Unit No.: Building Name: Postal/Zip Code: Country: Unit No.: Building Name: Postal/Zip Code: Country:

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1 Direct Purchase Insurance APPLICATION FORM IMPORTANT: Please attach the following documents to your application: Copy of Identity document and supporting documents. Please visit for the list of acceptable documents required. Signed Benefit Illustration, Product Summary, and My Direct Purchase Products Checklist. Backdated to (DD/MM/YY): For Official Use Only Contract.: WARNING: PURSUANT TO SECTION 25(5) OF THE INSURANCE ACT (CAP.142), YOU ARE TO DISCLOSE IN THIS APPLICATION FORM FULLY AND FAITHFULLY ALL FACTS WHICH YOU KNOW OR OUGHT TO KNOW, OTHERWISE THE INSURANCE EFFECTED MAY BE VOID. This policy is underwritten by Aviva Ltd and will be entered into the register of Singapore policies. The terms and conditions of this policy shall be governed by and construed in accordance with the laws of Singapore. Please complete in capital letters and tick boxes as appropriate. SECTION A: YOUR PARTICULARS (LIFE ASSURED) Full Name as shown in Identity Card/Passport: Salutation: Mr Mrs Mdm Miss Dr Family Given Gender: Male Female Marital Status: Single Married Widowed Divorced Others Identity Card/Passport.: Race: Chinese Malay Indian Others Date of Birth (DD/MM/YY): Country of Birth: City & Country of Residence Nationality: (Please list your nationalities) Residential Address Block/Street.: Street Singapore Contact.: (HP) (O) (H) Address: (Please provide at least 1 contact number) Unit.: Building Postal/Zip Code: Country: Correspondence Address Block/Street.: Street (if different from residential address): Unit.: Building Postal/Zip Code: Country: What is your highest educational qualification? Formal Education PSLE GCE O / N Level GCE A Level/Diploma Degree/Professional Qualification Are you proficient in spoken or written English? For existing policyholder with Aviva Ltd: If the correspondence address differs from our existing records, do you wish to update the correspondence address for all your other policy(ies)? Employment Status: Employed Self-employed Unemployed Retired Occupation: Exact Duties: Name of Employer: Address of Employer: Nature of Business: Accounting/Finance Casino/Other types of gaming/gambling operations Consulting Engineering SECTION B: DECLARATIONS Executive/Management Government/Military Involved in production/distribution of military products Money Service Business Professional Services Research & Development Sales/Marketing/Advertising Others, please specify: 1. Declaration of U.S. Indicia Do you have one or more United States of America (U.S.) Indicia*? *Indicia means Residency, Citizenship, Place of Birth, Taxpayer ID Number, Mailing or Residential Address or Contact Number. If, please complete the United States of America (U.S) Person Declaration Form (available at 2. Declaration of Beneficial Ownership Beneficial Owner means the natural person who ultimately owns or controls a customer or the natural person on whose behalf a transaction is conducted or business relations are established and includes any person who exercises ultimate effective control over a legal person or legal arrangement. For the avoidance of doubt, completion of this section is not a nomination of beneficiary(ies) under the policy. Do you have any beneficial owner(s)? If, please provide the beneficial owner(s) information and submit a copy of their Identity Card/Passport. Beneficial Owner Name : Identity Card/Passport.: Relationship to You: Company Reg..: K GST Reg..: MR Page 1 of 8

