dementia
14. HIV Infection due to Blood Transfusion 30. Muscular Dystrophy
15. Occupationally Acquired Human Immunodeficiency Virus 31. Surgery to Aorta
(HIV) Infection 32. Multiple Sclerosis
16. Full-blown AIDS 33. Primary Pulmonary Arterial Hypertension - of specified
17. End-Stage Lung Disease severity
18. Encephalitis - resulting in permanent inability to perform 34. Medullary Cystic Disease
Activities of Daily Living 35. Cardiomyopathy - of specified severity
36. Systemic Lupus Erythematosus with Severe Kidney
Complications
An Extended Total and Permanent Disability (ETPD) Rider is attachable to this SecureCover (Term) by default at no extra premium
charges to You.
The Extended TPD Riders covers:

1. Blindness - Permanent and Irreversible
2. Loss of Independent Existence
Note: If You wish to terminate this Rider, Your Extended TPD Rider will be terminated automatically.
(ii) The coverage term for this Rider is 30 years.

No explicit premiums are payable for this Rider as this is a unit deducting Rider. However, the cost of insurance for providing the
insurance coverage for this Rider will be charged from the value of Your units. The cost of insurance that will be charged and the Rider
terms may vary depending on Our underwriting requirement.

The insurance coverage charges for this Rider are deducted monthly from the value of Your units. The insurance charges will increase as
You grow older. Details of insurance charges for this Rider are given in the sales illustration.
(i) Importance of disclosure- You must disclose all material facts such as medical condition and state Your age correctly. You should
also provide sufficient and accurate information to enable Us to advise You on the suitability of the Rider, taking into consideration
the appropriateness of the Rider to Your needs and circumstances.

Supplementary Contract by You. We will refund to You the insurance charge for this Rider.
(iii) When the Account Value of the basic Policy is insufficient to pay for the insurance and other charges for both the basic Policy and
all unit deducting Riders attached to the basic Policy when due, You will be given a grace period of thirty (31) days to pay Your
premium, during which the basic Policy and this Rider will remain in force. However, the basic Policy and this Rider shall lapse at
the end of the grace period if any insurance and other charges shall remain unpaid at the end of the grace period.
(iv) Waiting Period-
a) the eligibility for TPD benefits under the Supplementary Contract of this Rider will only be payable provided that the Life
Assured continues to become permanently and totally disabled for at least six (6) consecutive months.
b) the eligibility for Critical Illnesses benefits under the Supplementary Contract of this Rider (except Critical Illness no. 2, 4, 5 and
6 as stated in the list of Critical Illnesses above) will only start thirty (30) days from the Issue Date or date of last reinstatement,
whichever is later.
c) the eligibility for Critical Illness no. 2, 4, 5 and 6 as stated in the list of Critical Illnesses above under the Supplementary
Contract of this Rider will only start sixty (60) days from the Issue Date or date of last reinstatement, whichever is later.
(v) SecureCover is guaranteed renewable.
(vi) The cost of insurance is not guaranteed and is charged according to the attained age of the Life Assured. The adjustment in cost of
insurance (if any) will aim to reflect Our claim experience, cost of medical treatment, advancement in medical technology and etc.
Rider.
6. What are the major exclusions and limitations under this Rider?
(i) This Rider shall not cover suicide, while sane or insane within twelve (12) months from the Issue Date or any Reinstatement Date,
whichever is later.
(ii) This Rider shall not cover any Total and Permanent Disability caused directly or indirectly, wholly or partly, by any one of the
following occurrences or circumstances:
a) attempted self-destruction or self-inflicted injuries while sane or insane;
b) war, invasion, act of foreign enemy, hostilities (whether declared or not), strike, riot and/or civil commotion, civil war, rebellion,
revolution, insurrection, military, usurped power or terrorist activity;
c) accidental events that are directly or indirectly related to the use of atomic, biological or chemical weapons as well as
radioactive, biological or chemical warfare agents or substances;
d) service in the armed forces in time of declared or undeclared war while under orders for warlike operations or restoration of
public order;
e) entering, exiting, operating, servicing, or being transported by any aerial device or conveyance except when the Policy Owner
is on a commercial passenger airline on a regular scheduled passenger trip over its established passenger route as a
passenger;
f) any congenital defect which manifests itself or is diagnosed before the Policy Owner attains seventeen (17) years of age and of
which We were not aware at the time of Supplementary Contract Issue Date;
g) an opportunistic infection or a malignant neoplasm if at the time of disability, there is present in the Policy Owner Acquired
Immunodeficiency. An opportunistic infection includes but is not limited to pneumocystis carini pneumonia, organism of chronic
enteritis, virus and/or disseminated fungi infection. A malignant neoplasm includes but is not limited to Karposi's sarcoma,
central nervous system lymphoma, hairy-cell leukemia and/or other malignancies now known or which become known as
immediate cause of disability or death in the presence of Acquired Immunodeficiency Syndrome; or
h) pre-existing conditions unless declared by You/the Life Assured and accepted by Us, on or prior to the Issue Date or
Reinstatement Date of Your Supplementary Contract, whichever is later.
(iii) This Rider shall not cover:
a) Any critical illness, other than Critical Illness no. 2, 4, 5 and 6 as stated in the list of Critical Illnesses above, which first
manifests itself prior to the thirtieth (30th) day following the Issue Date or date of last reinstatement of the Supplementary
Contract of this Rider, whichever is later; or
b) Critical Illness no. 2, 4, 5 and 6 as stated in the list of Critical Illnesses above, which first manifest itself prior to the sixtieth
(60th) day following the Issue Date or date of last reinstatement of the Supplementary Contract of this Rider, whichever is later;
or
c) Any critical illness which existed at the Issue Date or date of last reinstatement of the Supplementary Contract of this Rider,
whichever is later; or
d) Any critical illness which is due to self-inflicted injuries while sane or insane.
Rider.

If You find that this Rider is no longer appropriate, You may cancel Your Supplementary Contract of the Rider by giving a written notice to
Us. The Extended TPD Rider will also be cancelled.




Should You require additional information about investment-linked and medical and health insurance, please refer to the insurance info
booklet on "Investment-Linked Insurance" and "Medical and Health Insurance", available at all Our branches or You can obtain a copy
from the insurance agent or visit www.insuranceinfo.com.my.

