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NOMINATION FORM - AIG

Copyright AIG Malaysia Insurance Berhad. All Rights reserved. Version 1 Feb 2019 AIG Malaysia Insurance Berhad (795492-W) Menara Worldwide, 198 Jalan Bukit Bintang, 55100 Kuala Lumpur, Malaysia Telephone: 1 800 88 8811 Policy Number: Certificate Number: I/We agree and consent, and if I am submitting information relating to another individual, I represent and warrant that I have the authority to provide that information to AIG Malaysia Insurance Berhad ( AIG ) , I have informed the individual(s) about the purposes for which

The original duly completed and executed Nomination Form needs to be submitted to AIG Malaysia Insurance Berhad. 9. Please refer to Schedule 10 of the Financial Services Act 2013, for more information on “Payment of Policy Moneys under Life Policy and Personal Accident Policy”.

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