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Application is no longer available.
ACKNOWLEDGMENTS AND CONSENTS
POLICYHOLDER/LIFE ASSURED DECLARATIONS
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I/We hereby apply to the Insurer to issue a life assurance policy for insurance benefits in the name of the life assured.
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I/We declare that all the information provided in the application, any additional documentation, and any other written statements to the Insurer is to the best of my/our knowledge and belief, true and complete and that no material fact has been withheld.
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I/We agree to the policy being governed by the Policy Rules.
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I/We agree to provide additional information if requested by the Insurer.
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I/We understand that any misrepresentation or non-disclosure of material medical or factual information will render all benefits granted null and void and or result in any claim being repudiated.
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I/We authorise and request any doctor, medical practitioner, or other person who now holds or may in the future acquire any information regarding my/our health to disclose such information to the Insurer or its authorised representatives. I/We agree that this authorisation shall remain valid and enforceable even after my/our death.
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I/We consent to undergo any medical examinations or tests that may be required by the Insurer for the purpose of evaluating this application. This may include, where applicable, diagnostic tests such as cholesterol, blood sugar, ECG, HIV, or other relevant screenings. I/We understand that all associated costs will be borne by the Insurer.
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I/We confirm that my/our Financial Advisor has thoroughly explained the details, risks, and constraints associated with the product to me/us. I/We acknowledge that I/we fully understand the information provided to me/us.
9. I/We agree to the Insurer acting on instructions received from me/us and/or where applicable, my/our appointed Financial Advisor, and I/we confirm that I/we have read any and
all documentation relating to my/our policy.
10. I/We confirm that I/we am/are aware of any fees, premiums and commissions that I/we may pay in relation to my/our policy.
11. I/We confirm that I/we am/are fully aware of the premium associated with my/our policy and that the premium shall be paid by the premium due date to maintain continuous
coverage of my/our policy. I/We confirm that I/we understand that the failure to make payment by the due date may lead to a disruption in the coverage of my/our policy.
12. I/We confirm that the Financial Advisor has provided me/us with a comprehensive explanation of all the risks associated with the late or non-payment of the premium. I/We
further confirm that I/we understand the risks associated with the late or non-payment of the premium, including the risks of any insurance benefits not being readily available
to me/us.
13. I/We understand that any instruction will not be accepted unless the applicable Know Your Client information and any supporting documentation has been received and is
compliant. The Insurer and/or their duly appointed Compliance Officer reserves the right to request any further documentation as and when required.
14. I/We acknowledge and agree that I/we have acquainted myself/ourselves with the following:
14.1. The Insurer’s Data Protection and Privacy Policy which is available on its website as a download.
14.2. The Insurer’s Complaints Handling Policy which is available on its website as a download.
15. I/We understand my/our rights as data subjects as detailed in the Insurer’s Data Protection and Privacy Policy.
16. I/We consent to the collection, use, and processing of my/our personal data by the Insurer for any lawful purpose as required by the Insurer, as detailed in the Insurer’s Data
Protection and Privacy Policy.
17. I/We understand and agree that information provided to the Insurer by me/us will be stored on their computer systems and manually by its agents and delegates.
18. I/We as the guardian/parent of a child (minors under the age of 18 years of age) hereby consent to the use of their personal data provided, where applicable.
19. For the purpose of transferring my/our personal data outside Mauritius, I/we explicitly consent to the transfer, and I/we have been informed of the possible risks involved in the
transfer of my/our personal data.
20. In providing the Insurer with information, I/we hereby represent and warrant to the Insurer that I/we have obtained the consent of any data subjects other than myself/ourselves
authorising the Insurer to process their personal data (including the explicit consent of these data subjects for the processing of any special categories of personal data). For
the purposes of this form, “data subject,” “personal data”, “process/ing” and “special categories of personal data” shall have the meanings attributed to them in the Data
Protection Act 2017.
21. I/We hereby authorise the Insurer to accept facsimile/e-mail/other electronic documents and instructions regarding my/our policy (hereafter referred to as “Electronic
Documents and Instructions”).