Allianz Arena
50470 Kuala Lumpur

Please contact Us if You wish to know any other similar types of cover that We offer.
IMPORTANT NOTE:

1. You should satisfy Yourself that this Rider will best serve Your needs and that the cost of insurance under this Rider is affordable.
2. Insurance protection shall only be provided effective from the date of issue of the Supplementary Contract of this Rider.
For Life Assurance subject to full documentation received and We are satisfied that no further investigation is necessary.
5. It may not be advantageous to replace an existing life insurance Policy with a new one. If You intended to do so, We recommend that You
laws of Malaysia. Such Applicable Tax payable shall be paid in addition to the applicable premiums and other charges. All provisions in

ALLIANZ LIFE INVESTMENT FUNDS
FUND FACT SHEET
Allianz Life Equity Fund Allianz Life Managed Fund
1. Investment Objective 1. Investment Objective

An open-ended investment fund which aims to provide An open-ended investment fund which aims to provide
medium to long term capital appreciation by investing in medium to long term capital appreciation by investing in a
equities and equity-related securities. diversified equities and equity-related securities, fixed income
securities and money market instruments.
2. Investment Strategy & Approach
The investment would be a combination of: 2. Investment Strategy & Approach
• Top down analysis of the macroeconomic environment to The investment would be a combination of:
determine asset allocation and sector exposure strategy; and • Top down analysis of the macroeconomic environment to
• Rigorous bottom up analysis which include value analysis determine asset allocation and sector exposure strategy; and
and financial analysis, to select individual stocks to generate • Rigorous bottom up analysis which include value analysis
alpha return. and financial analysis, to select individual stocks/credits to
generate alpha return.
3. Asset Allocation
• Equity allocation - Maximum 95% and minimum 80% of the 3. Asset Allocation
Fund’s NAV • Equity allocation – Maximum 55% and minimum 30% of the
• Liquid assets - Minimum 5% of the Fund’s NAV Fund’s NAV
• Foreign investments - Up to 10% of the Fund’s NAV • Fixed income securities – Maximum 70% and minimum 45%
of the Fund’s NAV
4. Fund Manager
• Foreign investments - Up to 10% of the Fund’s NAV
Allianz Life Insurance Malaysia Berhad
4. Fund Manager
5. Target Market
The fund is suitable for Policy Owner who seeks moderate to
high capital appreciation, has moderate to high risk tolerance 5. Target Market
and has medium to long term investment horizon. The fund is suitable for Policy Owner who seeks low to
moderate capital appreciation, has low to moderate risk
6. Principal risks in investing in the fund
tolerance and has medium to long term investment horizon.
• Market Risk
• Currency Risk 6. Principal risks in investing in the fund
• Country/Foreign Investment Risk • Market Risk
• Specific Security Risk • Currency Risk
• Sector Risk • Country/Foreign Investment Risk
• Liquidity Risk • Specific Security Risk
• Sector Risk
7. Performance Benchmark
• Liquidity Risk
FTSE Bursa Malaysia Top 100 Index
• Interest Rate Risk
Further information on benchmark can be obtained from
• Credit Risk
Bloomberg.
50% FTSE Bursa Malaysia Top 100 Index + 50% 12-Month
Maybank Fixed Deposit Rate
Bloomberg and Maybank https://www.maybank2u.com.my.
FUND FACT SHEET
Allianz Life Dynamic Growth Fund Allianz Life Equity Income Fund

An open-ended investment fund which aims to achieve An open-ended investment fund which aims to provide
superior capital appreciation over the medium to long term medium to long term capital appreciation by investing in
period by investing in a diversified portfolio of stocks with an diversified equities and equity-related securities skewed
emphasis on small-to-medium sized companies. towards potential dividend yielding equities, fixed income
securities and money market instruments.
The investment would be a combination of: 2. Investment Strategy & Approach
• Top down analysis of the macroeconomic environment to The investment would be a combination of:
determine asset allocation and sector exposure strategy; and • Top down analysis of the macroeconomic environment to
• Rigorous bottom up analysis which include value analysis determine asset allocation and sector exposure strategy; and
and financial analysis, to select individual stocks to generate • Rigorous bottom up analysis which include value analysis
alpha return. and financial analysis, to select individual stocks/credits to
generate alpha return.
3. Asset Allocation
• Equity allocation - Maximum 95% of the Fund’s NAV 3. Asset Allocation
• Liquid assets - Minimum 5% of the Fund’s NAV • Equity allocation – Maximum 70% of the Fund’s NAV
• Foreign investments - Up to 10% of the Fund’s NAV • Fixed income securities – Maximum 90% of the Fund’s NAV
4. Fund Manager
Allianz Life Insurance Malaysia Berhad 4. Fund Manager
5. Target Market
The fund is suitable for Policy Owner who seeks superior 5. Target Market
capital appreciation, has high risk tolerance and has medium The fund is suitable for Policy Owner who seeks moderate
to long term investment horizon. capital appreciation, seeks stable income stream, has
moderate risk tolerance and has medium to long term
investment horizon.
• Market Risk
• Currency Risk 6. Principal risks in investing in the fund
• Country/Foreign Investment Risk • Market Risk
• Specific Security Risk • Currency Risk
• Sector Risk
• Liquidity Risk
FTSE Bursa Malaysia EMAS Index
• Credit Risk
Bloomberg.
• Dividend Policy Risk
70% FTSE Bursa Malaysia Top 100 Index + 30% 12-Month
Maybank Fixed Deposit Rate
FUND FACT SHEET
Allianz Life Bond Fund Allianz Life Dana Padu Fund

