Z-Alliance Cyber Protect
(*) indicates compulsory fields
Basic Information Section
 



 
Additional Insured (Spouse and children residing in the Insured's household) Section
 

IMPORTANT NOTE : You are advised to provide complete information in this section to ensure your named additional insured person is covered under the same policy. Should you require to amend or add additional insured person after the policy is issued, please email Zurich at callcentre@zurich.com.my

Name 01
Relationship
NRIC/Passport Number
Date of Birth
Name 02
Relationship
NRIC/Passport Number
Date of Birth
Name 03
Relationship
NRIC/Passport Number
Date of Birth
Name 04
Relationship
NRIC/Passport Number
Date of Birth
Name 05
Relationship
NRIC/Passport Number
Date of Birth
Name 06
Relationship
NRIC/Passport Number
Date of Birth
Disclaimer
  • YES! I would like to purchase Z-Alliance Cyber Protect that provides compensation in the event of financial loss due to Cyber Incident I understand that it is my duty to take reasonable care not to make any misrepresentation and I hereby declare that I have fully and accurately answered the questions above. I hereby unconditionally authorize Zurich General Insurance Malaysia Berhad to settle payment of the Insurance Premium due for payment indicated below by debiting/charging the Premium amount to my VISA/MasterCard card as detailed below in accordance with the accompanying terms and conditions of which I hereby agree to be bound.
  • The selected General Insurance Product is an optional insurance product / Produk Insurans Am yang dipilih adalah produk insurans opsyenal.
  • The selected General Insurance Product is underwritten by Zurich General Insurance Malaysia Berhad 201701035345 (1249516-V), a company licensed under the Financial Services Act 2013 and regulated by Bank Negara Malaysia. This insurance product is distributed by Alliance Bank Malaysia Berhad 198201008390 (88103-W).
  • I am entitled to a 15 days free-look period. If I am not satisfied with the selected General Insurance product, I can cancel by giving written notice and return the Policy Schedule to Zurich General Insurance Malaysia Berhad within 15 days of receiving the Policy Schedule.
  • I hereby give my unconditional and unequivocal consent to you and all your related companies to process my personal data revealed hereto. You are at liberty to process the data and share the information thereto with any of your service providers and your other related companies provided that the revelation of my personal data strictly for the purposes in relation to the insurance which I have applied hereto. The consent given hereto is in line with the requirement set forth in the Personal Data Protection Act 2010.
  • I hereby consent to the processing of my personal data for marketing and promotional purpose within and outside Malaysia including sending me information on products, services, promotions or other events by you, your advisors/agents and group of companies, as well as relevant third parties, with whom Zurich General Insurance Malaysia Berhad maintains business referral or other arrangement. Note: The processing of your personal data is subject to Zurich General Insurance Malaysia Berhad’s Personal Data Protection Notice, as published on Zurich Website.
  • I hereby undertake that I shall not in any way whatsoever hold Zurich General Insurance Malaysia Berhad or its employees liable for any omission and/or negligence and I agree to indemnify and keep indemnifying Zurich General Insurance Malaysia Berhad or its employee against all actions, proceedings, claims, damages, expenses, demands and/or losses whatsoever which Zurich General Insurance Malaysia Berhad carrying out or omitted to carry out by virtue of my above instruction.

 
 
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