22. I/We accept that if I/we suffer any loss as a result of the Insurer’s acceptance or interpretation of any Electronic Documents and Instructions coming from or purporting to come
from me/us, my/our financial advisor or my/our authorised representative, I/we shall have no claim against the Insurer, the Company, its Officers, Agents and Employees and/or
Contractors, all Shareholders in and the Directors of the Company and Cells. I/We further agree to indemnify the Insurer, the Company, its Officers, Agents and Employees
and/or Contractors, all Shareholders in and the Directors of the Company and Cells against any claims, demands, proceedings or actions of any nature whatsoever and
howsoever arising which may be made against one or more or all of them (by any person, including me/us and any third party) and against any liabilities, costs, charges,
losses or expenses incurred directly or indirectly by the Insurer as a result of it acting in accordance with any Electronic Documents and Instructions provided (other than
where there is fraud, gross negligence or wilful misconduct on the part of the Insurer or its Officers or Employees).
23. I/We confirm that my/our signature/s provided in the application form is/are my/our true and valid signature/s. Furthermore, I/we consent to the Insurer using these signatures
as the primary reference for signature verification on all future documents and/or communication submitted to the Insurer.
24. I/We acknowledge and accept that the Insurer may request further verification if my/our signature/s on any future documents and/or communication differ from the signature/s
provided in the application form.
25. I/We understand that documents and/or communication with signatures not matching the signature/s in my/our application form may be subject to delays or rejection until
proper verification is completed.
26. I/We agree to update the Insurer if my/our signature/s change for any reason.
27. I/We agree that any future use of my/our signature/s must be provided in PDF format, whether as an electronic signature or a scanned version of an original signature, provided
it matches the signature/s in the application form and is/are legible.
28. I/We agree that any signature (including any electronic symbol or process attached to, or associated with, this form or other document and adopted by me/us with the intent to
sign, authenticate or accept such form or other document) hereto or to any agreement or document related to this instruction, and any record-keeping through electronic
means shall have the same legal validity and enforceability as a manually executed signature or use of a paper-based recordkeeping system to the fullest extent permitted by
applicable law, including the Electronic Transactions Act 2000, the Guidelines for issue of Insurance Policy Documents in Digital Format issued under section 7(1) (a) of the
Financial Services Act 2007 and section 130 of the Insurance Act 2005, and I/we hereby waive any objection to the contrary.
29. I/We acknowledge that the Insurer does not provide legal/tax or financial advice and it is my/our responsibility to seek independent legal/tax or financial advice prior to
completing this instruction.
30. I/We agree to this policy being governed by Mauritius law and to the Courts in Mauritius having the right to decide any case that may be brought in relation to this policy.
31. I/We hereby declare that the Insurer is discharged from any liabilities and or claims arising from the processing of this application/instruction.
FINANCIAL ADVISOR DECLARATIONS
In my/our capacity of Financial Advisor to this/these policy/ies, I/we agree to the following terms and conditions:
1. All instructions should be received in a format as agreed by the Insurer.
2. The Insurer reserves the right to accept/reject any instruction from the Financial Advisor.
3. The Financial Advisor confirms that they have explained to the policyholder/life assured that any misrepresentation or failure to disclose material medical or factual information
may lead to the denial of a claim and/or the cancellation of all benefits under the policy, and that the policyholder/life assured has acknowledged and understood this
explanation.
4. The Financial Advisor confirms that they have fully explained to the policyholder/life assured the details, risks and constraints of the products, the policy rules, and further
confirms that the policyholder/life assured understands the information.
5. The Financial Advisor confirms that the policyholder/life assured fully understand the consequences of any incorrect information provided on the details, risks and constraints of
the products, and the policy rules.
6. The Financial Advisor confirms and declares that they have provided full and transparent disclosure of all fees, premiums and commissions to the policyholder and the Insurer
accepts no responsibility for any non-disclosure by the Financial Advisor.
7. The Financial Advisor will discuss any proposed alterations to the policy with the policyholder, and they must have the prior written agreement of the policyholder before any
instructions are forwarded to the Insurer.
8. The Financial Advisor confirms that it has such authorisations and licences with such regulatory bodies as is necessary to act as a Financial Advisor and agrees to notify the
Insurer in writing, immediately should this authorisation change or cease.