An open-ended investment fund which aims to provide a An open-ended investment fund which aims to provide
stable income stream and medium to long term capital medium to long term capital appreciation by investing in
appreciation by investing primarily in fixed income securities. Shariah-approved equities and equity related securities.
2. Investment Strategy & Approach 2. Investment Strategy & Approach
The investment would be a combination of: The investment would be a combination of:
• Top down analysis of the macroeconomic environment to • Top down analysis of the macroeconomic environment to
determine asset allocation and sector exposure strategy; and determine asset allocation and sector exposure strategy; and
• Rigorous bottom up analysis which include value analysis • Rigorous bottom up analysis which include value analysis
and financial analysis, to select individual credits to generate and financial analysis, to select individual credits to generate
alpha return. alpha return.
3. Asset Allocation 3. Asset Allocation
• Fixed income securities - Maximum 98% of the Fund’s NAV • Equity allocation - Maximum 95% of the Fund’s NAV
• Liquid assets - Minimum 2% of the Fund’s NAV • Shariah-approved liquid assets - Minimum 5% of the Fund’s
NAV
4. Fund Manager
4. Fund Manager
5. Target Market
The Fund is suitable for Policy Owner who is seeking for
potentially higher returns than fixed deposits, wants to 5. Target Market
diversify his/her overall investment portfolio by including The Fund is suitable for Policy Owner who is looking for fund
bonds as an asset class, seeks stable income stream; and that invests in Shariah-approved investments, seeks
has low risk tolerance. moderate to high capital appreciation, has moderate to high
risk tolerance and medium to long term investment horizon.
• Market Risk 6. Principal risks in investing in the fund
• Currency Risk • Market Risk
• Country/Foreign Investment Risk • Currency Risk
• Interest Rate Risk • Sector Risk
• Credit Risk • Liquidity Risk
• Risk of Non-Compliance with Shariah Requirements
12-month Maybank Fixed Deposit Rate 7. Performance Benchmark
Further information on benchmark can be obtained from 50% FTSE Bursa Malaysia EMAS Shariah Index + 50% 12-
Maybank https://www.maybank2u.com.my. month Maybank Islamic Fixed Deposit Rate
FUND FACT SHEET
Allianz Life Amanah Dana Ikhlas Fund Allianz Life ASEAN Plus Fund

An open-ended investment fund which aims to seek a mix of An open-ended investment fund which aims to provide
regular income stream and possible capital growth over the medium to long term capital appreciation by investing
medium to long term by investing in listed equities, Islamic primarily in ASEAN equities and equity-related securities.
debt instruments and other assets that are permissible under
the Shariah Principles.
The investment would be a combination of:
2. Investment Strategy & Approach • Top down analysis of the macroeconomic environment to
Allianz Life Amanah Dana Ikhlas is a feeder fund that invests determine asset allocation and sector exposure strategy; and
in an underlying fund known as Maybank Malaysia Balanced- • Rigorous bottom up analysis which include value analysis
I Fund which in turn invests in an optimal mix of assets and financial analysis, to select individual credits to generate
comprising of Shariah-compliant equities, Sukuk and Islamic alpha return.
money market instruments. The approach undertaken will
3. Asset Allocation
enable Policy Owner to attain income through investment in
• Equity allocation - Maximum 95% and minimum 80% of the
the above assets.
Fund’s NAV
3. Asset Allocation • Liquid assets - Minimum 5% of the Fund’s NAV
• The Fund feeds minimum 95% into Maybank Malaysia • Foreign investments - Up to 50% of the Fund’s NAV
Balanced-I Fund.
4. Fund Manager
• The Fund has maximum 5% in Shariah-approved liquid
assets.
5. Target Market
4. Fund Manager
The fund is suitable for Policy Owner who is looking for fund
that invests primarily in ASEAN investments, seeks moderate
5. Target Market to high capital appreciation, has moderate to high risk
The fund is suitable for Policy Owner who is looking for fund tolerance and has medium to long term investment horizon.
that invests in securities that are permissible under Shariah
Principles, seeks moderate investment returns by investing in
• Market Risk
securities that are permissible under Shariah Principles, has
• Country/Foreign Investment Risk
moderate risk tolerance and has medium to long term
• Currency Risk
investment horizon.
• Specific Security Risk
6. Principal risks in investing in the fund • Sector Risk
• Market Risk • Liquidity Risk
• Credit Risk
50% FTSE Bursa Malaysia Top 100 Index + 50% FTSE
ASEAN 40 Index
• Sector Risk
• Risk of Non-Compliance with Shariah Requirements
Bloomberg.
50% FTSE Bursa Malaysia EMAS Shariah Index + 50% 12-
month General Investment Account Rate
Bloomberg and Bank Negara Malaysia
http://www.bnm.gov.my.
8. Facts on Collective Investment Schemes (CIS)
i. Name : Maybank Malaysia Balanced-I Fund*
ii. Type : Managed Fund
iii. Fund Manager : Maybank Asset Management Sdn. Bhd
iv. Fund Currency : MYR
Historical actual annual investment returns of Maybank
Malaysia Balanced-I Fund:
Year Return^ Year Return^
2011 8.20% 2016 0.64%
2012 5.80% 2017 4.60%
2013 11.76% 2018 -5.69%
2014 6.48% 2019 5.20%
2015 -1.59% 2020 10.77%
*Maybank Malaysia Balanced-I Fund (previously known as
Maybank Dana Ikhlas) is managed by Maybank Asset
Management Sdn. Bhd. Please refer to https://www.maybank-
am.com.my/product for more information.
^The performance is calculated in Ringgit Malaysia on a daily
average NAV basis for the financial years ended 30
November.
FUND FACT SHEET
Allianz Life Total Return Asian Equity Fund
1. Investment Objective
The Allianz Life Total Return Asian Equity Fund (the “Fund”) aims to provide long-term capital growth and income by investing
in the equity markets of the Republic of Korea, Taiwan, Thailand, Hong Kong, Malaysia, Indonesia, the Philippines, Singapore
and/or the People’s Republic of China (the “PRC”).
• The Fund is a feeder fund that aims to achieve its investment objective by investing into an underlying fund known as Allianz
Total Return Asian Equity Fund (the “Target Fund”) which in turn invests in the equity markets of the Republic of Korea, Taiwan,
Thailand, Hong Kong, Malaysia, Indonesia, the Philippines, Singapore and/or the PRC.
• Please refer to point 7 for further details pertaining the Target Fund.
3. Asset Allocation
• The Fund feeds minimum 95% into the Target Fund.
• The Fund has maximum 5% in liquid assets.
4. Fund Manager
5. Target Market
The Fund is suitable for investors who: pursue the objective of general capital formation/asset optimisation and/or above-
average participation in price changes; have basic knowledge and/or experience of financial products; and are capable of
bearing a financial loss. The Fund may not be suitable for investors who wish to withdraw their capital from the Fund within a
short or medium timeframe.
• Market Risk
• Currency Risk
• Sector Risk
• Liquidity Risk
• Target Fund Risk
7. Information on the Target Fund
Relevant Information of the Allianz Total Return Asian Equity Fund
The following relevant information provided by the Target Fund Manager may be subject to change as and when the Target
Fund Manager deems it appropriate according to the Target Fund’s mandate and objectives as approved by the relevant
regulatory bodies.
Name Allianz Total Return Asian Equity Fund
Type Undertaking for Collective Investment in Transferable Securities (UCITS)
Fund Manager Allianz Global Investors Asia Pacific
Fund Currency USD
Fund Inception Date 3 October 2008
Investment Objective The Target Fund aims at long-term capital growth and income by investing in the equity markets of the
Republic of Korea, Taiwan, Thailand, Hong Kong, Malaysia, Indonesia, the Philippines, Singapore and
the PRC.
Investment Strategy The Target Fund adopts an investment process that is based on bottom up stock selection focuses on
& Approach Growth, Quality and Valuation. A minimum of 70% of Target Fund assets are invested in the equity
markets of the Republic of Korea, Taiwan, Thailand, Hong Kong, Malaysia, Indonesia, the Philippines,
Singapore and/or the PRC. Target Fund assets may be invested in Emerging Markets. A maximum of
30% of Target Fund assets may be invested into the China A-Shares market either directly through
Stock Connect or indirectly through eligible instruments. A maximum of 30% of Target Fund assets
may be held in deposits and/or invested in money market instruments and/or (up to 10% of Target
Fund assets) in money market funds. The Target Fund may use financial derivative instruments for
efficient portfolio management (including for hedging) purposes and/or for the purpose of optimising
returns or in other words investment purposes.
The Target Fund may invest in securities, money market instruments, cash and cash equivalents, as
well as securities that are offered within the scope of initial public offerings, the issuing terms of which
include the obligation to apply for admission to official listing on a stock exchange or in another
Regulated Market and the admission of which is obtained no later than one year after the issue. The
Target Fund may also invest in Undertaking For The Collective Investment in Transferable Securities
(“UCITS”) and other Undertaking For Collective Investments (“UCIs”). The Target Fund may use
financial derivative instruments for efficient portfolio management (including hedging) purposes.
Risk Management The manager of the Target Fund will calculate the global exposure of the Target Fund by using the
Commitment Approach. The Commitment Approach measures the global exposure related solely to
positions on financial derivative instruments which are converted into equivalent positions on the
underlying assets.
FUND FACT SHEET
Historical actual annual investment returns of the Target Fund compared with the benchmark^:
Fund / Year 2011 2012 2013 2014 2015
Return -13.54% 11.68% 19.06% 11.95% 12.12%
Allianz Total Return Asian Equity Fund
Benchmark -14.99% 18.04% 10.40% 11.88% 11.54%
Fund / Year 2016 2017 2018 2019 2020

Return 1.36% 26.75% -16.43% 18.92% 48.20%
Allianz Total Return Asian Equity Fund
Benchmark 10.17% 27.85% -12.56% 16.97% 22.94%
^MYR based
MSCI AC Asia Ex Japan Total Return (Net)
Further information on benchmark can be obtained from Bloomberg and https://sg.allianzgi.com/
FUND FACT SHEET
Allianz Life Global Income Fund
1. Investment Objective
The Allianz Life Global Income Fund (the “Fund”) aims to attain long term income and capital growth by investing in a broad
range of asset classes, in particular in global equity and global bond markets.
• The Fund is a feeder fund that aims to achieve its investment objective by investing into an underlying fund known as Allianz
Global Income Fund (the “Target Fund”) which in turn invest in global equity and global bond markets.
• Please refer to point 7 for further details pertaining the Target Fund.
3. Asset Allocation
• The Fund feeds minimum 95% into the Target Fund.
• The Fund has maximum 5% in liquid assets.
4. Fund Manager
5. Target Market
The Fund is suitable for investors who: pursue the objective of general capital formation/asset optimisation and/or above-
average participation in price changes; have basic knowledge and/or experience of financial products; and are capable of
bearing a financial loss. The Fund may not be suitable for investors who wish to withdraw their capital from the Fund within a
short timeframe.
• Market Risk
• Currency Risk
• Sector Risk
• Credit Risk
• Liquidity Risk
• Target Fund Risk
7. Information on the Target Fund
Relevant Information of the Allianz Global Income Fund
The following relevant information provided by the Target Fund Manager may be subject to change as and when the Target
Fund Manager deems it appropriate according to the Target Fund’s mandate and objectives as approved by the relevant
regulatory bodies.
Name Allianz Global Income Fund
Type Undertaking for Collective Investment in Transferable Securities (UCITS)
Fund Manager Allianz Global Investors US
Fund Currency USD
Fund Inception Date 15 Oct 2020
Investment Objective The Target Fund aims to attain long term income and capital growth by investing in a broad range of
asset classes, in particular in global equity and global bond markets.
Investment Strategy A maximum of 70% of Target Fund assets may be invested in Equities in accordance with the
& Approach investment objective. A maximum of 50% of Target Fund assets may be invested in High-Yield
Investments Type 1*, however Target Fund assets may be invested in Debt Securities that are only
rated CC (Standard & Poor’s) or lower (including max. 10% of defaulted securities). Fund assets may
be invested in Emerging Markets. A maximum of 25% of Target Fund assets may be held in deposits
and/or may be invested directly in money market instruments and/or (up to 10% of Target Fund assets)
in money market funds. A maximum of 20% of the Target Fund assets may be invested into the China
A-Shares market and/or into the China B-Shares market and/or the PRC bond markets. The Target
Fund may conduct securities lending transactions, over-the-counter(“OTC”) based repurchase and/or
reverse repurchase transactions and similar OTC transactions in aggregate for up to 80% of the Target
Fund’s assets. The Target Fund may invest in financial derivative instruments for efficient portfolio
management (including for hedging) but will not invest primarily or extensively in financial derivative
instruments for investment purposes.
The Target Fund may invest in equity and debt securities, money market instruments, cash and cash
equivalents, as well as securities that are offered within the scope of initial public offerings, the issuing
terms of which include the obligation to apply for admission to official listing on a stock exchange or in
another Regulated Market and the admission of which is obtained no later than one year after the
issue. The Target Fund may also invest in Undertaking For The Collective Investment in Transferable
Securities (“UCITS”) and other Undertaking For Collective Investments (“UCIs”). The Target Fund may
use financial derivative instruments for efficient portfolio management (including hedging) purposes.
*High-Yield Investments Type 1 means an investment in Debt Securities which at the time of
acquisition has a rating of BB+ or below (Standard & Poor’s and Fitch) or of Ba1 or below (Moody’s) or
the equivalent by another rating agency or, if unrated, as determined by the Investment Manager to be
of comparable quality. In case of a minimum (maximum) investment limit of High-Yield Investment
Type 1 securities according to the Target Fund’s investment restrictions, the lowest (highest) available
rating of a Debt Security at acquisition day is decisive for the assessment of the possible acquisition of
such Debt Security as High-Yield Investment Type 1. Generally, there is no intention to acquire Debt
Securities that are only rated CC, C or D (Standard & Poor’s), C, RD or D (Fitch) or Ca or C (Moody’s)
unless otherwise specified.
FUND FACT SHEET
Risk Management The manager of the Target Fund will calculate the global exposure of the Target Fund by using the
absolute Value-at-Risk approach. The expected level of leverage of derivatives is 0-2. The expected
level of leverage of derivatives of the Target Fund is expressed as a ratio between the aggregate of the
notional values of all derivatives (excluding non-derivative investments) entered into by the Target
Fund and the net asset value of the Target Fund calculated based on the fair market value of all
investments (including derivatives). The actual level of leverage of the Target Fund might change over
time and might temporarily exceed the expected level of leverage of derivatives of the Target Fund.
Derivatives might be used for different purposes including hedging and/ or investment purposes. The
calculation of the expected level of leverage does not distinguish between the different purposes of a
derivative. Therefore this figure delivers no indication regarding the true riskiness of the Target Fund.
Historical actual annual investment returns of the Target Fund^:

