12. HomeCare Insurance May2021 V1 - FWD

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DeclarationFWD in Hong KonguenI/WE HEREBY DECLARE AND AGREE THAT:1. The information and particulars provided on this application form are accurate, true andcomplete and are given to the best of my knowledge and belief. I/VIie have not withheld anymaterial information and accept that this application and declaration shall form the basis ofthe contract between the Company and me/us. I hereby acknowledge that failure to supplytrue and accurate answers to this application or inform the Company of all materialinformation about this application may render the the Company unable to accept orprocess this application or the insurance policy void.2. The insurance coverage applied for shall only take effect when this application has beenaccepted by the Company and I/We have paid the required premium.3. (If applicable) I/We have obtained the authorisation from the insured person to provide theinformation requested in this application and to deal with and receive or requestinformation concerning the insured person from the Company in relation to any mattersarising from this application. I/We further acknowledge that the insured person has beenexplicitly informed and agrees that his/her personal data will be transferred to theCompany for the purpose of this application and has been informed of his/ her rights underthe Personal Data (Privacy) Ordinance.4. I/we have read, understood and accepted the PICS.The Company intends to send you marketing communications or materials and use yourPersonal Data in accordance with paragraphs 8 & 9 of the PICS. If you do not agree toreceive such marketing communications or the Company's intended use of yourPersonal Data, please tick below to exercise your right to opt-out. Opt-out marketing communications or materials and the Company's intended use of mypersonal dataFWD spans Hong Kong, Macau, Thailand, Indonesia, the Philippines, Singapore, Vietnam, Japanand Malaysia. In Hong Kong, the FWD life insurance and general insurance businesses have beenassigned strong financial strength ratings by international rating agencies, and offer customerslife, medical insurance, general insurance, employee benefits, and financial planning.FWD is focused on creating fresh customer experiences and making the insurance journeysimpler, faster and smoother, with innovative propositions, and easy-to-understand and relevantproducts, supported by digital technology. Through this customer-led approach, FWD aims tobecome a leading pan-Asian insurer with a vision to change the way people feel about insurance.Established in Asia in 2013 with a trailblazer mentality, FWD is the primary insurance business ofinvestment group, Pacific Century Group.FWD in Hong Kong offers*Life InsuranceProducts range from individual life insurance, medical and criticalillness protection plans, savings plans, educational reserves forchildren, legacy, retirement plans, investment-linked insurance, andmore.General InsuranceA wide spectrum of insurance solutions for individual and corporatecustomers, including household, motor, personal accident, individualmedical, property, travel, working holiday, overseas study, golf, marinecargo, pet, business pack, office, and more.Employee BenefitsAn array of group life and health insurances are available to protectand retain corporations' invaluable assets - employees. Group lifesolutions cover members for total and permanent disablement, death,accidental death and dismemberment benefits and more, while grouphealth solutions protect members with