ULTIMA V2 PERSONAL ACCIDENT POLICY

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1 ULTIMA V2 PERSONAL ACCIDENT POLICY NOTICE: For all intents and purposes where there is a oonflict or ambiguity as to the meaning in the Bahasa Malaysia provisions of any part of the Contract, it is hereby agreed that the English version of the Contract shall prevail. WHEREAS the insured de.scribed in the Schedule hereto being desirous of insuring in the manner hereinafter mentioned with Berjaya Sompo Insurance Berhad (hereinafter called "The Company") has made a proposal and declaration which proposal and declaration is agreed shall be the basis of the contract for the insurance hereby intended to be made and incorporated herein and has paid to the Company the First Premium stated in the Schedule as a consideration for the Insurance for the period stated herein. NOW THIS POLICY OF INSURANACE WITNESSES that if during the Period of Insurance the Life Insured shall suffer Death or Loss or Disablement which is solely and directly occasioned by accidental bodily injury the Company will subject to the terms provisos exclusions and conditions of and endorsed on this Policy (which terms provisos exclusions and conditions shall so far as the nature of them respectively will permrt be deemed conditions precedent to the right to recover under this Policy) pay to the Insured or in the event of death to the lnsured's legal personal representative the sum or sums of money specified in the Table of Benefits. DUTY Of DISCLOSURE Where the Life Insured has applied for this Insurance wholly for purposes unrelated to Life lnsured's trade. business or profession, Life Insured had a duty to take reasonable care not to make a misrepre.sentation in answering the questions in the Proposal Form (or when Life Insured applied for this insurance). Life Insured should have answered the questions fully and accurately. Failure to have taken reasonable care in answering the questions may result in avoidance of Life lnsured's contract of insurance, refusal or reduction of claim(s), change of terms or termination of contract of insurance in accordance with the remedies in Schedule 9 of the Financia l Services Act Life Insured was also required to disclose any other matter that the Life Insured knew to be relevant to The Company's decision in accepting the risks and determining the rates and terms to be applied. Life Insured also has a duty to tell The Company immediately if at any time after Life lnsured's contract of insurance has been entered into, varied or renewed with The Company any of the information given in the Proposal Form (or when Life Insured applied for this insurance) is inaccurate or has changed. TABLE OF BENEFITS Death or Loss or Disablement solely and directly occasion by accidental bodily injtsy which injury shall solely and independently of any other cause result in the following Benefit 1 to Benefit 13. SUmlnsured Benefit 1 DEATH occurring within twelve calendar months of bodily injury as aforesaid. Benefit 2 PERMANENT DISABLEM=NT occurring within twelve caleooar months of bodily injury as aforesaid. The percentage are as stated under Benefits 2 Coverage. Benefit3 TEMPORARY TOTAL DISABLEMENT temporarily from engaging in or giving attention to the Life lnsured's profession or occupation due to injury caused by an accident covered ooder this Policy as certified by a qualified and registered Medical Practitione up to a period of fifty two (52) weeks in respect of any ooe injtsy. Pr<Mded only if such bodily injury occurs within twenty (20) days from the date of accident wholly and continooosly disable and prevent the Life Insured from performing his/her oca,pati. For the purpose of the PoliCY, Temporary Total Disablement shall mean the Life Insured is rendered completely incapable of attending to any part of his ordinary professio, business or occupation. (UV2 PA/PW 0918) 1