Fund / Year 2020*
Allianz Global Income Fund Return 2.09%
* Performance period: 15 October 2020 – 31 December 2020
^ MYR based
Not applicable. No benchmark because no appropriate benchmark is currently available for the Target Fund.
FUND FACT SHEET
Notes
The Policy Owner should be aware that reference to past experience is appropriate but the actual experience could be different.
Investment risks under the Policy will be borne solely by the Policy Owner.
The nature of risk changes according to the investment horizon. Equities are risky when the investment is short. However, fixed income
securities / money market instruments will be risky when the investment horizon lengthens due to the erosion effect as a result of inflation.
The Company reserves the right to suspend issuance or redemption of units under exceptional circumstances such as temporary closure of
any stock exchange in which the fund is invested, during any period when assets in a fund cannot be valued or other circumstances when
the Company, in its discretion, may consider exceptional.
Fund charges:
Types of fund Fund Management Charge
Allianz Life Equity Fund 1.50% per annum
Allianz Life Managed Fund 1.25% per annum
Allianz Life Dynamic Growth Fund 1.50% per annum
Allianz Life Equity Income Fund 1.35% per annum
Allianz Life Bond Fund 0.75% per annum
Allianz Life Dana Padu Fund 1.50% per annum
Allianz Life Amanah Dana Ikhlas Fund 1.35% per annum
Allianz Life ASEAN Plus Fund 1.50% per annum
Allianz Life Total Return Asian Equity Fund* 1.50% per annum
Allianz Life Global Income Fund* 1.25% per annum
* The Fund Management Charge as set out above includes fund management fee of the Target Fund. There will be no additional fee that is
charged to you other than the Fund Management Charge above.
The charges stated above are the maximum charges that We can impose. The actual Fund Management Charge will vary in according to
the actual asset mix of the fund if the fund is invested in more than one investment instrument. The Fund Management Charge will be
reviewed by Us no less frequent than quarterly basis. The Company reserves the right to vary the maximum Fund Management Charge by
giving the Policy Owner at least three (3) months prior written notice.
Although the funds may invest in Shariah-compliant assets, ALIM’s insurance plan is not a Shariah-compliant product.
Other charges include but not limited to government tax, auditor fee, custodian fee & transaction charge.
The price per unit of the fund is the total market value of assets in the fund divided by the total number of units of the fund. To ensure fair
treatment to all unit holders, transaction costs of acquiring and disposing of assets of the fund are recouped by making a dilution or
transaction cost adjustment to the NAV per unit of the fund.
The price per unit of the fund is calculated on daily basis.
Investment Alert
Investments in the funds are not obligations of deposits or guaranteed by the Company.
The performance of the funds is not guaranteed and the value of the units and the income derived therefrom may increase or decrease.
Past returns and any forecast is not necessarily a guide to future performance.
The Company does not warrant or make any representations that the funds will guarantee profits or not result in losses.
Before deciding to invest in the funds, Policy Owner should carefully consider their investment objectives, level of experience and risk
appetite.
Policy Owner should be aware of all the risks associated with fluctuations in an investment-linked fund and are advised to seek the advice
of a financial advisor/consultant before making any investment. In the event that the Policy Owner chooses not to seek advice from a
financial advisor before investing in the fund, he should consider whether the fund is suitable for him.
The Company disclaims any and all liabilities against loss, damages etc direct, indirect or consequential as a result of the Policy Owner’s
reliance of the fact sheet.
FUND FACT SHEET
Historical actual annual investment returns of the funds compared with the selected benchmarks are:
Fund/ Year 2011 2012 2013 2014 2015
Return 5.96% 13.41% 20.53% -3.47% 2.30%
Allianz Life Equity Fund
Benchmark* 0.78% 10.34% 9.83% -6.17% -2.89%
Return 4.87% 8.53% 10.68% -0.13% 2.79%
Allianz Life Managed Fund
Benchmark* 1.94% 6.78% 6.57% -1.48% 0.32%
Return 5.41% 13.18% 19.79% -1.48% 2.48%
Allianz Life Dynamic Growth Fund
Benchmark* 1.10% 9.05% 12.38% -6.13% -2.26%
Return 5.89% 12.37% 14.57% -0.43% 1.79%
Allianz Life Equity Income Fund
Benchmark* 1.47% 8.20% 7.89% -3.37% -0.95%
Return 4.14% 3.88% 1.60% 2.98% 3.06%
Allianz Life Bond Fund
Benchmark* 3.10% 3.22% 3.20% 3.28% 3.35%
Return 7.26% 10.28% 15.32% 0.94% 3.85%
Allianz Life Dana Padu Fund
Benchmark* 2.75% 7.53% 8.25% -0.40% 3.01%
Return - 1.68% 10.35% 0.75% 0.19%
Allianz Life Amanah Dana Ikhlas Fund
Benchmark* - 2.83% 8.17% -0.53% 2.92%
Return - - 1.40% 2.96% 1.92%
Allianz Life ASEAN Plus Fund
Benchmark* - - -1.08% -1.55% -12.78%
Fund/ Year 2016 2017 2018 2019 2020

