Insurance Declaration Form

Insurance Declaration Form Template for Malaysia

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Key Requirements PROMPT example:

"I need a comprehensive Insurance Declaration Form for a new private medical insurance policy in Malaysia, incorporating both English and Bahasa Malaysia versions, with specific sections for pre-existing conditions and family medical history."

Document background

The Insurance Declaration Form is a crucial document in the Malaysian insurance industry, required by both conventional insurers and Takaful operators under the Financial Services Act 2013 and Islamic Financial Services Act 2013. This form must be completed by prospective policyholders before insurance coverage can be provided, serving as their formal declaration of material facts and circumstances relevant to the risk being insured. It includes personal information, risk details, insurance history, and various declarations regarding the accuracy of information provided. The document plays a vital role in the underwriting process, helping insurers assess risks accurately while ensuring compliance with Malaysian regulatory requirements, including those set by Bank Negara Malaysia. It also serves as a legal record of the applicant's consent for personal data processing under the Personal Data Protection Act 2010.

Suggested Sections

1. Personal Information: Declarant's details including full name, ID/passport number, date of birth, nationality, and contact information

2. Risk Details: Specific information about the subject matter to be insured (property, life, health condition, etc.)

3. Insurance History: Previous insurance coverage, claims history, and existing policies

4. Financial Information: Income details, source of funds for premium payments, and other relevant financial information

5. Health Declaration: Current health status, medical history, and lifestyle factors (for life/health insurance)

6. Beneficiary Information: Details of nominated beneficiaries including full names, relationship, and contact information

7. Declaration Statements: Standard declarations regarding truth of information, understanding of terms, and consent for data processing

8. Authorization: Permissions for information verification, medical record access, and personal data processing

Optional Sections

1. Occupation Details: Required for specific types of insurance where occupation affects risk assessment (e.g., life, personal accident insurance)

2. Property Details: Required for property insurance, including location, construction details, security measures

3. Vehicle Information: Required for motor insurance, including vehicle details, usage, and modification information

4. Travel Details: Required for travel insurance, including destination countries, travel dates, purpose of travel

5. Family Medical History: Required for life/health insurance where family health background is relevant

6. Lifestyle Questions: Optional section for specific insurance types requiring information about dangerous sports, smoking, etc.

7. Business Details: Required for commercial insurance, including business nature, turnover, and employee information

Suggested Schedules

1. Schedule A - Medical Questionnaire: Detailed health-related questions for life/health insurance applications

2. Schedule B - Property Schedule: Detailed list of property/assets to be insured with values and specifications

3. Schedule C - Claims History: Detailed listing of previous insurance claims

4. Appendix 1 - Privacy Notice: Detailed information about how personal data will be collected, used, and protected

5. Appendix 2 - Declaration Language Options: Translations of key declarations in main languages used in Malaysia (Bahasa Malaysia, English, Mandarin)

6. Appendix 3 - Required Documents Checklist: List of supporting documents required for the insurance application

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Insurance

Financial Services

Healthcare

Banking

Real Estate

Automotive

Manufacturing

Retail

Transportation

Construction

Professional Services

Islamic Finance

Relevant Teams

Legal

Compliance

Risk Management

Underwriting

Claims Processing

Customer Service

Sales

Operations

Product Development

Data Protection

Shariah Advisory

Policy Administration

Relevant Roles

Insurance Underwriter

Risk Manager

Compliance Officer

Insurance Agent

Insurance Broker

Claims Manager

Legal Counsel

Policy Administrator

Product Development Manager

Customer Service Representative

Sales Manager

Actuarial Analyst

Operations Manager

Data Protection Officer

Shariah Compliance Officer

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Let's create your Insurance Declaration Form

Authors

Alex Denne

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