ABSOLUTE ASSIGNMENT AMERICAN INTERNATIONAL ASSURANCE COMPANY, LIMITED
I, ____________________________________________________ (N (Nam ame e of Po Poli licy cyow owne ner) r) in consideration of the sum of ___________________ this day paid by _______________________________________________ (Name ___________________ t ( Name of Ass Assign ignee) ee) of _____________________________________________________________________________ (Address of Assignee) (hereinafter called “the Assignee”), do hereby sell, assign and transfer to the Assignee the full benefit of all moneys (Policy icy Numb Number) er) of assu assure red d or to beco becom me paya payabl ble e by or unde underr the the Polic olicy y of Insu Insura ran nce num numbere bered d ____________________ (Pol (Policy icy Date) (her the Ameri American can Intern Internati ationa onall Assur Assuranc ance e Com Compan pany, y, Limite Limited d dat dated ed _______________ _______________ (Pol (herei eina naft fter er refe referr rred ed to as “the said policy”) together with assignable Supplementary Contracts. This Assignment is inclusive of the cash surrender and loan value of the said policy and of any dividends that may be decl declar are ed upon upon the the said said poli policy cy from from tim time to tim time and and I here hereby by coven ovenan antt with ith the the Assig ssigne nee e that that I have ave not not and and will not not do or know knowin ingl gly y suff suffer er anyth nythin ing g to be done done where hereby by the the said said poli policy cy may be rend render ered ed void void or void voidab ablle or the the Assign signee ee may be prev preven ente ted d from from rece receiv ivin ing g or be depr depriv ived ed of the the righ rightt to rece receiv ive e the the money oneys s assu assure red d or to beco becom me paya payabl ble e by or unde underr the the said said poli policy cy,, and and I decl declar are e that that a rece receip iptt sign signed ed by the the Assi Assign gnee ee shal shalll full fully y disc discha harg rge e the the Amer Americ ican an Inte Intern rnat atio iona nall Assu Assura ranc nce e Company, Limited from its liabilities and obligations under the said policy in respect of which the receipt is given. IN WITNESS WHEREOF, I and the Assignee have hereunto set our hands this _________________ day of __________________________ (Month) 20 ______________ 20 ______________ (Year) Relationship of Assignee to Assignor: _________________________________________________________________ Assignor: _________________________________________________________________ If Assignee is related to the servicing AIA Financial Services Consultant, please indicate relationship. Write "Nil" if there is no relationship: __________________________________________________________________ relationship: __________________________________________________________________
DECLARATION & AUTHORISATION
I/We I/We here hereby by auth author oris ise, e, agre agree e and and cons consen entt to the the Comp Compan any y to use use and/ and/or or disc disclo lose se any any info inform rmat atio ion n coll collec ecte ted d and/ and/or or held held (whether contained in this application or otherwise obtained) to enable the Company, its associated indi indivi vidu dual als/ s/or orga gani nisa sati tion ons s and/ and/or or inde indepe pend nden entt thir third d part partie ies, s, withi ithin n or outs outsid ide e Singap ngapor ore, e, with ith rega regard rd to any any matter tters s pert pertai aini ning ng to the the Appl Applic icat atio ion/ n/Po Poli licy cy and/ and/or or any any othe otherr poli polici cies es that that I/we I/we curr curren entl tly y ma may y have have with with the the Comp Compan any, y, incl includ udin ing g but but not not lim limited ited to, proc proces essi sing ng of this this Appli pplica cati tion on,, and/ and/or or prov provid idin ing g subs subseq eque uent nt serv servic ices es to me/us e/us and/ and/or or prov provid idin ing g advi advice ce and/ and/or or info inform rmat atio ion n conc concer erni ning ng prod produc ucts ts and/ and/or or serv servic ices es whic which h the the Comp Compan any y beli believ eves es ma may y be of inte intere rest st to me me/u /us s and/ and/or or communicating with me/us for any purpose. I/We hereby specifically waive any right to bring a claim of any nature against the Company, its associated individuals/organisations and/or independent third parties, within or outside Singa ingapo porre, in resp respec ectt of any any abov abovee-m menti ention oned ed dis disclos closur ure e and/ and/or or any any disc disclo losu sure re in the the natu nature re desc descri ribe bed d abov above. e. This his authorisation shall bind my/our successors and assignees, and remains valid, notwithstanding death, irrespective of whether or not not my/ou y/ourr Appli pplica cati tion on is acce accept pted ed by the the Com omp pany. any. A phot photoc ocop opy y of this this auth author oris isat atio ion n shal shalll be effe effect ctiv ive e and and valid as the original.
SIGNATURE / NAME / NRIC OF WITNESS
SIGNATURE OF POLICYOWNER/ASSIGNOR
ADDRESS OF WITNESS
SIGNATURE / NAME / NRIC OF WITNESS
SIGNATURE OF ASSIGNEE
ADDRESS OF WITNESS
PT 0011003 (10/2008 (10/2008 06/2009) - Pg 1
+Q22171:121313+
*P110609010202*
DECLARATION & AUTHORISATION
This is to notify you of the above Assignment and shall be grateful if you will kindly register the same in your records.
SIGNATURE OF ASSIGNEE
This form is furnished by the American International Assurance Company, Limited as a matter of courtesy, but the Company assumes no responsibility for the validity or legality of the Assignment.
IMPORTANT NOTES 1) All signatures must be signed in ink. 2) For each signatory, there should be a witness with the Signature, Name and NRIC Number clearly indicated. The witness has to be 21 years old and above, and should not be the beneficiary of this policy. 3) Kindly submit 2 copies of the form. 4) Kindly submit the photocopy of the NRIC/Passport of the policyowner (i.e. the Assignor). The policyowner needs to sign on the photocopy and there should be a witness with the Signature, Name and NRIC clearly indicated. The witness has to be 21 years old and above, and should not be the beneficiary of this policy. 5) For policy assigned to an individual, kindly submit the photocopy of the NRIC/Passport of the Assignee. The Assignee needs to sign on the photocopy and there should be a witness with the Signature, Name and NRIC clearly indicated. The witness has to be 21 years old and above, and should not be the beneficiary of this policy. 6) For policy assigned to Company or Financial Institution, kindly submit a copy of the Identification document (eg. NRIC or Passport) of the authorized personnel/signatory who signs on the assignment document.
AIA Customer Service Centre, 1 Finlayson Green, Singapore 049246
Monday - Friday: 8.45am - 5.30pm
AIA Customer Care Hotline: 1800 248 8000
AIA.COM.SG
PT 0011003 (10/2008 06/2009) - Pg 2