Return 1.68% 19.76% -19.84% 3.10% -2.78%
Allianz Life Equity Fund
Benchmark* -2.45% 12.74% -9.28% -2.88% 3.49%
Return 2.25% 11.97% -8.76% 4.35% 0.64%
Allianz Life Managed Fund
Benchmark* 0.44% 7.87% -2.99% 0.21% 3.36%
Return 0.00% 18.07% -20.13% 4.98% -5.51%
Allianz Life Dynamic Growth Fund
Benchmark* -2.77% 12.87% -10.93% -1.77% 3.87%
Return 1.17% 15.39% -12.75% 4.10% -0.42%
Allianz Life Equity Income Fund
Benchmark* -0.71% 9.80% -5.52% -1.02% 3.53%
Return 3.47% 3.51% 3.62% 6.02% 5.12%
Allianz Life Bond Fund
Benchmark* 3.25% 3.14% 3.41% 3.25% 2.24%
Return 1.20% 10.99% -11.39% 4.50% -2.24%
Allianz Life Dana Padu Fund
Benchmark* -1.44% 6.91% -5.26% 3.65% 6.66%
Return 0.37% 3.70% -6.43% 5.34% 8.88%
Allianz Life Amanah Dana Ikhlas Fund
Benchmark* -1.41% 6.90% -5.21% 3.82% 7.01%
Return 5.08% 14.13% -18.18% 2.68% -4.66%
Allianz Life ASEAN Plus Fund
Benchmark* 1.77% 20.67% -8.77% 1.05% -3.31%
Past fund performance of Allianz Life Total Return Asian Equity Fund and Allianz Life Global Income Fund are not available as these funds
were launched in 2021.
* The respective benchmarks used prior to 1st December 2013:
Allianz Life Equity Fund : FTSE Bursa Malaysia KLCI

Allianz Life Managed Fund : 50% FTSE Bursa Malaysia KLCI + 50% 12-months Fixed Deposit Rate
Allianz Life Dynamic Growth Fund : FTSE Bursa Malaysia EMAS Index
Allianz Life Equity Income Fund : 70% FTSE Bursa Malaysia KLCI + 30% 12-months Fixed Deposit Rate
Allianz Life Bond Fund : 12-months Fixed Deposit Rate
Allianz Life Dana Padu Fund : 50% FTSE Bursa Malaysia EMAS Shariah Index + 50% 12-months General Investment Account
Rate
Allianz Life Amanah Dana Ikhlas : 50% FTSE Bursa Malaysia EMAS Shariah Index + 50% 12-months General Investment Account
Fund Rate
Allianz Life ASEAN Plus Fund : 50% FTSE Bursa Malaysia Top 100 Index + 50% FTSE ASEAN 40 Index
The performance is calculated in Ringgit Malaysia on a NAV-to-NAV basis1. It is strictly the performance of the investment fund and not the
returns earned on the actual premiums paid of the investment-linked product.
The basis of calculation of past performance is as follows:

( UP31 December 20xx - UP31 December 20xx-1 )
R20xx = x100%
UP31 December 20xx-1
Where:
R20xx is the rate of return
UP31 December 20xx is the price per unit as at 31st December 20xx
UP31 December 20xx-1 is the price per unit as at 31st December 20xx-1
_______________________________________________
1The performance for Allianz Life Amanah Dana Ikhlas Fund and Allianz Life Equity Income Fund is calculated in Ringgit Malaysia on a
NAV-to-NAV basis with gross dividends reinvested.
FUND FACT SHEET
Brief description of the types of risk referred to in this fact sheet are:
Market Risk – The value of the Fund’s investment assets may be affected by changes in economic fundamentals, interest rate movement,
regulatory policy, political and industrial developments. These market factors may result in fluctuations in the value of the Fund’s investment
assets. This risk may be mitigated by ensuring a rigorous review of macroeconomic factors and asset allocation strategy.
Currency Risk – For foreign investment, fluctuations in currency exchange rates may have an impact on the value of the Fund’s investment
assets. This risk may be minimized by engaging in foreign currency hedging.
Country/Foreign Investment Risk – This risk refers to the risks of investing in foreign markets. The value of the foreign investment assets
directly or indirectly held by the Fund may be affected by country-specific factors, such as the country’s economic fundamentals, social and
political stability and regulatory policy. This risk may be mitigated by ensuring a rigorous review of macroeconomic factors and asset
allocation strategy.
Specific Security Risk – The value of the assets in particular securities and money market instruments may be affected by company-
specific factors, such as business situation, financial condition and corporate governance of the company. This risk may be minimized
through diversification of investments in a wide scope of companies belonging to a multitude of sectors.
Sector Risk – The value of the Fund’s investment assets may be adversely affected by the changes in sector-specific factors, such as the
business condition, industry outlook and demand/supply dynamic of the industry. This risk may be minimized through portfolio diversification
and control on sector concentration risk.
Interest Rate Risk – Interest rate risk arises when the value of the securities fluctuates due to interest rate movement. As prices of bonds
move inversely with the interest rates, prices of bonds will decline when interest rate rise and vice-versa. Debt securities with longer
maturity and lower coupon rate are more sensitive to interest rate changes. This risk may be mitigated by rigorous review of asset allocation
and duration strategy.
Credit Risk – The creditworthiness (solvency and willingness to pay) of the issuer of a fixed income security, counterparty to a derivative
contract or money market instrument may subsequently fall. This usually leads to a decrease in the price of the asset greater than that
caused by general market fluctuations. This risk is minimized through portfolio diversification, stringent credit selection and control on sector
concentration risk.
Liquidity Risk – If an asset has insufficient liquidity, there is the risk that the asset cannot be sold or can only be sold at a significant
discount to the purchase price. The lack of liquidity of an asset may cause its purchase price to increase significantly. The risk is managed
by including liquidity factor into security selection and further mitigated by diversification.
Dividend Policy Risk – This risk may occur when there is a significant deterioration in a company’s business or if there is a change in
management policy resulting in a reduction or removal of the company’s dividend policy. Such risk is particularly relevant to a fund that
focuses largely on dividend yielding stocks. This risk can be mitigated by investing mainly in companies with consistent historical record of
paying dividends, companies operating in fairly stable industries or companies with strong cash flows.
Risk of Non-Compliant with Shariah Requirements - For Shariah-approved funds, there is the risk that the fund may hold securities
which are Shariah non-compliant due to:
1) “Shariah-compliant securities” which are subsequently considered “Shariah non-compliant”; and
2) Investment in Shariah non-compliant securities.
The risk of Shariah non-compliant is mitigated by regular review of the Fund’s compliance with the list of securities approved by the Shariah
Advisory Council of the Securities Commission.
Target Fund Risk – As the Fund is a feeder fund, it will invest into a Target Fund which is being managed by a Target Fund Manager. While
we would make every effort to ensure that the objectives of the Target Fund are appropriately aligned with those of ours, we do not have
control over the Target Fund Manager’s investment in terms of its approach, intelligence, operations and management. In the unlikely event
of any mishandling of the Target Fund, the NAV of our Fund, which is investing predominantly into the Target Fund, could be similarly
adversely affected. This risk may be mitigated by our constant monitoring of the Target Fund, which is requisite to ensuring that the Target
Funds’ objective, risk profile and characteristics are in line with ours.
POLICY INFORMATION STATEMENT
This Policy Information Statement contains information which will help You, the Policy Owner, to observe Your obligations under
the Policy and shall be read in conjunction with the provisions contained in the Policy Contract.
1. The proof of age of the Life Assured will be required prior to payment of any benefits under this Policy unless the age
had been admitted.
2. If You are insuring Y our own life under the Policy, t hen You may nominate a person to receive the policy money in
accordance with Schedule 10 Paragraph 2 of the Financial Services Act 2013 at the time of applying the Life
Insurance or after the Policy is issued. For details of the nomination procedure and guidelines, please refer to the
explanatory notes in the nomination form.
3. When a policy (except for MRTA) has acquired a Cash Value:
a) And if it is provided for in the Policy Contract, We shall, subject to the sole security of the Policy, loan to the Policy
Owner an amount which shall not exceed 90% of the Cash Value. The loan shall be subject to interest at the
rate determined by Us. Please enquire with Our Customer Care Department on the applicable loan rate.
b) The Policy Owner may surrender the Policy to receive the Cash Value after it has acquired Cash Value. It m ay not
be advantageous to surrender or replace an existing Life Insurance Policy with a new one. If You intend to do so,
we recommend You to consult Our Customer Care Department before making Your final decision.
For MRTA Policy, in the event the Life Assured has fully discharged the outstanding loan before the expiration of
the term, a surrender value will be refunded.
4. You are advised to pay each and every premium applicable to this Policy on or before its Due Date to keep the
Policy inforce. Subject to the provisions of the Policy Contract, failure to pay premium on or before its Due Date will
cause the Policy to lapse.
5. Your agent is NOT AUTHORISED to collect premiums on behalf of ALIM. Please opt for hassle-free payment method .The
following facilities are available for payment of premium , if applicable :
i) C a s h o r c h e q u e
ii) Auto – De b it f a c i l it y (not applicable t o M R TA )
iii) Banker’s Order/ Standing Instruct ion (not applicable t o M RTA )
iv ) C r e d i t C a r d – S w i p i n g a n d d i r e c t d e b i t
v) Cre dit C ard – t o re mit p ayme nt at He ad Off ice on ly f or M RTA
v i) B i r o A n g k a s a
6. F o r a n y i n f or m a t i o n , e n q u i r y o r s e r v i c e r e l a t i n g t o Y o u r P o l i c y , p l e as e c ont act O ur A llianz

C o n t a c t C e n t e r a t 1-300-22-5542 o r e m a i l Us at customer.service@allianz.com.my.
7. In order for Us to update You with the necessary changes or important information or any Policy related matters,
it is i m p o r t a n t f or You to keep Us informed of Your latest correspondence address as well as latest address of the
nominee(s).
8. Schedule 8 Paragraph 2 of t he Financial Services Act 2013 – A Policy Owner may return the Policy document
within 15 days or such longer period as may be specified by Bank Negara Malaysia, from the receipt date of the
Policy for a full refund. However, the Insurer has the right to deduct any expenses incurred for medical examination /
report.
9. If You are not satisfied with Our decision made in relation to a Life Insurance Policy, the following avenues are available
to You:
Lodging of Complaints
We are committed to maintaining high levels of service, honesty, integrity and trustworthiness. If You have any reason to be
dissatisfied with any of Our products or services, We would like to hear from You. Your feedback is very important to Us as
we are always looking for ways to improve and serve you better.
To provide Us with Your feedback, You may contact Us via the following channels:
Write to: Phone: 1-300-22-5542

Customer Feedback Center Facebook Messenger: @AllianzMalaysia
Allianz Arena Email: customer.service@allianz.com.my
Ground Floor Block 2A Chat: www.allianz.com.my
Plaza Sentral
Jalan Stesen Sentral 5
50470 Kuala Lumpur
Avenues to Seek Redress
You may submit Your complaint to the Ombudsman for Financial Services (OFS) if You are not satisfied with Our final
response or decision in the event that Your complaint is within the scope of the OFS and Your insurance claim does not
exceed RM250,000.00.
PIS / JULY 2019 Page 1 of 2

The OFS can be contacted at the following address:
Ombudsman for Financial Services Phone: 03-2272 2811

