Magic Filler - CI Pro Universe

Policy Information

Policy No.

Insured's Name

Insured's IC No.

Choose one or more request (only request that is "checked in the box" will appear)

A. Update Customer Details

B. Change of Payment Mode

C. Change of Payment Method

D. Change of Signature

E. Others

A. Update Customer Details

Documentary proof is required, i.e. Birth Certificate/Identity Card/Passport.

Customer's Role (choose one or more to update)

Insured Policy Owner Nominee/Assignee/Trustee

Insured - Update Details

Name (tick checkbox before key in)

Date of Birth (tick checkbox before key in)

IC/BC/Passport No. (tick checkbox before key in)

Sex (tick checkbox before key in)

Country of Birth (tick checkbox before key in)

Nationality (tick checkbox before key in)

Policy Owner - Update Details

Name (tick checkbox before key in)

Date of Birth (tick checkbox before key in)

IC/BC/Passport No. (tick checkbox before key in)

Sex (tick checkbox before key in)

Country of Birth (tick checkbox before key in)

Nationality (tick checkbox before key in)

Nominee/Trustee/Assignee - Update Details

Name (tick checkbox before key in)

Date of Birth (tick checkbox before key in)

IC/BC/Passport No. (tick checkbox before key in)

Sex (tick checkbox before key in)

Country of Birth (tick checkbox before key in)

Nationality (tick checkbox before key in)

B. Change of Payment Mode

Annual

Semi-Annual

Quarterly

Monthly

C. Change of Payment Method

Internet Banking

Direct Debit (FPX)

D. Change of Signature

Insured

Policy Owner

Assignee

Trustee

Tap to Sign (Old Signature)

Tap to Sign (New Signature)

E. Others

Signature Details

Signed at (State)

Day Month Year

Signature of Policy Owner

Policyowner is same as Insured

Name of Policyowner

IC No.

Tap to Sign (Policyowner)

Signature of Witness

Name of Witness

IC No. Mobile No.

Tap to Sign (Witness)

Signature of Assignee

Name of Assignee

IC No.

Tap to Sign (Assignee)