9. The Insurer reserves the right to remove the Financial Advisor from the policy without specifying a reason and on giving one-month written notice to thepolicyholder and the
Financial Advisor.
10. The Financial Advisor may resign his appointment by giving one month’s written notice to the policyholder and the Insurer.
11. The Financial Advisor’s appointment shall cease immediately upon the death, bankruptcy, dissolution, wilful misconduct or negligent act or omission, conviction for criminal
offence or insolvency of the Financial Advisor or if the Financial Advisor is in breach of any regulatory requirement or it becomes illegal for the Financial Advisor to act in this
capacity.
12. The Financial Advisor confirms that they have independently verified all the relevant policyholder/life assured identities and personal details, as disclosed in this form and
enclose certified copies of all requisite documents for the Insurer’s records.
13. The Financial Advisor confirms that they are not aware of any reason why this instruction should not be concluded.
14. The Financial Advisor declares that, to the best of their knowledge and belief, the information given in this form is true and complete.
15. The Financial Advisor declares that they have not made any changes to this form after the authorised signatory/ies, or policyholder/life assured have signed it.
16. The Financial Advisor declares that they have informed the policyholder/life assured of the Insurer’s Data Protection and Privacy Policy and explained to the policyholder/life
assured their rights as Data Subjects in relation to the Data Protection Act 2017.
This section contains important declarations and disclaimers applicable to you and your financial adviser. It outlines the responsibilities, terms, and consents relating to your policy. By signing the relevant sections of the application form or any other associated forms and documents, you and your financial adviser confirm that you have read, understood, and agree that your policy will be governed by the terms outlined in this section.
For clarity:
-
The terms “I,” “we,” “me,” “us,” “my,” “our,” “you,” and “your” refer to the policyholder or life assured, as applicable, unless otherwise specified.
-
The term “Insurer” refers to International Life.
-
The term "Financial Advisor" means the financial advisory firm and their named representative, appointed by the policyholder to represent them in matters related to the policy. The financial advisory firm may also have additional authorised signatories who are permitted to act on behalf of the firm, even if they are different from the named representative.
Please review this section in full for all relevant declarations and disclaimers that apply to you.
You are deemed to be legally competent and have accepted the declarations and disclaimers outlined under the Acknowledgements and Consents section below. These terms govern your relationship with the Insurer.
The Insurer reserves the right to amend these declarations and disclaimers at any time. Any amendments will take effect immediately upon being posted on the Insurer’s website or communicated through other means. It is your responsibility to periodically review these terms to stay informed of any updates. By continuing to use the policy after such amendments, the policyholder shall be deemed to have accepted the updated terms.
LEGAL ACKNOWLEDGEMENTS
INTERNATIONAL LIFE
12. The Financial Advisor confirms that they have independently verified all the relevant policyholder/life assured identities and personal details, as disclosed in this form and
enclose certified copies of all requisite documents for the Insurer’s records.
13. The Financial Advisor confirms that they are not aware of any reason why this instruction should not be concluded.
14. The Financial Advisor declares that, to the best of their knowledge and belief, the information given in this form is true and complete.
15. The Financial Advisor declares that they have not made any changes to this form after the authorised signatory/ies, or policyholder/life assured have signed it.
16. The Financial Advisor declares that they have informed the policyholder/life assured of the Insurer’s Data Protection and Privacy Policy and explained to the policyholder/life
assured their rights as Data Subjects in relation to the Data Protection Act 2017.
In my/our capacity of Financial Advisor to this/these policy/ies, I/we agree to the following terms and conditions:
1. All instructions should be received in a format as agreed by the Insurer.
2. The Insurer reserves the right to accept/reject any instruction from the Financial Advisor.
3. The Financial Advisor confirms that they have explained to the policyholder/life assured that any misrepresentation or failure to disclose material medical or factual information
may lead to the denial of a claim and/or the cancellation of all benefits under the policy, and that the policyholder/life assured has acknowledged and understood this
explanation.
4. The Financial Advisor confirms that they have fully explained to the policyholder/life assured the details, risks and constraints of the products, the policy rules, and further
confirms that the policyholder/life assured understands the information.