2 SECTION B: DECLARATIONS (continued) 3. Declaration of Politically Exposed Person (PEP) Are you or any immediate family member or Beneficial Owner previously or currently entrusted with prominent public functions* in Singapore or a foreign country; or a close associate** of one who is/was entrusted with prominent public functions in Singapore or a foreign country? * Prominent public functions includes the roles held by a head of state, a head of government, government ministers, senior civil or public servants, senior judicial or military officials, senior executives of state owned corporations, senior political party officials, members of the legislature and senior management of international organisations. ** Close associate means a natural person who is closely connected to a politically exposed person, either socially or professionally. If, please provide details: Name of the Person previously or currently entrusted with prominent public functions: Your relationship to the person listed above: SECTION C: PLAN DETAILS Please refer to the Benefit Illustration for the Plan Details. Basic Plan Policy Term (years)/ Expiry Age Premium Term Sum Assured Premium Payable Supplementary Benefits Policy Term (years)/ Expiry Age Premium Term Sum Assured Premium Payable Total Premium Payable SECTION D: PREMIUM PAYMENT DETAILS Contract Currency: SGD Payment Frequency: Yearly Half-Yearly Quarterly Monthly (For monthly frequency, minimum ONE month s premium is required) Initial Premium Payment Method: Cash / Cheque / Bank Draft Credit Card (Please complete the section on Visa/Mastercard Authorisation) Subsequent Premium Payment Method: Interbank GIRO (Please complete the attached Application for Interbank GIRO Form) Credit Card (Please complete the section on Visa/Mastercard Authorisation) VISA/MASTERCARD AUTHORISATION I authorise Aviva Ltd to charge the premium(s) to my credit card account for this insurance policy. This authorisation is to remain in effect until I terminate it by written notification to Aviva Ltd at least 30 days in advance of the intended date of termination. Name of Cardholder (as shown in Identity Card/Passport): Identity Card/Passport.: Card Number: Card Expiry Date (MM/YY): Signature of Cardholder: Visa Mastercard Issuing Bank: SECTION E: PAYMENT INFORMATION Name of Payor: (If you are not the Payor) Identity Card/Passport.: *If payor is an individual, please provide a copy of Payor s Identity Card/Passport. Payor s relationship to you: Business Registration./Unique Entity.: *If payor is a business entity, please provide evidence of incorporation/ownership. Source of Premium: Business Profits Gift/Inheritance Investment Earnings Salary Sale of Real Estate Others, please specify: Company Reg..: K GST Reg..: MR Page 2 of 8

3 SECTION F: GENERAL QUESTIONS 1. What is the legal basis of your stay in the current country of residence? (Please attach a copy of the document which shows the issue and expiry date) Citizen/Permanent Resident Work Visa or Permit Employment Pass Dependent Pass Others: 2. What is your annual fixed income before tax (excluding fringe benefits such as allowance and commissions) and annual expenses? Annual Income Annual Expenses Currency Amount 3. Do you currently engage in or do you have definite plans to take up the following; scuba diving, mountain or rock climbing (excluding artificial wall climbing), flying (other than as a fare paying passenger), parachuting or sky diving, motor sports (car, bike, boat), other extreme or hazardous sport? If, please select the activity(ies): Scuba diving and/or Others (what activities) For scuba diving, please complete the following: a) Are you an instructor? b) Are you a certified diver? c) Do you ever dive over 40 metres? d) Do you ever dive alone or unaccompanied? e) Do you participate in cave or wreck diving or other more hazardous diving activities? If, please provide details. 4. Have you ever had an application, reinstatement or renewal of a Life, Critical Illness, Health, Accident or Disability policy deferred, declined or accepted with special terms? If, please provide details: Name of Company: Type of Policy: Reason: 5. Do you have any other application outside of Aviva for Life, Critical Illness, Health or Disability insurance which are pending or being contemplated currently? If, please provide details: Name of Company: Sum Assured: Currency: Type of Insurance: 6. Have you ever made any claim(s) on a Life, Critical Illness, Accident or Disability policy? If, please provide details of each claim and the benefits received. 7. Have you travelled in the past 12 months or do you plan to travel in the next 12 months outside your current country of residence for more than 14 days (other than Australia, Canada, European Union, New Zealand, USA, UK, South Korea, Hong Kong, Taiwan, Japan, Malaysia, China, India, Indonesia and Philippines)? If, please provide details: Last 12 months Dates of Stay Country and City of Residence Purpose of Travel (Business or Pleasure) Frequency (Number of Trips Per year) Duration of Each Stay Next 12 months Dates of Stay Country and City of Residence Purpose of Travel (Business or Pleasure) Frequency (Number of Trips Per year) Duration of Each Stay Company Reg..: K GST Reg..: MR Page 3 of 8

