FAST TRACK DENTIST FORM

Your duty of disclosure

You have the duty to disclose to Chubb Insurance Malaysia Berhad any matter that:(a) You know to be relevant to our decision on whether to accept the risks or not and the rates and terms to be applied; or (b) a reasonable person in circumstances could be expected to know to be relevant.
You have the duty to disclose those matters to Us before you renew, extend , vary or reinstate a contract of general insurance,

Non-Disclosure

If you fail to comply with duty of disclosure, We May have the option of avoiding the contract of insurance from its beginning. If you non-disclosure is fraudulent, We may also have the right to keep the premium that you have paid.

Change of Risks or circumstances

You should advice US as soon as practicable of any change to your normal business as disclosed in this application.

Subrogation

Where you have agreed with another person or company, who would otherwise be liable to compensate you for any loss or damage which is covered by the policy , that you will not seek to recover such loss or damage from that person , Chubb will not covet you to the extent permitted by law , for such loss or damage.

Underwriting & Distribution

The policy is underwritten by Chubb Insurance Malaysia Berhad, Registration Number: 197001000564 (“Chubb”). Chubb is licensed under the Financial Services Act 2013 and regulated by Bank Negara Malaysia. This policy is distributed by Tan Secretarial Services, a registered agent of Chubb, on the platform owned and operated by MedIndemnity.

- I have read and understood the importance notices contained in this application.
- I agree that this proposal together with any other information will form the basis of any contract of insurance.
- I acknowledge that if this application is accepted, the contract of insurance will be subject to terms and conditions as set out in the policy wording as issued or as otherwise specifically varied in writing by Chubb
- I declare after inquiry that the statement, particulars and information contained in this application and in any document accompanying this application are true and correct in every detail and that no other material facts have been misstated, suppress or omitted .
- I undertake to inform Chubb of any material alteration to those facts before completion of the contract of insurance.
- I understand the Chubb needs to deal with our personal data to administer our Policy and offer us insurance products and services . To achieve these purpose ,I allow Chubb to collect, use and disclose our personal data to selected third parties in or outside Malaysia, in accordance with Personal Data Protection Notice