Consent 

1. I declare that the information given in this application and any information supplied to Prudential is true and that no material facts (i.e. facts likely to influence the assessment and acceptance of this application) have been withheld by me and to the best of my knowledge and belief, the information given herein is true and complete. I acknowledge and agree that Prudential can request supporting documents in relation to the information requested in this application.

2. I am aware that I can seek advice from a qualified advisor before I submit this application. Should I choose not to, I take sole responsibility in ensuring that this product is appropriate to my financial needs and insurance objectives.

3. I confirm that the entire marketing and online application process in respect of my proposed insurance application has been conducted in Singapore, which includes but is not limited to the following:

 (a) I have received all of the insurance related marketing materials in Singapore;

 (b) I have read the details of my proposed insurance plan in Singapore;

 (c) Supplementary document(s) where applicable, in respect of my proposed insurance application is/are signed in Singapore; and

4. I declare that I have received or downloaded a copy of each of the following:
– “Product Summary” and
– “Your Guide to Health Insurance”

and that I have read and understood the contents of these documents, including any coverage exclusion set out in the Product Summary.

5. I understand that the policy applied for herein shall be underwritten as a Singapore policy and be entered in the register of Singapore policies of Prudential. I further understand that the terms and conditions of the policy will be governed by and interpreted according to the laws of the Republic of Singapore.

6. I declare that I am not an undischarged bankrupt and that I have committed no act of bankruptcy within the last twelve months and that no receiving order or adjudication in bankruptcy has been made against me during that period.

7. I understand that if I do not hold Singapore citizenship, it is my sole responsibility to ensure that, by completing and submitting this application, I will not breach or violate any of the applicable local laws and regulations of the jurisdiction of the country of my nationality (the “Applicable Local Laws”). I hereby fully indemnify and hold harmless Prudential and its officers and employees against all losses, damages, civil penalties and expenses (including but not limited to legal expenses on a solicitor-client basis) that may be suffered by any of them in connection with any breach or violation by me of the Applicable Local Laws.

8. I will obtain my own advice on the tax implications and/or any other ancillary implications in respect of my application for this policy. I acknowledge that Prudential does not make any representations nor assume any responsibility for these.

9. I expressly authorise and consent Prudential and its related corporations, respective representatives, agents, third party service providers, contractors and/or appointed distribution/business partners (collectively referred to as “Prudential and its authorised representatives”) to collect, use, retain, disclose and process, at their sole discretion, any and all information relating to me, including my personal particulars, my transactions and dealings and my policy or policies of insurance with Prudential, and disclosing such information to any of the following, whether in Singapore or elsewhere for purposes stated here and in Prudential’s Privacy Notice (which is available at https://www.prudential.com.sg/Privacy-Notice):

 (a) Prudential’s holding companies, branches, representative offices, subsidiaries, related corporations or affiliates;

 (b) any of Prudential’s contractors or third-party service providers or distribution / business partners or professional advisers or agents;

 (c) any regulatory, supervisory or other authority, court of law, tribunal or person, in any jurisdiction, where disclosure is required by law, regulation, judgement or order of court or order of any tribunal or as a matter of practice;

 (d) any actual or potential assignee(s) or transferee(s) of any rights and obligations of Prudential and its authorised representatives under or relating to my policy or policies for any purpose connected with the proposed assignment or transfer; and

 (e) any credit bureau, insurer or financial adviser, for the purposes of providing financial advisory services, underwriting, customer servicing (which include contacting me for review of my financial and/or insurance portfolio), statistical analysis, investigation of Prudential’s representatives, monitoring undesirable sales practices, conducting customer due diligence, reporting to regulatory or supervisory authorities and for auditing.

 Where any personal data (“third party Personal Data”) relating to another person (“Individual”) (e.g. insured persons, family members, and beneficiaries) is disclosed by me, I represent and warrant that I have obtained the consent of the Individual to collect and use the third party Personal Data and to disclose the third party Personal Data to the persons enumerated above, whether in Singapore or elsewhere, for the purposes stated above and in Prudential’s Privacy Notice.

 I understand that if I qualify for any reward program(s) / membership(s) under the products and/or services distributed by Prudential and its authorised representatives, I may receive regular updates from Prudential and its authorised representatives on the benefits and privileges entitled to me under such program(s) /membership(s).