5. The Financial Advisor confirms that the policyholder/life assured fully understand the consequences of any incorrect information provided on the details, risks and constraints of
the products, and the policy rules.
6. The Financial Advisor confirms and declares that they have provided full and transparent disclosure of all fees, premiums and commissions to the policyholder and the Insurer
accepts no responsibility for any non-disclosure by the Financial Advisor.
7. The Financial Advisor will discuss any proposed alterations to the policy with the policyholder, and they must have the prior written agreement of the policyholder before any
instructions are forwarded to the Insurer.
8. The Financial Advisor confirms that it has such authorisations and licences with such regulatory bodies as is necessary to act as a Financial Advisor and agrees to notify the
Insurer in writing, immediately should this authorisation change or cease.
9. The Insurer reserves the right to remove the Financial Advisor from the policy without specifying a reason and on giving one-month written notice to thepolicyholder and the
Financial Advisor.
10. The Financial Advisor may resign his appointment by giving one month’s written notice to the policyholder and the Insurer.
11. The Financial Advisor’s appointment shall cease immediately upon the death, bankruptcy, dissolution, wilful misconduct or negligent act or omission, conviction for criminal
offence or insolvency of the Financial Advisor or if the Financial Advisor is in breach of any regulatory requirement or it becomes illegal for the Financial Advisor to act in this
capacity.
FINANCIAL ADVISOR DECLARATIONS
9. I/We agree to the Insurer acting on instructions received from me/us and/or where applicable, my/our appointed Financial Advisor, and I/we confirm that I/we have read any and
all documentation relating to my/our policy.
10. I/We confirm that I/we am/are aware of any fees, premiums and commissions that I/we may pay in relation to my/our policy.
11. I/We confirm that I/we am/are fully aware of the premium associated with my/our policy and that the premium shall be paid by the premium due date to maintain continuous
coverage of my/our policy. I/We confirm that I/we understand that the failure to make payment by the due date may lead to a disruption in the coverage of my/our policy.
12. I/We confirm that the Financial Advisor has provided me/us with a comprehensive explanation of all the risks associated with the late or non-payment of the premium. I/We
further confirm that I/we understand the risks associated with the late or non-payment of the premium, including the risks of any insurance benefits not being readily available
to me/us.
13. I/We understand that any instruction will not be accepted unless the applicable Know Your Client information and any supporting documentation has been received and is
compliant. The Insurer and/or their duly appointed Compliance Officer reserves the right to request any further documentation as and when required.
14. I/We acknowledge and agree that I/we have acquainted myself/ourselves with the following:
14.1. The Insurer’s Data Protection and Privacy Policy which is available on its website as a download.
14.2. The Insurer’s Complaints Handling Policy which is available on its website as a download.
15. I/We understand my/our rights as data subjects as detailed in the Insurer’s Data Protection and Privacy Policy.
16. I/We consent to the collection, use, and processing of my/our personal data by the Insurer for any lawful purpose as required by the Insurer, as detailed in the Insurer’s Data
Protection and Privacy Policy.
17. I/We understand and agree that information provided to the Insurer by me/us will be stored on their computer systems and manually by its agents and delegates.
18. I/We as the guardian/parent of a child (minors under the age of 18 years of age) hereby consent to the use of their personal data provided, where applicable.
19. For the purpose of transferring my/our personal data outside Mauritius, I/we explicitly consent to the transfer, and I/we have been informed of the possible risks involved in the
transfer of my/our personal data.
20. In providing the Insurer with information, I/we hereby represent and warrant to the Insurer that I/we have obtained the consent of any data subjects other than myself/ourselves
authorising the Insurer to process their personal data (including the explicit consent of these data subjects for the processing of any special categories of personal data). For
the purposes of this form, “data subject,” “personal data”, “process/ing” and “special categories of personal data” shall have the meanings attributed to them in the Data
Protection Act 2017.
21. I/We hereby authorise the Insurer to accept facsimile/e-mail/other electronic documents and instructions regarding my/our policy (hereafter referred to as “Electronic
Documents and Instructions”).