4 SECTION G: HEALTH QUESTIONS 1. What is your height and weight? Height: metres Weight: kg 2. Have you smoked tobacco or cigarettes in the last 12months? If, how many sticks per day? sticks per day 3. Do you drink alcohol? If, what is the average total number of standard alcoholic drinks you consume per week? Average number per week 1 standard alcoholic drink equates to 330ml beer, 125ml glass of wine or 30ml nip of spirits. 4. Have you ever taken or used addictive or illegal drugs, or been treated for drug addiction or alcoholism? If, please provide details: Substance Used Date When Started Taking Date When Ceased Treatment 5. Do you have a regular doctor? If, please provide details: Address: 6. Have you ever experienced symptoms or received medical advice or had treatment for any of the following conditions (whether diagnosed or not)? a) Heart attack, chest pain or discomfort, irregular heart beat, heart valve disorder, heart murmur, palpitations or any other blood vessel or heart disease or disorder? b) High blood pressure or high cholesterol? c) Cancer, tumour, cyst, lump or growth of any kind including cancer screening tests that were not normal? d) Diabetes, elevated or raised blood sugar, thyroid disorders or any other endocrine disease or disorder? e) Asthma, bronchitis, pneumonia, tuberculosis, emphysema or any other breathing or lung disease or disorder? f) Depression, anxiety, stress or any other mental or nervous disorder? g) Arthritis, gout or any other disorder, pain or injury to the muscles, bones, tendons, limbs, joints, spine (back or neck)? h) Stroke, epilepsy, fits, paralysis or weakness of limb, head injury or any other neurological disease or disorder? i) Crohn s disease, ulcerative colitis, gastritis, stomach or duodenal ulcers, blood in stools or any other bowel, stomach or intestinal disease or disorder? j) Hepatitis B or C, fatty liver, abnormal or elevated liver function, gallstones or any other liver or gallbladder disease or disorder? k) Anaemia, thalassaemia, haemophilia or any other blood disease or disorder? l) Kidney stones, kidney infection, urine abnormalities or any other kidney, bladder, prostate or gynaecological disease or disorder? m) Eye, ear, nose or throat disease or disorder (excluding sight problems corrected by prescription lenses)? n) Any other illness, disorder, operation, physical disability or injury not mentioned above? If you have answered to any of the above Question 6(a) to 6(n), please complete the following: Name of Condition Date of first symptoms or diagnosis Have you made a full recovery with no further treatment, ongoing symptoms or complications? Name and address of the doctor who you consulted Question ( ) Condition: 0 to 6 months 7 to 12 months 1 to 2 years How long has it been since your full recovery? What treatment or medication are you taking? Address: 2 to 3 years 0 to 6 months 7 to 12 months 3 to 5 years 1 to 2 years 2 to 3 years 5 years or more 3 to 5 years 5 years or more Company Reg..: K GST Reg..: MR Page 4 of 8

5 SECTION G: HEALTH QUESTIONS (continued) Name of Condition Date of first symptoms or diagnosis Have you made a full recovery with no further treatment, ongoing symptoms or complications? Name and address of the doctor who you consulted Question ( ) Condition: 0 to 6 months 7 to 12 months 1 to 2 years How long has it been since your full recovery? What treatment or medication are you taking? Address: 2 to 3 years 0 to 6 months 7 to 12 months 3 to 5 years 1 to 2 years 2 to 3 years 5 years or more 3 to 5 years 5 years or more Question ( ) Condition: 0 to 6 months 7 to 12 months 1 to 2 years How long has it been since your full recovery? What treatment or medication are you taking? Address: 2 to 3 years 0 to 6 months 7 to 12 months 3 to 5 years 1 to 2 years 2 to 3 years 5 years or more 3 to 5 years 5 years or more 7. Other than conditions that you have already told us about, in the last 5 years have you had any abnormal medical test result from medical test(s) such as X-ray, ultrasound, imaging scan, biopsy, electrocardiogram (ECG), HIV test, blood or urine test, prostate check, pap smear or mammogram? If, please provide details: Name of medical test Date of initial test Have you had a follow-up test? Date of follow-up test Have you been prescribed treatment or been advised to have any further test? Name and address of the doctor who you consulted? 0 to 6 months 7 to 12 months 1 to 2 years If, what was the result? normal 0 to 6 months 7 to 12 months 1 to 2 years If, please provide details Address: 2 to 3 years abnormal 2 to 3 years 3 to 5 years don t know 3 to 5 years 8. Other than for conditions that you have already told us about, are you currently experiencing symptoms or considering seeking medical advice or treatment for your health other than minor illnesses such as cold or flu? If, please provide details: What symptoms or condition? Date of first symptoms 0 to 6 months 7 to 12 months 1 year or more 0 to 6 months 7 to 12 months 1 year or more Date of any planned medical consultation 9. Have any of your natural parents or siblings died or suffered from Alzheimer s Disease, Angina, Bowel Cancer, Breast Cancer, Cardiomyopathy, Colon Cancer, Congestive Heart Failure, Coronary Artery Disease, Diabetes, Heart Attack, Heart Failure, Huntington s Disease, Ischaemic Heart Disease, Motor Neurone Disease, Multiple Sclerosis, Ovarian cancer, Parkinson s Disease, Polycystic Kidney disease and Stroke? If, please provide details: Name of medical condition (specify exact condition e.g. if cancer, specify which type, if heart disease, name the condition) Family member s relationship to you Age when diagnosed Age at death (if applicable) Company Reg..: K GST Reg..: MR Page 5 of 8

