Understanding Your Insurance Needs

PROTECTION : Unexpected events may strike anyone anytime (e.g. accident, disability, loss of job)

1) If this happens, will you and your family be able to maintain the current standard of living?
Yes No

2) If this happens, do you have ready funds sufficient to cover household expenses?
Yes No
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HEALTH / MEDICAL - Health and medical are of great significance needs anytime.

3) Medical costs are rising between 12% - 15% every year. Would you want a plan that can protect you against the rising medical costs?
Yes No

4) In event of illness or accident, do you have sufficient funds to cover the medical or hospitalization expenses?
Yes No
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SAVINGS / INVESTMENT - Our savings / returns from our investments enable us to maintain our lifestyle.

5) What do you want to achieve from your investment?

To have returns on a regular basis

To have returns on a regular basis and have capital gains

To have capital gains

6) What is your investment time horizon?

1 5 years 6 10 years 11 20 years > 20 years
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EDUCATION - One of the best gifts parents can give their children is the gift of education for a better future.
7) Where would you prefer to send your children for their higher education?
Local University Overseas College/University Private University (twinning program)
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RETIREMENT - Retirement is your time to enjoy the fruits of your labour after your active working years.
8) What do you expect upon your retirement?
Maintain your current lifestyle Enjoy a luxury lifestyle
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9) Currently, do you have any life insurance or medical plan?
Yes No

If yes, please specify

10) What kind of insurance benefits are important to you? (You may choose more than one)
Protection Savings / Investment Retirement Health Education

11) How much would you be willing to set aside every month for the above insurance coverage(s)?
RM 150 RM 200 RM 300 RM 400 RM 500

Customer Information
Name: Occupation:
Address:
Email: Annual Income:
Mobile number: .. ( ) Below RM 20,000 ( ) RM 20,000 RM 40,000
( ) RM 40,000 RM 80,000 ( ) RM 80,000 RM 100,000
Age:( ) < 20 ( ) 20-29 ( ) 30-39 ( ) 40-49 ( ) >50 ( ) Above RM 100,000

Marital status: ( ) Single ( ) Married No. of children: . Age range of children:

Who else can benefit from this?

(Note: Please ensure that the individuals named below have consented to the release of their name and contact details to AIA Bhd.)

Name Telephone No. Name Telephone No.

Declaration: I understand and agree that any personal information collected or held by AIA Bhd. (AIA) (whether contained in this application or
otherwise obtained) may be held, used and disclosed by AIA to individuals/organization related to and associated with AIA or any selected third party
(within or outside of Malaysia, including reinsurance and claims investigation companies and industry/federations) for the purpose of processing this
survey and providing service to AIA financial products and to communicate with me for such purposes. I understand that I have a right to obtain access
to and to request correction of any personal information held by AIA concerning me/us. Such request can be made to any AIA Customer Service Centre.

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Customers Signature
Name: