I, the Cardholder hereby authorise Allianz General Insurance Company (Malaysia) Berhad (“the Company”) to activate Recurring Payments function for the frequency and duration indicated in this payment instruction (“Recurring Payments”) and charge my credit/debit card ("Credit/Debit Card") to pay the insurance premium as invoiced by the Company for the Insured Person’s policy with the Reference ID stated above (“Policy”) together with the relevant one time stamp duty and applicable service tax for the Policy.
I, the Cardholder understand that the Policy shall take effect provided that (1) the first premium payment for the Policy is received by the Company evidenced by the approval from the Credit/Debit Card Company for this direct debit payment instruction; and (2) the Policy application is approved by the Company.
I, the Cardholder, understand and agree that my instructions to activate Recurring Payments by charging my Credit/Debit Card will continue to subsist to pay the relevant premium for the Policy and for subsequent renewals of the Policy unless the Company receives written instructions from me or the Policyholder to do otherwise.
I, the Cardholder understand and agree that the premium upon each yearly renewal of the Policy will increase according to the Insured Person’s attained age and the Company may charge the relevant insurance premium together with the relevant one time stamp duty and applicable service tax for each renewal of the Policy.
I, the Cardholder and the Policyholder/Insured Person understand that the Policy will not be effective if this direct debit authorization payment instruction is subsequently rejected by the Credit/Debit Card Company and that the Insured Person may not receive the benefits of the Policy in the event of any claim.
I, the Cardholder further agree and consent that the Company and/or its service providers may collect, use and process personal information (whether obtained in this payment instruction or otherwise obtained) and disclose such information in accordance with the Company's Privacy Statement (Notice to Customers of Allianz General Insurance Company (Malaysia) Berhad on the Personal Data Protection Act 2010) which can be found on the Company's website at https://www.allianz.com.my/.
I, the Cardholder, declare that at the time of application, the Policyholder/Insured Person and I have not been convicted and are not in any way committing or involved in any offences under the Anti-Money Laundering, Anti-Terrorism Financing and Proceeds of Unlawful Activities Act 2001("AMLATFPUAA") and sections 130N, 130O, 130P or 130Q of the Penal Code.
I, the Cardholder understand and agree that all refund of premiums for the Policy, if any, shall be made to the account of the Policyholder.