Common Reporting Standard (CRS) Declaration (Member and Life(s) to be Assured)

The Company is required to collect information regarding the tax residency status of each Account Holder in order to comply with the Income Tax Act 9947 and the Income Tax (Automatic Exchange of Financial Account Information) Rules 2016 ("collectively referred to as Malaysian Laws on International Tax Compliance"). The Malaysian Laws on International Tax Compliance implement the standard for automatic exchange of financial account information in tax matters, commonly known as Common Reporting Standard ("CRS"), developed by the Organisation for Economic Co-operation and Development ("OECD").

Pursuant to the Malaysian Laws on International Tax Compliance, the Company may be legally obliged to share the information provided by an Account Holder and other financial information with respect to the financial accounts of an Account Holder with the Inland Revenue Board of Malaysia ("IRBM"). IRBM may exchange such information with the tax authorities of another jurisdiction or jurisdictions in which the Account Holder may be tax resident pursuant to an intergovernmental agreement to exchange financial account information.

Each jurisdiction has its own rules for defining tax residence. If you have any questions on how to determine your tax residency status, you should consult your tax adviser or the information could be obtained at the OECD automatic exchange of information portal http://www.oecd.org/tax/transparency/automaticexchangeofinformation.htm. The Company will not be in a position to provide assistance beyond the information set out herein.

Note: In the case of a Cash Value Insurance Contract or an Annuity Contract, the Account Holder is any person entitled to access the Cash Value or change the beneficiary of the contract. If no person can access the Cash Value or change the beneficiary, the Account Holder is any person named as the owner in the contract and any person with a vested entitlement to payment under the terms of the contract. Upon the maturity of a Cash Value Insurance Contract or an Annuity Contract, each person entitled to receive a payment under the contract is treated as an Account Holder.

Common Reporting Standard (CRS) Declaration

I certify that I am the account holder (or I am authorised to sign for the account holder) in respect of this policy.

I acknowledge that the information contained in this form, including information regarding the Account Holder and any reportable account(s) may be reported to IRBM and exchanged with the tax authorities of another country or countries in which the Account Holder may be tax resident, pursuant to intergovernmental agreements to exchange financial account information.

I declare that all statements made in this form are, to the best of my knowledge and belief, correct and complete. I undertake to inform the company within 30 days if there is a change in circumstances that affects the tax residency status of the Account Holder or causes the information in this form to be incorrect or incomplete. I shall provide the Company with an updated self-certification form within 90 days of such change in circumstances.

I understand that any person who provided any incorrect information required to be provided under the Malaysian laws on International Tax Compliance shall (unless he can show that he provided such incorrect information in good faith) be guilty of an offence and is punishable in accordance with the prevailing Common Reporting Standard Rules and Regulations.

I agree to complete and sign such documents and do such things for purposes reasonably required by the Company to evaluate my proposal and to provide the products or services which I am applying for.