6 SECTION G: HEALTH QUESTIONS (continued) 10. Have you or your spouse or partner been told to have, received any medical advice, counselling or treatment in connection with sexually transmitted diseases, AIDS, AIDS Related Complex or any other AIDS related condition? If, please provide details: 11. Female Only: a) Are you currently pregnant? b) Do you have, or does your doctor expect you to have any complications such as high blood pressure, abnormal blood sugar, gestational diabetes? i) What condition? ii) How many months pregnant are you? months SECTION H: DECLARATION / REPLACEMENT OF EXISTING POLICY(IES) 1. Are you a first time buyer of Life Insurance with Aviva Ltd? 2. Do you have any existing life insurance policy(ies) outside of Aviva Ltd? If, please provide details: Name of Company Life Please complete the Sum Assured in contract currency Total & Permanent Disability Critical Illness Disability Income Others Year Issued 3. Is this application to replace or intended to replace any life insurance policy(ies) or unit trust(s), with Aviva Ltd or any other insurance company, bank, or financial adviser? If, please provide details: Name of Company Type of Policy Sum Assured Year Issued Warning: If you are replacing your existing life insurance policy with this new application, some of the disadvantages of replacing your existing plan may be: a) you may not be insurable on standard terms b) you may have to pay a different premium in view of older age c) you may lose the financial benefit accumulated over the years d) the terms and conditions may be different If you are replacing your existing investment-linked insurance policy or unit trust with this application, you should find out whether you are entitled to free switching within your existing plan, as some of the disadvantages may be: a) you may incur transaction costs without gaining any real benefit b) the new policy may offer a lower level of benefit at a higher cost or same cost, or offer the same level of benefit at a higher cost c) you may incur penalties for terminating the policy d) the new policy may be less suitable for you We would advise you to consult your present financial adviser/insurer before making a final decision. Make a careful comparison so that you can be sure that you are making a decision that is in your best interest. Company Reg..: K GST Reg..: MR Page 6 of 8