medical insurance andlong-term disability income etc.Financial PlanningProfessional financial advisers help customers analyse their financialsituations and propose tailor ed plans to build and boost customers'wealth and investment portfolios.Where the Applicant(s) has/have an Insurance Broker:I/We understand, acknowledge and agree that, as a result of the purchasing and taking up thepolicy by me/us, with the policy issued by the Company, the Company will pay my/ourauthorized insurance broker commission during the continuance of the policy includingrenewals, for arranging the said policy. (If applicable) Where the applicant is a bodycorporate, I/We am/are the authorized person(s) signing on behalf of the applicant and I/Wefurther confirm to the Company that I/We am/are authorized to do so.I/We understand that the above agreement is necessary for the Company to proceed with theapplication.I21 .A. f.llil'l, Jlt PJl:Mifill!il: :1. Jlt alH1!P'IPlim:1!1:a';J &!ffifl1l "l,l ;iJliil!li , Jlil'&. .)Ji:'!'f;z f!! , :Mi.!H lill:zl A / f.llil'll'Ji &l'Jimiiii1'F;,;g:a';) 0 21 .A. f.llil'ltt5 HH DllifffoJm 'i'l'fl&fill!il:Jlt al mZP'l@& PJl/m . .21 0lal&:zl A ttil'lz1Jil zff(1JiHIHI O 21 .A. ttil'lttJltlii ,* m,1tl!i;i;:&2"liil!li z1t ll 21 0lalfffoJ1ill!IJ1t1Jil z!l! 1t , :moJ l'&:zl z}la],f: f1!:l't Jltf,il :,js:jjjllp. llJ( 0I II2. 1Jil - el tt:zl ll21 0lal!1! &21 .A. / f.\l-fl'lBl!iSel!,f .tf,ilft l!iloJ llJ(013. (lmMl 21 .A. f.llil'lB!l: t1Jil.A.wt m,!\21 ,aliii1iJz-tn , ttw.X21 ztm111 :i:l: , W21 0lall!H'i'Se5!v , ttioJ:ll:U'!l& mtW:l'ti,-'U1illllz'i'l'fl O 21 .A. / f.\lil'lttlii :'i'tilil.A.B!IPJlliill D&fillli, , :lt@.A.Jt J(f M1)- :zl 0la.li'Flll 21 ;z /ll , WSBti D :ltttil!I.A.Jtfl ( ) ill' i9ffPli 1l"a';Jl!l Ll 021tA / J.l!fl"lBl!llllli , IIJll l&!i'!ii!Uffi!Ai!l lf PJl ,* --ioJM m rn - &ffl H@AW IIJlMB&M9 UM @ Life Insurance, employee benefits and financial planning are offered by FWD Life Insurance Company(Bermuda) Limited and General Insurance is offered by FWD General Insurance Company Limited mt wffl lil:ir 1' , iU , iil llll , WiE , nini: , 1iiin !Ei , , a 21 &. ,1nil:o: , i' , iima';J.A.l!iilil &- 1Jil ui:Paill[ll]P/i H&l Ulnl . a';JM llfjJ , ttmi!\.A. &llfffif,il -Jill!f,il , iiii111ifLl , &M ffilLlijbl 0lil:mw5:t. .S/StiUmfir1iiil!H,, Jlllti:lilU , mmM!\'!, !Jl'fl]Jl,l;,t,,a';JgLl/lJi ,11,, it!!@1Jil l!!! l!':Mil!' tc! 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I ll llll:#.i .A. ;r;J.UsJl.A.HH!f illifill! .A.A.a1Jil Hffi&ft 1Jil H ff , ill, Ji;it-fl!iff(ffl.llJ , i.!#HIIJ llt'i!tffil11Jil 0 aoo.A.& SJS m a';J1Jil n ml! · @A * irnl.A.Bffi M I mJIJl, *ff - JI 'lo/) 1110: , Iil'/i i-' -il-1Jil , - 9Lll!llll!!.A.a:&1ltffi1Jill. :DI, , . . . 'ef:tl:a';J'l'l' - iiii 0 1!!!.A.l!in * & llllffl ; iiii!Wllffl1Jtffin 11,JBl!lillffi&-&llll 1Jil ' 111: 00 m & - W WMD S/S9ffiM m a';JM ffi&lltJin ,Name of Agent/ Broker/ Technical Representative1-'cl.!l.A. I 2 I i,H 1-'c Date (DD / MM / YYYY)E3Jl!l (E3 /,El /fjc)IIAccount Code!!&J i!WiJ;;ffiShould there be any discrepancy between the English and the Chinese versions of this application form,the English version shall apply and prevail. *Ef3 ffi-S9 3tll&* ,ft , J.;{J;!t5tll&: 0) IC):0"'is,0 "'i::,

In Hong Kong, the FWD life insurance and general insurance businesses have been assigned strong financial strength ratings by international rating agencies, and offer customers life, medical insurance, general insurance, employee benefits, and financial planning. FWD is focused on creating fresh customer experiences and making the insurance journey

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