business package

because we understand your trade

that’s the solution we offer

SmartBusiness for
Specialised Services
takes care of you, your employees and
your business continuity
benefits that matter in your business

Fire Group Personal Accident

Protect your building, fixtures and equipment Providing protection for you and your staff from
from loss or damage caused by fire or lightning bodily injury caused by accident.
and other causes.
Client's Personal Effects
Hospital Cash Pay up to RM1,000 for loss or damage of your
Daily cash allowance of up to RM200 per day. client’s personal belongings.
You may use it to hire temporary worker when you
or your employee is hospitalised. Plate Glass
Compensate for accidental breakage of plate
Burglary glass at your business premises.
Pay for the loss or damage of your property due
to burglary, armed robbery and theft.
 20% increase in sum insured during
festive seasons.

NEW
Lump sum cash payout of up to RM50,000

Major Critical Illness

Lump sum cash payout for the following illnesses:
 Cancer  Coronary Artery By-Pass
 Heart Attack  End Stage Kidney Failure
 Stroke  End Stage Lung Disease
 Parkinson’s Disease  End Stage Liver Failure

For more information...

Contact us at
(603) 2170 8282
[email protected]
or your AXA Agent
Proposal Form
YES! My business meets the following terms and conditions:
 Construction class 1A* – brick/concrete walls and roofed with non-combustible materials or
 Construction class 1B* – partly brick/concrete walls and roofed with non-combustible materials
*Note: Refer to Revised Fire Tariff for details
 No claim experience for the past 2 years
 All entrances to my premises are protected with roller shutter/glass door/iron grilles and padlock
 The proposed insurance now has not been declined, cancelled, refused renewal or subject to any
special terms by any other insurance company
If your business does not meet the above terms and conditions, please contact us at
(603) 2170 8282 or email to [email protected]

1a. Fire (Compulsory)/Special All Risks (Optional) Sum Insured (RM)

Item(s) to be insured Fire Special All Risks

Building Not applicable

Stocks in Trade including Goods held in trust and/or on commission Not applicable
Business Furniture, Fixtures and Fittings including Office Equipment
Others. Please specify
Note: Total Sum Insured
1. Fire coverage is mandatory.
2. Please ensure all items are adequately insured.
3. Special All Risks insures your physical assets, including office equipment, furniture, fixtures and fittings against loss or damage
caused by fire, perils, theft and other accidental causes.

Special Perils (Please tick () the required perils.) Rate (% of Insured Sum)
Storm, Tempest 0.015
Flood (Subject to no claims reported for the past 2 years) 0.086
Impact Damage (Including Insured’s Vehicle) 0.004
Riot, Strike and Malicious Damage 0.014
Bursting/Overflowing of water tanks/pipes (above 5 storeys) 0.006
Bursting/Overflowing of water tanks/pipes (others) 0.005
Others. Please specify
Premium inclusive of 6% Service Tax RM

1b. Fire Consequential Loss (Optional)

Indemnify your Business Interruption in the event of fire loss or damage for a period of months

Insure my Annual Sum (RM): Please tick () whichever applicable and complete.
Gross Profit RM Gross Revenue/Rental RM
I wish to include the following:
Auditor’s fee RM
Others. Please specify: RM
Extension:
Prevention of Access Failure of Public Utilities (electricity, water and gas)
Premium inclusive of 6% Service Tax RM

Subtotal Premium inclusive of 6% Service Tax RM

2. Smart Package (Optional)

Basic Cover Double Cover

Benefits
(RM) (RM)

Hospital Cash (Up to 12 employees) 100 per day 200 per day
- Accident or Sickness

Money
In Transit 10,000 20,000
In Premises 10,000 20,000
Smart Package Damage to Premises 1,000 2,000
Damage to Locked Safe, Drawers or Cash Register 2,000 4,000
& Cabinets
Personal Accident (Up to 2 employees) 10,000 20,000

Burglary 10,000 20,000

Additional Coverage during Festive Seasons 2,000 4,000

Public Liability 500,000 1,000,000

Fidelity Guarantee 2,500 5,000

Complimentary Client’s Personal Effects 500 1,000

Infectious Disease (Up to 12 employees) 250 per day 500 per day

Premium inclusive of 6% Service Tax (please select) 451.56 877.68

Employer’s Liability 500,000 1,000,000

Premium inclusive of 6% Service Tax (please select) 90.10 159.00

Add On
Plate Glass 2,500 5,000

Premium inclusive of 6% Service Tax (please select) 31.80 53.00

Subtotal Premium inclusive of 6% Service Tax RM

 3. Employee Benefits (Optional)

Group Personal Accident (Up to 12 employees) Basic Cover (RM) Double Cover (RM)

Accidental Death & Permanent Disablement 25,000 50,000

Liability Any One Accident 100,000 200,000

Temporary Total Disablement 50 per week 100 per week

Temporary Partial Disablement 25 per week 50 per week

Accidental Medical Expenses 1,000 2,000

Ambulance Fee 250 500

Repatriation Expenses 1,000 2,000

Funeral Expenses 1,000 2,000

Premium inclusive of 6% Service Tax (please select) 190.80 318.00

Major Critical Illness (Please select cover) Basic Cover (RM) Double Cover (RM)
 Cancer  Coronary Artery By-Pass
 Heart Attack  End Stage Kidney Failure 25,000 50,000
 Stroke  End Stage Liver Failure Premium Premium
 Parkinson’s Disease  End Stage Lung Disease inclusive of 6%
Service Tax
inclusive of 6%
Service Tax