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11 POLISI INSURANS KEMALANGAN DIRI ULTIMA V2 PEMBERITAHUAN: Bagi tujuan dan maksud sekiranya terdapat konflik atau kekaburan berkenaan makna di dalam peruntukan Bahasa Malaysia tentang mana-mana bahagian Kontrak, adalah dipersetujui bahawa Kontrak versi Bahasa lnggeris akan digunakan. BAHAWASANYA ORANG Diinsuransl<an yang dihuraibn di dalam Jadual dalam dokumen ini bemasrat untulc diinsuransl<an dalam cara yang disebutkan kemucian dari ini dengan Berjaya Sompo Insurance Berhad (dinamakan sebagai "S,,,,rikat" kemucian dari ini) telah membuat cadangan dan akuan yang mana cadangan dan akuan tersebut telah dipersetujui, akan menjadi asas kepada lrontrak rnsurans tersebut derlgan ini bertujuan untuk dibuat atau dimasukbn dalam perjanjian ini dan telah membayar kepada Syarikat Premium Pertama yang dinyatakan di dalam Jadual sebagai balasan kepada lnsurans tersebut ts1tuk tempoh yang dinyatakan dalam perjanjian ini. MAl<A POUSI INSURANS INI MEMPERSAKSIKAN bahawa jika pada masa Tempoh lnsurans tersebut, Orang Diinsuranskan mengalami Kematian atau Kerugian atau Ketidakupayaan yang secara tunggalnya dan secara langsungnya diakibatkan oleh kecederaan anggota akibat daripada kemalangan, Syarikat akan tertakluk kepada terma, proviso, pengecualian dan syarat padanya dan yang diendorskan pada Polisi in i (yang mana terma, proviso, pengecualian dan syarat hendaklah sejauh mana keadaan asal masing-masing dibenarkan untuk dianggap sebagai syarat terdahulu kepada hak untuk mendapatkan semula di bawah Polisi ini) membayar jumlah atau jumlah-jumlah wang yang dinyatakan dalam Jadual Manfaat kepada Pihak Oiinsuranskan atau kepada wakil peribadi Pihak Oiinsuranskan di sisis undang-undang sekiranya berlaku kematian. KEWAJIPAN PENDEDAHAN Apabila Orang yang Oiinsuranskan telah memohon insurans ini.sepenuhrrya untuk tujuan yang tidak berkaitan dengan perdagangan, perniagaan atau profe.sion Orang yang Oiinsuranskan, Orang yang Oiinsuranskan mempunyai kewajipan untuk mengambil langkah yang munasabah untuk tidak salah nyata dafam menjawab soalan yang terdapat dalam borang cadangan (atau semasa permohononan insurans ini). Orang yang Oiinsuranskan perlu menjawab soalan dengan penuh dan tepat. Kegagalan dalam mengambil langkah munasabah dalam menjawab soalan-.soafan boleh mengakibatkan pembatalan kontrak insurans, keengganan atau pengurangan gantirugi, Perubahan terma atau penamatan kontrak insurans Orang yang Oiinsuranskan selaras dengan remedi di Jadual 9 Akta Perkh i dmatan Kewangan Orang yang Oiinsuranskan juga dikehendaki mendedahkan perkara-perkara lain yang Orang yang Oiinsuranskan tahu akan mempengaruhi keputusan Syarikat dalam menerima ri.siko dan menentukan kadar dan terma yang akan dikenakan. Orang yang Oiinsuranskan juga mempurryai kewajipan untuk memberitahu Syarikat dengan serta-merta jika pada bila-bila ma.sa selepa.s kontrak insurans Orang yang Oiinsuranskan ditandatangani, diubah atau diperbaharui dengan Syarikat,. apa-apa maklumat yang diberikan di dalam Borang Cadangan ( atau semasa permohonan insurans ini) tidak tepat atau telah berubah. JADUAL MANFAAT l<ematian atau l<erugjan atau l<etidakupayaan yang secara tunggalnya dan secara langsungnya ciakibatkan oleh kecederaan anggota akibat daripada kemalangan yang mana kecederaan hendaklah secara tunggalnya dan bebas daripada apa-apa sebab lain yang mernbawa kepada manfaat 1 hirwa manfaat 13 berikut. Jumlah Oiinsuranskan Manfaat 1 Manfaat 2 KEMATIAN yang berlaku dalam masa dua belas bulan blendar disebabkan oleh kecederan anggota seperti yang disebotl<an sebelumnya. KETIDAKUPAYAAN KEKAl yang bertaku dalam masa dua belas bulan kalendar cisebabl<an oleh kecederaan anggota seperti yang diseootkan sebelumnya. Peratusannya adalah seperti yang dinyatakan di bawah Perlindungan Manfaat 2. 11

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21 KEMABUKAN Palisi ini dilanjutkan untuk melindungi kematian atau kecederaan anggota yang timbul daripada kemabukan oleh arak melainkan pemandu mabuk seperti yang disyaratkan di bawah undang-undang dan/atau ubat-ubatan yang mesti dipre.skripsikan oleh pengamal perubatan yang bertauliah dan berdaftar. LEMAS DI DALAM AIR, PENYEDUTAN GAS, LEMAS AKIBAT ASAP ATAU WASAP BERACUN. Polisi ini dilanjutkan untuk melindungi kematian atau ketidakupayaan yang timbul daripada akibat kemalangan lemas di dalam air, penyedutan gas, lemas akibat asap atau wasap beracun. MEMBURU Palisi ini dilanjutkan untuk melindungi kematian atau ketidakupayaan seperti yang ditakrifkan di dalam Polisi semasa Orang Diinsuranskan melibatkan diri dalam akitiviti memburu. Oengan syarat kegiatan memburu sedemikian dijalankan oleh Orang Oiinsuranskan secara sekali;ekala dan untuk rekreasi dan untuk tempoh yang pendek dan bukan sebagai seorang profesional. IMPOFrrANT/PENTING The Life Insured/Insured shall read this Policy carefully, and if any error or misdescription be found herein, or if the cover is not in accordance with the wiahff of the Life Insured/Insured, advice should at once be given to the Company and the Policy returned for alteration. Pihak Diinsuram.tkan hendaldah membaca Poli-Si ini dengan berhati-hati don jika terdapat apa-aptj kesilopan afou a.a/ah gambaran dalam perjanjfan ini, atau 11ko perlindungan tidak diberikan mengikvt kehendak Pihak Diinsun:mskan, makluman hendaldah diberikan dengon Heep.at mungkin kepada pihak Syarikat dan Pofisi ini dikembalikan untuk pindaan, 21

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