7 SECTION I: PERSONAL DATA CONSENT I agree to be contacted by Aviva (and/or Aviva group of companies or their service providers) for special marketing offers, promotions, information about Aviva s products and services which may be of interest. Please tick to provide your consent: By Mail or By SMS By Telephone Call I consent to the collection, use and disclosure of my personal data by Aviva and Aviva group of companies for the above purpose. I consent to Aviva (and Aviva related group of companies) collecting, using and/or disclosing my personal data (whether contained in this form or from other sources; existing data in Aviva s record or to be collected in future) to issue and administer my existing and/or new policy(ies) and/or account(s) with Aviva, including the processing of my personal data for underwriting purposes, payment of premiums and/or claims purposes; for statistical, research, compliance, audit and regulatory purposes; to provide general information on product enhancements and services relevant to my needs or policies (including increasing benefits, adding riders/supplements and/or insured lives) as well as to provide financial advice or product recommendations to me, where applicable. I also consent to Aviva (and Aviva related group of companies) transferring my personal data to Aviva related group of companies and/or third party service providers, reinsurers, suppliers or intermediaries, whether located in Singapore or elsewhere, for the above purposes. For full details of the purposes of collection, use and disclosure of your personal data, please visit SECTION J: ADDITIONAL DECLARATION 1. I confirm that I have received a copy of the Benefit Illustration, Product Summary, and Direct Purchase Product Factsheet and that I have read and understood their content. 2. I understand the plan s benefits, exclusions and the 14 day free-look period whereby I have a right to cancel for a refund of premium paid. I further acknowledge that I have received a copy of Your Guide to Life Insurance and Your Guide to Health Insurance (applicable if critical illness supplementary benefit is selected) or have accessed a copy of the guides via and I have also read and understood the guide(s). 3. I understand that the insurance shall not take effect until this application is accepted, the full premium is received and the policy is issued by Aviva Ltd. 4. I declare that no material fact, that is, any fact likely to influence the assessment and acceptance of this application has been withheld and to the best of my knowledge and belief, the information furnished is true and complete. I agree to inform Aviva Ltd if there is any change in the state of my health or activities between the date of this application and the date the policy is issued by Aviva Ltd to me. 5. I agree that all medical examination reports done for the purpose of this application are properties of Aviva Ltd to be used solely for insurance purposes. 6. I am aware that the product I am applying for is authorised for sale in Singapore and I acknowledge that I am responsible for ensuring that the laws and regulations applicable to my nationality and country of residence allow my purchase of this product. I understand that no liability can be accepted by Aviva Ltd for any legal consequences under the laws of any other country or any tax implications that may arise in connection with my purchase of this product. I am also responsible for my own tax affairs and hereby declare that I have not been convicted of any serious tax crimes. 7. I further declare that I am not an undischarged bankrupt and that I have committed no act of bankruptcy within the last twelve months and no receiving order or adjudication order in bankruptcy has been made against me during that period. 8. I authorise any medical source, insurance office or organisation to release to Aviva Ltd and similarly Aviva Ltd to release to any medical source, insurance office or organisation, to the extent permitted by law, relevant information concerning me at any time, regardless of whether the application is accepted by Aviva Ltd. A photographic or electronic copy of this authorisation shall be as valid as the original. 9. I acknowledge that I have verified my affordability and adequacy of insurance coverage, and I take sole responsibility to ensure that this product is appropriate to my financial needs and insurance objectives. Important tes: If a material fact is not disclosed in this application, any policy issued may not be valid. If you are in doubt as to whether a fact is material, you are advised to disclose it. This includes any information that you may have provided to our customer service officer but was not included in the application. Please check to ensure you are fully satisfied with the information declared in this application. Your Signature (Life Assured) (For age next birthday 19 years & above) Identity Card/Passport.: Date (DD/MM/YY): This section is to be completed if you are accompanied by a Trusted Individual* during the application process. Signature of Trusted Individual Name of Trusted Individual: Relationship to You (Life Assured): Identity Card/Passport.: Date (DD/MM/YY): *A Trusted Individual must be at least 18 years or older, is proficient in spoken or written English and possesses at least GCE O or N Level certifications, or equivalent academic qualifications Company Reg..: K GST Reg..: MR Page 7 of 8

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9 APPLICATION FOR INTERBANK GIRO Please submit original form to Aviva Ltd ( Aviva ) FOR APPLICANT S COMPLETION Date (DD/MM/YY): To: Name of Bank: Name of Billing Organisation ( BO ): Aviva Ltd Bank Branch: Policy Number*: Name of Policy Owner: NRIC Number: Relationship to Account Holder: (required if Account Holder is not Policy Owner) * Please write the Policy Number which you wish to apply for GIRO using this bank account number only. a) I/We hereby instruct you to process Aviva s instruction to debit my/our account. b) You are entitled to reject Aviva s debit instruction if my/our account does not have sufficient funds and charge me/us a fee for this. You may also at your discretion allow the debit even if this results in an overdraft on the account and impose charges accordingly. c) This authorisation will remain in force until terminated by your written notice sent to my/our address last known to you or upon receipt of my/our written revocation through Aviva. d) The use of correction tape is not allowed. Amendments made on this form must be countersigned by applicant. My/Our Bank Account Name(s): Mr/Mdm/Ms/Dr My/Our NRIC Number(s): My/Our Bank Account Number: My/Our Contact Number (Home/Handphone): My/Our Signature(s)/Thumbprint(s)^ (as in Bank s Record): ^ If your account is operated by thumbprint, your thumbprint needs to be witnessed and verified by the bank s staff. PERSONAL DATA CONSENT I/We consent to Aviva (and Aviva related group of companies) collecting, using and/or disclosing my/our personal data for the processing of the above transaction and such other purposes ancillary or related to the administering of the policy(ies), account(s) and/or managing my/our relationship with Aviva. I/We also consent to Aviva (and Aviva related group of companies) transferring my/our personal data to Aviva related group of companies and/or third party service providers, reinsurers, suppliers or intermediaries whether located in Singapore or elsewhere, for the above purposes. For full details of the purposes of collection, use and disclosure of your personal data, please visit FOR BILLING ORGANISATION S COMPLETION Bank Branch Aviva s Bank Account Number Aviva s Customer Reference.: Bank Branch Account Number to be Debited FOR BANK S COMPLETION To: Aviva Ltd This Application(s) is hereby REJECTED (please tick) for the following reason(s): Signature/Thumbprint # differs/irregular # from bank s records Signature/Thumbprint # is incomplete/unclear # Account operated by Signature/Thumbprint # Wrong account number Amendments not countersigned by customer Others # Please delete where applicable Name of Approving Officer: Authorised Signature: Date: Company Reg..: K GST Reg..: MR Page 1 of 1