22. I/We accept that if I/we suffer any loss as a result of the Insurer’s acceptance or interpretation of any Electronic Documents and Instructions coming from or purporting to come
from me/us, my/our financial advisor or my/our authorised representative, I/we shall have no claim against the Insurer, the Company, its Officers, Agents and Employees and/or
Contractors, all Shareholders in and the Directors of the Company and Cells. I/We further agree to indemnify the Insurer, the Company, its Officers, Agents and Employees
and/or Contractors, all Shareholders in and the Directors of the Company and Cells against any claims, demands, proceedings or actions of any nature whatsoever and
howsoever arising which may be made against one or more or all of them (by any person, including me/us and any third party) and against any liabilities, costs, charges,
losses or expenses incurred directly or indirectly by the Insurer as a result of it acting in accordance with any Electronic Documents and Instructions provided (other than
where there is fraud, gross negligence or wilful misconduct on the part of the Insurer or its Officers or Employees).
23. I/We confirm that my/our signature/s provided in the application form is/are my/our true and valid signature/s. Furthermore, I/we consent to the Insurer using these signatures
as the primary reference for signature verification on all future documents and/or communication submitted to the Insurer.
24. I/We acknowledge and accept that the Insurer may request further verification if my/our signature/s on any future documents and/or communication differ from the signature/s
provided in the application form.
25. I/We understand that documents and/or communication with signatures not matching the signature/s in my/our application form may be subject to delays or rejection until
proper verification is completed.
26. I/We agree to update the Insurer if my/our signature/s change for any reason.
27. I/We agree that any future use of my/our signature/s must be provided in PDF format, whether as an electronic signature or a scanned version of an original signature, provided
it matches the signature/s in the application form and is/are legible.
28. I/We agree that any signature (including any electronic symbol or process attached to, or associated with, this form or other document and adopted by me/us with the intent to
sign, authenticate or accept such form or other document) hereto or to any agreement or document related to this instruction, and any record-keeping through electronic
means shall have the same legal validity and enforceability as a manually executed signature or use of a paper-based recordkeeping system to the fullest extent permitted by
applicable law, including the Electronic Transactions Act 2000, the Guidelines for issue of Insurance Policy Documents in Digital Format issued under section 7(1) (a) of the
Financial Services Act 2007 and section 130 of the Insurance Act 2005, and I/we hereby waive any objection to the contrary.
29. I/We acknowledge that the Insurer does not provide legal/tax or financial advice and it is my/our responsibility to seek independent legal/tax or financial advice prior to
completing this instruction.
30. I/We agree to this policy being governed by Mauritius law and to the Courts in Mauritius having the right to decide any case that may be brought in relation to this policy.
31. I/We hereby declare that the Insurer is discharged from any liabilities and or claims arising from the processing of this application/instruction.
ACKNOWLEDGMENTS AND CONSENTS
POLICYHOLDER/LIFE ASSURED DECLARATIONS
-
I/We hereby apply to the Insurer to issue a life assurance policy for insurance benefits in the name of the life assured.
-
I/We declare that all the information provided in the application, any additional documentation, and any other written statements to the Insurer is to the best of my/our knowledge and belief, true and complete and that no material fact has been withheld.
-
I/We agree to the policy being governed by the Policy Rules.
-
I/We agree to provide additional information if requested by the Insurer.
-
I/We understand that any misrepresentation or non-disclosure of material medical or factual information will render all benefits granted null and void and or result in any claim being repudiated.
-
I/We authorise and request any doctor, medical practitioner, or other person who now holds or may in the future acquire any information regarding my/our health to disclose such information to the Insurer or its authorised representatives. I/We agree that this authorisation shall remain valid and enforceable even after my/our death.
-
I/We consent to undergo any medical examinations or tests that may be required by the Insurer for the purpose of evaluating this application. This may include, where applicable, diagnostic tests such as cholesterol, blood sugar, ECG, HIV, or other relevant screenings. I/We understand that all associated costs will be borne by the Insurer.
-
I/We confirm that my/our Financial Advisor has thoroughly explained the details, risks, and constraints associated with the product to me/us. I/We acknowledge that I/we fully understand the information provided to me/us.
This section contains important declarations and disclaimers applicable to you and your financial adviser. It outlines the responsibilities, terms, and consents relating to your policy. By signing the relevant sections of the application form or any other associated forms and documents, you and your financial adviser confirm that you have read, understood, and agree that your policy will be governed by the terms outlined in this section.
For clarity:
-
The terms “I,” “we,” “me,” “us,” “my,” “our,” “you,” and “your” refer to the policyholder or life assured, as applicable, unless otherwise specified.
-
The term “Insurer” refers to International Life.
-
The term "Financial Advisor" means the financial advisory firm and their named representative, appointed by the policyholder to represent them in matters related to the policy. The financial advisory firm may also have additional authorised signatories who are permitted to act on behalf of the firm, even if they are different from the named representative.
Please review this section in full for all relevant declarations and disclaimers that apply to you.
You are deemed to be legally competent and have accepted the declarations and disclaimers outlined under the Acknowledgements and Consents section below. These terms govern your relationship with the Insurer.
The Insurer reserves the right to amend these declarations and disclaimers at any time. Any amendments will take effect immediately upon being posted on the Insurer’s website or communicated through other means. It is your responsibility to periodically review these terms to stay informed of any updates. By continuing to use the policy after such amendments, the policyholder shall be deemed to have accepted the updated terms.
LEGAL ACKNOWLEDGEMENTS
INTERNATIONAL LIFE
LEGAL ACKNOWLEDGEMENTS
INTERNATIONAL LIFE
This section contains important declarations and disclaimers applicable to you and your financial adviser. It outlines the responsibilities, terms, and consents relating to your policy. By signing the relevant sections of the application form or any other associated forms and documents, you and your financial adviser confirm that you have read, understood, and agree that your policy will be governed by the terms outlined in this section.
For clarity:
-
The terms “I,” “we,” “me,” “us,” “my,” “our,” “you,” and “your” refer to the policyholder or life assured, as applicable, unless otherwise specified.
-
The term “Insurer” refers to International Life.
-
The term "Financial Advisor" means the financial advisory firm and their named representative, appointed by the policyholder to represent them in matters related to the policy. The financial advisory firm may also have additional authorised signatories who are permitted to act on behalf of the firm, even if they are different from the named representative.
Please review this section in full for all relevant declarations and disclaimers that apply to you.
You are deemed to be legally competent and have accepted the declarations and disclaimers outlined under the Acknowledgements and Consents section below. These terms govern your relationship with the Insurer.
The Insurer reserves the right to amend these declarations and disclaimers at any time. Any amendments will take effect immediately upon being posted on the Insurer’s website or communicated through other means. It is your responsibility to periodically review these terms to stay informed of any updates. By continuing to use the policy after such amendments, the policyholder shall be deemed to have accepted the updated terms.
ACKNOWLEDGMENTS AND CONSENTS
POLICYHOLDER/LIFE ASSURED DECLARATIONS
-
I/We hereby apply to the Insurer to issue a life assurance policy for insurance benefits in the name of the life assured.
-
I/We declare that all the information provided in the application, any additional documentation, and any other written statements to the Insurer is to the best of my/our knowledge and belief, true and complete and that no material fact has been withheld.
-
I/We agree to the policy being governed by the Policy Rules.
-
I/We agree to provide additional information if requested by the Insurer.
-
I/We understand that any misrepresentation or non-disclosure of material medical or factual information will render all benefits granted null and void and or result in any claim being repudiated.
-
I/We authorise and request any doctor, medical practitioner, or other person who now holds or may in the future acquire any information regarding my/our health to disclose such information to the Insurer or its authorised representatives. I/We agree that this authorisation shall remain valid and enforceable even after my/our death.
-
I/We consent to undergo any medical examinations or tests that may be required by the Insurer for the purpose of evaluating this application. This may include, where applicable, diagnostic tests such as cholesterol, blood sugar, ECG, HIV, or other relevant screenings. I/We understand that all associated costs will be borne by the Insurer.
-
I/We confirm that my/our Financial Advisor has thoroughly explained the details, risks, and constraints associated with the product to me/us. I/We acknowledge that I/we fully understand the information provided to me/us.
9. I/We agree to the Insurer acting on instructions received from me/us and/or where applicable, my/our appointed Financial Advisor, and I/we confirm that I/we have read any and
all documentation relating to my/our policy.
10. I/We confirm that I/we am/are aware of any fees, premiums and commissions that I/we may pay in relation to my/our policy.
11. I/We confirm that I/we am/are fully aware of the premium associated with my/our policy and that the premium shall be paid by the premium due date to maintain continuous
coverage of my/our policy. I/We confirm that I/we understand that the failure to make payment by the due date may lead to a disruption in the coverage of my/our policy.
12. I/We confirm that the Financial Advisor has provided me/us with a comprehensive explanation of all the risks associated with the late or non-payment of the premium. I/We
further confirm that I/we understand the risks associated with the late or non-payment of the premium, including the risks of any insurance benefits not being readily available
to me/us.
13. I/We understand that any instruction will not be accepted unless the applicable Know Your Client information and any supporting documentation has been received and is
compliant. The Insurer and/or their duly appointed Compliance Officer reserves the right to request any further documentation as and when required.
14. I/We acknowledge and agree that I/we have acquainted myself/ourselves with the following:
14.1. The Insurer’s Data Protection and Privacy Policy which is available on its website as a download.
14.2. The Insurer’s Complaints Handling Policy which is available on its website as a download.
15. I/We understand my/our rights as data subjects as detailed in the Insurer’s Data Protection and Privacy Policy.
16. I/We consent to the collection, use, and processing of my/our personal data by the Insurer for any lawful purpose as required by the Insurer, as detailed in the Insurer’s Data
Protection and Privacy Policy.
17. I/We understand and agree that information provided to the Insurer by me/us will be stored on their computer systems and manually by its agents and delegates.
18. I/We as the guardian/parent of a child (minors under the age of 18 years of age) hereby consent to the use of their personal data provided, where applicable.
19. For the purpose of transferring my/our personal data outside Mauritius, I/we explicitly consent to the transfer, and I/we have been informed of the possible risks involved in the
transfer of my/our personal data.
20. In providing the Insurer with information, I/we hereby represent and warrant to the Insurer that I/we have obtained the consent of any data subjects other than myself/ourselves
authorising the Insurer to process their personal data (including the explicit consent of these data subjects for the processing of any special categories of personal data). For
the purposes of this form, “data subject,” “personal data”, “process/ing” and “special categories of personal data” shall have the meanings attributed to them in the Data
Protection Act 2017.
21. I/We hereby authorise the Insurer to accept facsimile/e-mail/other electronic documents and instructions regarding my/our policy (hereafter referred to as “Electronic
Documents and Instructions”).
22. I/We accept that if I/we suffer any loss as a result of the Insurer’s acceptance or interpretation of any Electronic Documents and Instructions coming from or purporting to come
from me/us, my/our financial advisor or my/our authorised representative, I/we shall have no claim against the Insurer, the Company, its Officers, Agents and Employees and/or
Contractors, all Shareholders in and the Directors of the Company and Cells. I/We further agree to indemnify the Insurer, the Company, its Officers, Agents and Employees
and/or Contractors, all Shareholders in and the Directors of the Company and Cells against any claims, demands, proceedings or actions of any nature whatsoever and
howsoever arising which may be made against one or more or all of them (by any person, including me/us and any third party) and against any liabilities, costs, charges,
losses or expenses incurred directly or indirectly by the Insurer as a result of it acting in accordance with any Electronic Documents and Instructions provided (other than
where there is fraud, gross negligence or wilful misconduct on the part of the Insurer or its Officers or Employees).
23. I/We confirm that my/our signature/s provided in the application form is/are my/our true and valid signature/s. Furthermore, I/we consent to the Insurer using these signatures
as the primary reference for signature verification on all future documents and/or communication submitted to the Insurer.
24. I/We acknowledge and accept that the Insurer may request further verification if my/our signature/s on any future documents and/or communication differ from the signature/s
provided in the application form.
25. I/We understand that documents and/or communication with signatures not matching the signature/s in my/our application form may be subject to delays or rejection until
proper verification is completed.