 I understand that I can refer to Prudential’s Privacy Notice, which is available at https://www.prudential.com.sg/Privacy-Notice for more information on contacting Prudential for Feedback, Access, Correction and Withdrawal of using my personal data.

I understand that if I am a European Union (“EU”) resident individual (i.e. my residential address is based in any of the EU countries), I can refer to Prudential’s Privacy Notice which is available at https://www.prudential.com.sg/Privacy-Notice for more information on the rights available to me under the General Data Protection Regulation.

10. I understand and agree that:

 a) I am submitting an application electronically, through the use of electronic records and electronic communication, to Prudential;

 b) I will not hold Prudential liable for any loss or consequence arising directly or indirectly from the electronic transaction; and

c) I have verified the accuracy of my email address and agree to its usage in electronic communications.

In consideration of Prudential considering my electronic application, I agree:

 a) that by ticking the boxes relating to certain terms and conditions in the application, I am indicating my agreement to such terms and conditions and my intention to be bound under an enforceable contract;

 b) that the electronic application bearing my name will be legally binding;

 c) to the admission, as evidence in any court of law or tribunal in Singapore, of the electronic records or documents electronically shown to me or electronically signed or agreed to by me during the online application for insurance (the "Electronic Records");

 d) that the Electronic Records stored in Prudential's secure portal are admissible in any court of law in Singapore as original documents and I agree not to challenge or dispute their admissibility, authenticity or accuracy in any proceedings; and

e) that Prudential takes no responsibility for the accuracy and integrity of any copy of the Electronic Records outside of Prudential's secure portal (such as but not limited to copies transmitted via email and/or downloaded by me).

11. I understand and agree that Prudential is entitled not to accept or process this application should a person connected with this application be found to be a Prohibited Person, meaning a person or entity (including but not limited to any director or direct/indirect shareholder or person having executive authority or natural persons appointed to act on my behalf, beneficiaries or my Beneficial Owner(s) or beneficiaries’ Beneficial Owner(s) therein) subject to any laws, regulations and/ or sanctions administered by any regulatory authorities in any country, which have the effect of prohibiting Prudential from providing insurance coverage, transacting business with or otherwise offering any economic benefits to me or any other beneficiaries or assignees under the relevant Policy, and the decision of Prudential shall be final. I further agree that in the event that Prudential becomes aware that a person connected with the policy that is issued based on this application (the “relevant Policy”) (including but not limited to any of the Assured, trustee, assignee, Beneficiary, Beneficial Owner, or nominee) is or has become a Prohibited Person, Prudential may block and/or terminate the (i) coverage of that Insured, and/or (ii) relevant Policy, with immediate effect, and shall not thereafter be required to transact any business with any person connected with the relevant Policy in connection with the relevant Policy, including but not limited to, making or receiving any payments under the relevant Policy. I also agree (as an ongoing obligation) to notify Prudential in writing immediately of any change(s) to the identities, status/constitution/establishment, particulars and identification documents of a person connected with the relevant Policy. If an application is accepted or processed by Prudential despite a person connected with the relevant Policy being a Prohibited Person, Prudential shall be entitled to block and/or terminate the relevant Policy at any time, whether with effect from inception of the relevant Policy or otherwise.

Marketing Consent
By submitting this form, I confirm that I have read, understood and given my consent for Prudential and its authorised representatives to collect, use, disclose and/or process my personal data for the purpose of contacting me about products and services distributed, marketed and/or introduced by Prudential and its authorised representatives through marketing activities via all channels including but not limited to SMS, social media, in-app push notification, phone call etc and perusing my contact details which Prudential and its authorised representatives has in its records from time to time and in accordance to the Prudential’s Privacy Notice.
 

I hereby expressly understand and agree that my given consent(s) herein do not supersede or replace any other consents and/or previous consents which I may have previously given to Prudential and its authorised representatives in respect of my personal data and is without prejudice to any legal rights available to Prudential and its authorised representatives to collect, use or disclose my personal data.
 

For existing customers:
I understand that I can refer to Prudential's Privacy Notice, which is available at https://www.prudential.com.sg/Privacy-Notice for more information on contacting Prudential for feedback, access, correction and withdrawal on the use of my personal data.
 

For individuals who are new to Prudential:
 I understand that I will receive a notification through email or SMS on how I can provide feedback and request to access, correct and withdraw the use of my personal data.