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11 DIRECT PURCHASE INSURANCE PART 1 FACT SHEET What are Direct Purchase Insurance (DPI)? DPI are life insurance products that you can buy directly from insurance companies, without paying any commissions. You do not need to pay commissions because these products are sold without any financial advice. Please read this fact sheet together with the benefit illustration, product summary, and policy contract 1 and product brochures (if available) carefully before buying any DPI. A checklist is also provided to help you in your purchase of a DPI. What are the types of DPI offered? There are two main types of DPI available: (a) Term life with Total and Permanent Disability (TPD) cover and an optional Critical Illness (CI) rider (b) Whole life with TPD cover and an optional CI rider TPD is the complete inability to engage in any business/occupation, or total and irrecoverable physical loss, due to accident or sickness. What is the difference between a term life DPI and a whole life DPI? A term life DPI provides insurance protection for a fixed period of time and may be suitable if you wish to provide for your financial dependants until they become self-reliant. There will be a payout if you pass away, or suffer a terminal illness during the coverage period. Terminal illness is the conclusive diagnosis of an illness that is expected to result in death within 12 months. In comparison, a whole life DPI generally provides life-long insurance protection. As term life DPI are pure protection policies with no savings or investment feature, they are generally cheaper than whole life products. However, this also means that a term life DPI has no cash value when the policy expires, or if you end the policy early. Whole life DPI are typically more expensive than term life DPI as their premiums are invested to build up cash value in addition to paying for insurance coverage. If you end a whole life DPI early, there may be a cash value (known as surrender value). However, there may be no cash value if you end the policy in the first few years as most of the premiums you have paid would have been used to pay for the initial administrative expenses incurred by the insurers for setting up the policy. For more information, visit Should I buy a critical illness rider for my DPI? Once you have chosen a term or whole life DPI, you may choose to add a CI rider. The CI rider pays out the full coverage amount of a term or whole life DPI in a lump sum either when you are first diagnosed with a CI or after you have undergone surgery covered under the rider (except 1 As life insurers only provide policy contracts upon request, you may wish to request for a copy of the DPI policy contract to find out more details about the policy, such as the exclusion clauses and other terms and conditions of the policy. 1

