myTravel Protect Chubb Declaration

WARRANTY AND DECLARATIONS:I, the Policyholder/Main Insured warrant that all the named insured(s) in this Policy:

are Singapore citizens, Singapore permanent residents, a holder of a valid work permit, employment pass, dependant’s pass, long-term visit pass, S pass or student pass;

will commence from and return to Singapore within the Period of Insurance;

agree for this Policy to be classified as a Singapore Policy for accounting purposes;

understand and agree that no insurance is in force until application is accepted by Chubb and a Policy Certificate is issued;

are aware of and agree to abide by the Policy’s terms, conditions and exclusions, as amended from time to time;

are aware that any pre-existing medical condition(s) are not covered under the Policy;

currently have stable health and are not travelling contrary to the advice of a Doctor or for the purpose of obtaining medical treatment;

understand and agree that where a third-party credit card is used, I/we declare that the cardholder has authorised and consented to its use;

agree and authorise any medical source (including hospitals and clinics), insurance company or any other organisation to release to Chubb at any time any information concerning the Insured Person(s) if required;

have provided complete, true and accurate information on the enrolment form and that no material information has been withheld. I/we also agree that the information provided forms part of the contract between Chubb and the Insured Person(s) and acknowledge that Chubb relies and acts on the information provided to issue a Policy;

give consent and authorisation to Chubb to collect, use, disclose, and/or process my/our personal data or information supplied to Chubb, without further notification to me/us, confidentially with its affiliated companies, third party service providers, business partners and/or other parties which may be sited outside of Singapore, for the purposes stated in Chubb's Purpose Statement including administering policies taken out with Chubb, handling claims and customer services. I agree that if I am submitting information relating to other individuals, I conﬁrm they have consented to Chubb's collection, use and disclosure of their personal information as described above. A copy of Chubb’s Personal Data Protection Policy can be found at www.chubb.com/sg-privacy and all are deemed to have read the same; and

will write to Chubb’s Data Protection Officer at 138 Market Street, #11-01 CapitaGreen, Singapore 048946 for any request to withdraw my/our consent, access to and/or correct any information supplied to Chubb and Chubb reserves the right to charge a reasonable fee to offset the administrative costs in complying with access requests.

PLEASE TAKE NOTE:

You must fully and faithfully disclose all facts which you know or should know in respect of your application for insurance. Otherwise, the Policy may be void.

This Policy is protected under the Policy Owners’ Protection Scheme which is administered by the Singapore Deposit Insurance Corporation (SDIC). Coverage for your Policy is automatic and no further action is required from you. For more information on the types of benefits that are covered under the scheme as well as the limits of coverage, where applicable, please contact Chubb or visit the following websites:

General Insurance Association of Singapore, http://www.gia.org.sg/
Life Insurance Association of Singapore, http://www.lia.org.sg/
SDIC http://www.sdic.org.sg