Summary

IMPORTANT NOTICE TO SUBMITTER

If you, the submitter of this application, are submitting this form for another person who is the actual Policyholder; and in consideration for EQ Insurance Company Ltd processing this application upon your request:

1. You agree that you have been validly & legally authorised by the Policyholder to do so; and
2. You warrant that you have shown this entire completed application to the intended Policyholder and had obtained his/her agreement & consent to everything; and
3. You, in your personal capacity, agree to indemnify and keep EQ Insurance Company Ltd indemnified against all proceedings, costs, expenses, claims, liabilities, losses or damages if any part of this application turns out to be false and whatsoever, on a strict liability basis, that is, even if your state of mind was unintentional, intentional, negligent, inadvertent, accidental, unknowing, etc.

General Declaration

Each and every person seeking to be insured warrants and declares that:

1. He/she has received, read or been advised and understood, the contents of the brochure and any information material relating to this insurance product.
2. He/she understands and agrees that this insurance is in force only if an application is accepted by EQ Insurance Company Limited, premium payment received in full and a Certificate of Insurance is issued.
3. He/she is aware and accepts the Policy terms, conditions and exclusion.
4. He/she is in good health and free from any physical impairment, infirmity, deformity or illness.
5. He/she is not travelling against the advice of any doctor or for the purpose of obtaining medical treatment.
6. None of the intended persons to be insured have already left Singapore on any trip meant to be covered by this insurance policy.
7. He/she is unaware of any circumstance which is likely to lead to the cancellation or curtailment of the journey.
8. The information given and answers to questions in this application are true and correct to the best of his/her knowledge and have not withheld any facts likely to influence EQ Insurance Company Limited's assessment of this application.
9. He/she agrees and authorizes any hospitals, clinics, insurance companies or any other organization to release to EQ Insurance Company Limited at any time any information concerning the Insured Person if required.
10. By submitting his/her information through this application or through other means, he/she agrees that the information may be used and disclosed by EQ Insurance Company Limited to individuals/organizations associated with EQ Insurance Company Limited or any selected third party (within or outside Singapore) for any matters relating to this application, for the purpose of processing claims, and to provide advice or information concerning products and services which EQ Insurance Company Limited believes may be of interest to him/her and to communicate with him/her for any purpose.

Personal Data Collection Statement

I agree and consent that EQI may collect, use and process my personal information (whether obtained In this application form or otherwise obtained) and disclose such information to the following whether in or outside of Singapore: third party service vendors, suppliers, reinsurers, intermediaries, medical professionals and institutions, dispute resolution parties, courts, parties who investigate, administer and adjudicate claims; financial institutions; industry associations, any regulatory, government and statutory body, for the purpose stated in EQI's Data Privacy Policy which includes:

1. processing, underwriting, administering and managing my relationship with EQI,
2. make or obtain payments and recovering any debt owed to us,
3. processing any claims under your policy, including the settlement of claims and any necessary investigations relating to the claims;
4. complying with all applicable laws, including reporting to regulatory and industry entities.

Note: Please refer to the full version of EQI's Data Privacy Policy found at http://www.eqinsurance.com.sg/CorporatePolicies before providing your consent.