12 DIRECT PURCHASE INSURANCE for Angioplasty 2 ). This payout may ease your financial burden as your treatments and medication can be costly. Your income may also be affected as you may not be able to work due to the CI. It is important to note that the term or whole life DPI, together with the CI rider, will be terminated once the coverage amount is paid out under the CI rider. There is a total of 30 CIs covered under the CI rider. For more information on the CIs covered, please refer to You should also refer to the policy contract for detailed definition of each CI as you will receive a payout under the CI rider only if the illness falls within the definition stated in the contract. How much insurance coverage do I need? You should consider your financial commitments (e.g. loans, family expenses and children s educational needs) and existing insurance coverage, including insurance provided by your employer, when deciding the insurance coverage that you need. You may use the Insurance Estimator at the following link: to help you decide on the amount of coverage you need. You should also consider whether you can afford to pay the premiums for the entire duration of the policy, taking into account your outstanding loans, regular expenses and your income over the long term. If you are unable to pay the premiums, your insurance policy will lapse (or end) and you will no longer be covered. You may use the Budget Calculator available on the MoneySENSE website at: to check if the premium is affordable based on your current income and expenditure. How much insurance coverage can I buy? You can insure yourself for up to S$400,000 per insurer, with a cap of S$200,000 for whole life DPI. The following are some scenarios to illustrate how the cap of S$400,000 for DPI and sub-limit of S$200,000 for whole life DPI work. Scenario 1: If you have bought a term life DPI with sum assured of S$300,000, you may buy an additional term life DPI or whole life DPI with sum assured of $100,000 from the same insurer. Scenario 2: If you have bought a whole life DPI with sum assured of S$150,000 from an insurer, you may buy another whole life DPI with sum assured not exceeding S$50,000, or a term life DPI with sum assured not exceeding S$250,000 from the same insurer. The scenarios above are not exhaustive. Visit for more examples on the amount of DPI you can buy. 2 The CI rider will only pay out 10% of the coverage amount of the main policy or $25,000 whichever is lower, for Angioplasty and other invasive treatment for coronary artery. After the insurance company pays out the above, the remaining coverage amount for the main policy and CI rider continues to be in effect. 2

13 DIRECT PURCHASE INSURANCE What are the different coverage periods offered for term life DPI and how do I choose among them? You may choose from three different coverage periods for your term life DPI: (a) 5 year renewable (b) 20 years (c) Term up to age 65 A 5 year renewable term life DPI may be suitable if you prefer shorter coverage and the flexibility to renew your policy. The premiums may be higher at the point of renewal due to your age, but any medical conditions uncovered since the start of the term life DPI will continue to be covered after the renewal. The other options are a term life DPI with coverage period of 20 years, and a term life DPI that covers you up to age 65. These may be suitable if you prefer longer coverage. As your dependants will not benefit from the DPI s coverage after it expires, you should consider the age of your dependants when choosing your policy coverage period. What are the different premium payment periods offered for whole life DPI and how do I choose between them? You may choose to pay premiums for your whole life DPI up to age 70 or age 85. If you choose to pay premiums until age 70, you will need to pay higher premiums every year, but the total amount paid over the entire premium payment period will be lower. If you choose to pay premiums until age 85, you will pay lower premiums every year, but the total amount paid over the entire premium payment period will be higher. Consider if you can afford to pay the premiums until the age you have chosen, taking into account that you may not be earning any income after you retire. What other important points should I be aware of? You should read and understand the policy contract and product summary which set out the terms and conditions of the policy, such as the following: 1. Coverage period (for whole life DPI) Insurers may either set a maturity age (e.g. age 99 or 100) when all benefits would be paid out, or pay the benefits only upon your death or diagnosis of a terminal illness, even if this occurs beyond age 99 or Premiums for TPD coverage The coverage for TPD lasts up to a maximum age of 65. The premiums that you pay may change throughout the premium payment period, depending on how the insurers price the TPD coverage. (a) If the TPD coverage is priced separately from the main DPI, the premiums will be reduced once TPD coverage ends after age 65. 3

14 DIRECT PURCHASE INSURANCE (b) If the TPD coverage is priced as part of the main DPI and spread out equally over the entire premium payment period, the premiums will remain the same even though TPD coverage ends after age Exclusion clauses Different insurers may have different exclusion clauses which state the situations when benefits under the DPI are not payable. For example, some insurers may not pay out the TPD benefit if the policyholder becomes totally and permanently disabled arising from travel on a noncommercial aircraft. Some insurers may void the policy contract if the policyholder s death arises from any criminal activity; or an act of war (whether declared or not). You should read the product summary and policy contract to find out what these exclusions are and whether the DPI meets your needs. What do I need to disclose in my DPI application? You should disclose all information requested in the proposal form (including any pre-existing medical conditions) fully and truthfully. If material information 3 is not disclosed, or is falsely disclosed, you or your dependants may not be able to claim the benefits under the DPI. If you are unsure whether the information is material, you are advised to disclose it. After you submit your application, the insurer will conduct its underwriting. As the terms and benefits of the DPI may change after underwriting, you should consider whether the revised terms and benefits still meet your needs when you receive the policy documents. I am still not sure what type of DPI to buy and how much coverage I need. What should I do? DPI may not be suitable for you if you are unsure about which type of DPI or how much coverage to buy as no financial advice is provided during the purchase process. In such a case, you are encouraged to seek advice from a financial advisory representative who will be able to advise you on a suitable product. Useful resources and tools: 1) MoneySENSE website (including Frequently Asked Questions on DPI): 2) Web Aggregator (for life insurance products): 3) MoneySENSE Budget Calculator: 4) CPF Board Insurance Estimator: Calculators.htm. 3 Examples of material information include: Whether you are a smoker Whether you are currently on any medication or receiving any treatment Whether you have any pre-existing medical conditions 4