26. I/We agree to update the Insurer if my/our signature/s change for any reason.
27. I/We agree that any future use of my/our signature/s must be provided in PDF format, whether as an electronic signature or a scanned version of an original signature, provided
it matches the signature/s in the application form and is/are legible.
28. I/We agree that any signature (including any electronic symbol or process attached to, or associated with, this form or other document and adopted by me/us with the intent to
sign, authenticate or accept such form or other document) hereto or to any agreement or document related to this instruction, and any record-keeping through electronic
means shall have the same legal validity and enforceability as a manually executed signature or use of a paper-based recordkeeping system to the fullest extent permitted by
applicable law, including the Electronic Transactions Act 2000, the Guidelines for issue of Insurance Policy Documents in Digital Format issued under section 7(1) (a) of the
Financial Services Act 2007 and section 130 of the Insurance Act 2005, and I/we hereby waive any objection to the contrary.
29. I/We acknowledge that the Insurer does not provide legal/tax or financial advice and it is my/our responsibility to seek independent legal/tax or financial advice prior to
completing this instruction.
30. I/We agree to this policy being governed by Mauritius law and to the Courts in Mauritius having the right to decide any case that may be brought in relation to this policy.
31. I/We hereby declare that the Insurer is discharged from any liabilities and or claims arising from the processing of this application/instruction.
FINANCIAL ADVISOR DECLARATIONS
In my/our capacity of Financial Advisor to this/these policy/ies, I/we agree to the following terms and conditions:
1. All instructions should be received in a format as agreed by the Insurer.
2. The Insurer reserves the right to accept/reject any instruction from the Financial Advisor.
3. The Financial Advisor confirms that they have explained to the policyholder/life assured that any misrepresentation or failure to disclose material medical or factual information
may lead to the denial of a claim and/or the cancellation of all benefits under the policy, and that the policyholder/life assured has acknowledged and understood this
explanation.
4. The Financial Advisor confirms that they have fully explained to the policyholder/life assured the details, risks and constraints of the products, the policy rules, and further
confirms that the policyholder/life assured understands the information.
5. The Financial Advisor confirms that the policyholder/life assured fully understand the consequences of any incorrect information provided on the details, risks and constraints of
the products, and the policy rules.
6. The Financial Advisor confirms and declares that they have provided full and transparent disclosure of all fees, premiums and commissions to the policyholder and the Insurer
accepts no responsibility for any non-disclosure by the Financial Advisor.
7. The Financial Advisor will discuss any proposed alterations to the policy with the policyholder, and they must have the prior written agreement of the policyholder before any
instructions are forwarded to the Insurer.
8. The Financial Advisor confirms that it has such authorisations and licences with such regulatory bodies as is necessary to act as a Financial Advisor and agrees to notify the
Insurer in writing, immediately should this authorisation change or cease.
9. The Insurer reserves the right to remove the Financial Advisor from the policy without specifying a reason and on giving one-month written notice to thepolicyholder and the
Financial Advisor.
10. The Financial Advisor may resign his appointment by giving one month’s written notice to the policyholder and the Insurer.
11. The Financial Advisor’s appointment shall cease immediately upon the death, bankruptcy, dissolution, wilful misconduct or negligent act or omission, conviction for criminal
offence or insolvency of the Financial Advisor or if the Financial Advisor is in breach of any regulatory requirement or it becomes illegal for the Financial Advisor to act in this
capacity.
12. The Financial Advisor confirms that they have independently verified all the relevant policyholder/life assured identities and personal details, as disclosed in this form and
enclose certified copies of all requisite documents for the Insurer’s records.
13. The Financial Advisor confirms that they are not aware of any reason why this instruction should not be concluded.
14. The Financial Advisor declares that, to the best of their knowledge and belief, the information given in this form is true and complete.
15. The Financial Advisor declares that they have not made any changes to this form after the authorised signatory/ies, or policyholder/life assured have signed it.
16. The Financial Advisor declares that they have informed the policyholder/life assured of the Insurer’s Data Protection and Privacy Policy and explained to the policyholder/life
assured their rights as Data Subjects in relation to the Data Protection Act 2017.