(Formerly known as Financial Mediation Bureau) Fax: 03-2272 1577
Level 14, Main Block, Menara Takaful Malaysia Email: enquiry@ofs.org.my
No 4, Jalan Sultan Sulaiman Website: www.ofs.org.my
50000 Kuala Lumpur
If Your complaint does not fall within the purview of the OFS, You may refer Your complaint to
Laman Informasi Nasihat dan Khidmat (LINK) of Bank Negara Malaysia (BNM) at the following address:
Write to (BNMTELELINK): Walk-in (BNMLINK): Phone: 1-300-88-5465

Pengarah Ground Floor, Block D Fax: 03-2174 1515
LINK & Pejabat BNM Bank Negara Malaysia Email: bnmtelelink@bnm.gov.my
Bank Negara Malaysia Jalan Dato' Onn Website: www.bnm.gov.my
P.O. Box 10922 50480 Kuala Lumpur
50929 Kuala Lumpur
You may check with Our Customer Feedback Center on the types of complaints handled by the OFS or BNM before
submitting Your complaint.
10. EU Privacy Law - General Data Protection Regulation (GDPR)

With the recent significant developments in European data protection law, We are taking the opportunity to communicate Our
position on the processing of Your personal data as Your insurer. As a registered Data User Your personal data is being
processed under the Personal Data Protection Act 2010 (“PDPA”) and in accordance with Our Privacy Statement which can
be found at http://www.allianz.com.my. If You have a residential address in any of the European Union (EU) member states,
please reach out to Us at: privacy@allianz.com.my in order for Us to assess and comply with the EU Privacy Law - General
Data Protection Regulation (GDPR).
11. Going Paperless

Effective April 2019, We will send all our notifications and policy related communication to You via Your email address on
record with Us. We will no longer be using paper to notify or communicate with Our policyholders. If You have not registered
Your email with Us, You will receive an SMS notification with a link to Our Allianz Customer Portal, where You can download
our notifications and communication to You, after You have logged in .

Member of PIDM
Allianz Life Insurance Malaysia Berhad is a member of Perbadanan Insurans Deposit Malaysia (PIDM). As a member of PIDM, some of
the benefits insured under the insurance policies offered by Allianz Life Insurance Malaysia Berhad are protected against loss of part or
all of insurance benefits by PIDM, in the unlikely event of an insurer member failure. For further details of the protection limits and
the scope of coverage, please obtain a PIDM information brochure from Allianz Life Insurance Malaysia Berhad or visit PIDM website
(www.pidm.gov.my) or call PIDM toll free line (1-800-88-1266).
PIS / JULY 2019 Page 2 of 2

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Allianz Life Insurance Malaysia Berhad (198301008983)

CHIA SWEE YEE

CASB - SBU_D - 100442-3

Welcome to Allianz Life.

ALLIANZ CUSTOMER SERVICE CENTER

POLICY OWNER POLICY NO. ISSUE DATE

ASSURED NAME NRIC NO. AGE SEX ADMITTED RELATIONSHIP TO

Allianz PowerLink 50,000.00 2,592.00 13/01/2120 99 13/01/2121

TOTAL ANNUAL PREMIUM (MYR): 2,592.00

ALLIANZ CUSTOMER SERVICE CENTER

When used in this Policy,

“ENDORSEM ENT” means variation to this Policy.

“HEAD OFFICE” refers to Our principal place of business.

“INDEBT EDNESS” means any amount due and ow ing to Us.

“ISSUE DATE” means the date Your Policy is issued.

PLK_10V6 / Sept 2021 Page 1 of 13

“PROPOSAL” means Your request for an insurance under this Policy.

“COMPANY/WE/US/OUR” means Allianz Life Insurance Malaysia Berhad.

2. CHANGE OF FREQUENCY OF PREMIUM PAYMENT

1. AMOUNT PAYABLE ON MATURITY/EXPIRY DATE

2. AMOUNT PAYABLE IN THE EVENT OF DEATH

3. AMOUNT PAYABLE IN THE EVENT OF DEATH FROM SUICIDE (SUICIDE CLAUSE)

2. CHANGE OF OWNERSHIP / ASSIGNMENT

3. TRANSFER OF OWNERSHIP (FOR JUVENILE POLICIES ONLY)

3. CHANGE OF PLAN / CONVERSION

4. CURRENCY AND PLACE OF PAYMENT

5. FREEDOM FROM RESTRICTIONS

6. FREE LOOK PERIOD

8. MISSTATEMENT OF AGE AND SEX

PLK_10V6 / Sept 2021 Page 4 of 13

(i) immediately, if delivered personally; or

10. PARTICIPATION IN DIVISIBLE SURPLUS

11. POLICY SUSTAINABILITY

13. REINSTAT EM ENT

To reinstate Your Policy, We require the follow ing:-

14. OPTION TO PURCHASE NEW PLAN UPON MATURITY

PLK_10V6 / Sept 2021 Page 5 of 13

19. CLAIM NOTIFICATION

20. PROOF OF DEATH

21. FILING PROOF OF DEATH

23. APPLICABLE TAX

24. ANTI-MONEY LAUNDERING, ANTI-TERRORISM FINANCING AND PROCEEDS OF UNLAWFUL ACTIVITIES

PLK_10V6 / Sept 2021 Page 6 of 13

1. PURPOSE OF THE FUND

2. INVESTMENT OF THE FUND

The Fund Value shall be equal to the follow ing:

PLK_10V6 / Sept 2021 Page 7 of 13

PLK_10V6 / Sept 2021 Page 8 of 13

PLK_10V6 / Sept 2021 Page 9 of 13

The administration costs (referred to as Service Charges) shall be as follow s:

10. METHOD OF CHARGING THE COST OF INSURANCE

11. WITHDRAWAL OF ASSETS

13. FUND CLOSURE

14. EXCEPTIONAL CIRCUMSTANCES

THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK.

PLK_10V6 / Sept 2021 Page 11 of 13

FUND MANAGED BY Us or any party or person as We may appoint at Our discretion.

Allianz Life Dynamic (i) Up to 95% of NAV in equities and equity

Allianz Life Dana Padu (i) Up to 95% of NAV in Shariah-approved

The Fund has maximum 5% in Shariah-approved

BORROWING RESTRICTIONS No borrow ing is allow ed.

PLK_10V6 / Sept 2021 Page 13 of 13

2. RISKS EXCLUDED PROVISIONS