15 DIRECT PURCHASE INSURANCE PART 2 - CHECKLIST (i) This section must be completed before you can buy a DPI. I have a) Read and understood the DPI Fact Sheet b) Read and understood the benefit illustration and product summary, including any coverage exclusions of the DPI c) Declared all pre-existing medical conditions in the Proposal Form d) Disclosed all existing life insurance policies that I own, or am in the process of applying for in the Proposal Form e) Declared my current financial situation, such as my income and expenses in the Proposal Form f) Completed and disclosed fully and truthfully all the information requested in the Proposal Form and any supplementary questionnaire(s) g) Decided to buy the DPI, without seeking any advice from any financial advisory representative (ii) You are encouraged to go through the following items before buying a DPI: Have you a) Used the Insurance Estimator at the following link: to calculate the amount of life insurance coverage you would need? b) Used the Budget Calculator at the following link: to check if the premium that you will pay is affordable based on your current income and expenditure? c) Visited to compare the features and premiums of DPI and other types of life insurance products? d) Considered the different types of DPI and other types of life insurance products that are available, and whether the DPI that you intend to purchase is suitable for your financial circumstances and needs? Acknowledgement of Receipt of DPI Fact Sheet I acknowledge that (a) I have received a copy of the DPI Fact Sheet and have read and understood all of its contents. (b) I have completed the DPI Checklist and have decided to purchase (Fill in the name of DPI) NRIC/ID: Date: Signature: 5

16 DIRECT PURCHASE INSURANCE FACT SHEET SUPPLEMENTARY FORM Definitions and Requirements Relating to Selected Client & Trusted Individual 1) Selected Client is defined as any Client who meets any two of the following criteria: (i) 62 years of age or older; (ii) t proficient in spoken or written English; or (iii) Has below GCE O level or N level certifications, or equivalent academic qualifications. 2) Selected Client should be accompanied by a Trusted Individual (TI) when purchasing a DPI. 3) If the Selected Client is not accompanied by a TI, the client can still choose to purchase a DPI and the Life Insurer needs to remind the client: (i) that the DPI is bought without financial advice; (ii) that there is a 14-day free-look period; and (iii) to check with a TI on the DPI bought within the free-look period. I acknowledge that: (a) I have been briefed on the above 3 items by the Life Insurer and understood all of them. (b) I will check with a Trusted Individual on the DPI I have just bought within the next 14 days. NRIC/ID: Date: Signature: 4) Trusted Individual (TI) is defined as: (i) At least aged 18; (ii) Possess at least GCE O or N level certifications or equivalent academic qualifications; (iii) Be proficient in spoken or written English; and (iv) Be a person who has the trust of the Selected Client. I acknowledge that: I am familiar with Investment or Life Insurance Products. I have fulfilled the above definition and I am a Trusted Individual to (Client s name). I consent to Aviva (and Aviva related group of companies) collecting, using and/or disclosing my personal data (whether contained in this form or from other sources; existing data in Aviva s record or to be collected in future) for the purpose of issuing the relevant policy to the applicant insured including but not limited to underwriting, processing and/or administering the policy, for statistical, research, compliance, audit, regulatory and such other purposes as may reasonably be required. I also consent to Aviva (and 1

17 DIRECT PURCHASE INSURANCE Aviva related group of companies) transferring my personal data to Aviva related group of companies, service providers, reinsurers, suppliers or intermediaries, whether located in Singapore or elsewhere, for the above purposes. For full detail of the purposes of collection, use and disclosure of personal data by Aviva, please visit NRIC/ID: Date: Signature: 2