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Personal Accident Insurance

Accidents resulting in prolonged or permanent injury bring life to a halt, especially if you’re providing for someone else. Total One Protection provides coverage for expenses or loss of income as a result of injury or death from an accident. Enter your information below and pay for your personal accident insurance instantly.
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PRIMARY ASSURED CONTACT DETAILS

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Name

Birthday

Address

Contact Info

Beneficiary

CHOOSE YOUR ACCIDENT INSURANCE PACKAGE

Please choose if you are purchasing for yourself or for the whole family.

If the Principal Assured is Married, the following family members are covered by insurance:
Spouse: provided he/she is not more than 65 years old as of the date of application. Child/children (maximum of 4): provided the child is not more than 55 years old as of the date of application.  
 
If the Principal Assured is Single, the following family members are covered by insurance:
Parent/s: provided he/she is not more than 65 years old as of the date of application. Sibling/s (maximum of 4): provided the sibling is not more than 65 years old, as of the date of application.

Name

Birthday

Beneficiary

Declaration

DATA PRIVACY I acknowledge that Malayan Insurance Company, Inc. (Malayan) may collect, use, process and share my personal information to its employees, duly authorized representatives, other insurers, reinsurers, adjusters, investigators, and other third party providers for purposes such as underwriting, administration, claims adjudication and management, investment, data analytics, statistical analysis, risk analysis/ assessment/management, financial and tax monitoring/review/reporting, protection against fraud, errors, or misrepresentations, profiling, research, due diligence, company evaluation, studies/customer satisfaction surveys, and compliance with legal, regulatory or contractual requirements. Further, I agree that Malayan may notify and offer me any of its products and services that may be useful to me. In furtherance of these purposes, my personal information, unless prohibited, may be processed outside the Philippines and be subject to different data protection standards.


AUTHORITY TO DISCLOSE I hereby authorize Malayan to grant the members of the Yuchengco Group of Companies (YGC), their and Malayan’s affiliates, subsidiaries, contractors, partners, agents and representatives, intermediaries, industry associations, and other third parties access to my personal information, including this form, for purposes of marketing, sales or promotional information campaigns, and provision of any products, services, or offers through mail/email/SMS/telephone, or any type of electronic facility.


AUTHORITY TO VERIFY INFORMATION I also authorize Malayan to verify and investigate the information given by me, including submitted documents from whatever source it may consider appropriate.


RIGHTS OF THE DATA SUBJECT I acknowledge that I have the right to access the given information and I undertake to correct, rectify or supplement the same should any information be found to be inaccurate or incomplete. I shall notify Malayan in writing of any changes in the information given above.


UNDERTAKING I hereby warrant that all personal information given by me are true, correct, updated to the best of my knowledge, and freely and voluntarily given to Malayan. I agree and consent that the above information are being collected, used, processed and recorded for purposes of securing insurance protection or any other business transaction(s) with Malayan and for other purpose as indicated herein. If purchasing, transacting and/or acting in behalf of other person(s), I hereby warrant that I have been duly authorized to perform such acts and permitted to give their information to Malayan. I hereby bind myself to advise all other persons in whose behalf I have acted, transacted with and/or purchased any product or services from Malayan of all the terms and conditions herein. I will hold Malayan, directors, officers, employees, agents, successors and assigns free and harmless from any liability that may arise as a result of the authorization given above.


By signing this form, I hereby certify that I have read and understood the foregoing and this consent remains valid and binding unless I submit a written notice to Malayan revoking or altering the same.

Agreement

I acknowledge and agree to the data sharing declaration above and give authority to disclose, authority to verify information and undertaking.

Anti-Fraud: Section 251 of the lnsurance Code, as amended, imposes a fine not exceeding twice the amount claimed and/or imprisonment of two (2) years, or both, at the discretion of the court, to any person who presents or causes to be presented any fraudulent claim for the payment of a loss under a contract of insurance, and who fraudulently prepares, makes or subscribes any writing with intent to present or use the same, or to allow it to be presented in support of any claim.