Health Enquiries
1. Have you ever been treated, diagnosed, received or receiving medical advice, counseling or currently under
investigation for raised blood sugar, diabetes or cancer? Yes No
2. Have you ever been hospitalised for heart, hypertension, cholesterol and/or chest pain condition?
Yes No

Insured’s Name: Date Of Birth: dd/mm/yy

I/C No./Passport No.: Signature:

For additional Insured’s name, please use Major Critical Illness Additional Insured’s Name Form.
Note:
1. You are considered as a smoker if you smoke 1 stick of cigarette or more for the past 12 months.
2. Your application for Major Critical Illness will be rejected if the answer is ‘Yes’ to any of the Health Enquiries questions.
3. Calculation excludes stamp duty.
Basic Cover (RM) Double Cover (RM)
Annual Premium Table
Non Smoker Smoker Non Smoker Smoker
Age Group
Male Female Male Female Male Female Male Female
18 - 20 45.58 36.04 51.94 39.22 90.10 71.02 103.88 77.38
21 - 25 45.58 38.16 51.94 42.40 90.10 74.20 103.88 84.80
26 - 30 48.76 55.12 59.36 65.72 96.46 108.12 118.72 130.38
31 - 35 64.66 87.98 89.04 109.18 128.26 173.84 177.02 218.36
36 - 40 104.94 137.80 161.12 180.20 208.82 274.54 321.18 359.34
41 - 45 178.08 198.22 295.74 273.48 356.16 395.38 590.42 545.90
46 - 50 275.60 270.30 479.12 395.38 550.14 539.54 957.18 788.64
51 - 55 491.84 393.26 876.62 612.68 982.62 786.52 1,753.24 1,225.36
56 - 60 852.24 574.52 1,527.46 941.28 1,702.36 1,146.92 3,052.80 1,882.56
Renewal is available up to age 70
Note: Calculation of the age is based on age next birthday.
Premium rates above are inclusive of 6% Service Tax.
Total Premium
RM
inclusive of 6% Service Tax
 Date:

IMPORTANT NOTES
1. Pursuant to Paragraph 5 of Schedule 9 of the Financial Services Act 2013, if You are applying for this Insurance
Pursuant to Paragraph 4(1) of Schedule 9 of the Financial Services Act 2013, if You are applying for this
Insurance for a purpose related to Your trade, business or profession, You have a duty to disclose any matter that
You know to be relevant to Our decision in accepting the risks and determining the rates and terms to be applied
and any matter a reasonable person in the circumstances could be expected to know to be relevant, otherwise it
may result in avoidance of Your contract of insurance, refusal or reduction of Your claim(s), change of terms or
termination of Your contract of insurance.
The above duty of disclosure shall continue until the time Your contract of insurance is entered into, varied or
renewed with Us.
You also have a duty to tell Us immediately if at any time after Your contract of insurance has been entered into,
varied or renewed with Us any of the information given in the Proposal Form (or when You applied for this
insurance) is inaccurate or has changed.
2. The personal data submitted by and collected from You may be used by Us and/or any company within the AXA
Group of companies and/or any of its associated companies, within or outside Malaysia, for administration or
direct marketing purposes and in this connection, We may transfer or disclose that information to any of those
other companies. We will cease to use the Personal Data for direct marketing purposes if You request Us to do so.
For further details, please refer to Our “Data Privacy Notice” stipulated in Our website.
3. 60 Days PREMIUM WARRANTY: By this warranty, the insurance policy is automatically cancelled unless the full
premium is paid to the Insurer within 60 days from the commencement date of cover. Please note that if this
insurance is transacted through your insurance broker, the broker is acting on your behalf for the purpose of
formation of this contract of insurance. It is important that you make full payment of the premium to your broker
as soon as possible and in any case within the 60 days period of the premium warranty so as to enable your
broker to remit the premiums early to your Insurer. You are advised to request your broker to furnish you with the
broker’s and Insurer’s receipt on the premium that you paid.
4. No cover is in force until the proposal has been accepted in writing by the company.
5. Premium charged for this Policy exclude applicable tax(es) that would be imposed in the future and from time to
time, We will be entitled to recover from You any taxes that We are required by law to collect.

All questions must be fully answered - ticks and dashes will not suffice. Please write in block letters and tick ()
as appropriate.

4. PARTICULARS OF PROPOSER

Name (as in new NRIC/Passport):

Telephone No.: Mobile No.:

New NRIC/Passport No.: Date of Birth: d d m m y y
Marital Status: Nationality: Gender: F / M
E-mail:
Correspondence Address:

Postcode:

Private Use: Yes No

Collective Agreement/SOCSO/Workmen Compensation Agreement: Yes No
5. PARTICULARS OF PREMISES TO BE INSURED

Name of Company:

Co. Registration No.:

Telephone No.:

Location of Premises:

Postcode:
Nature of Business:
Period of Insurance: From d d m m y y To d d m m y y

6. PAYMENT METHOD & DECLARATION

I wish to pay my premium RM (inclusive of all tax) (“Total Amount Due”)

Cash Cheque (Please cross the cheque and made payable to ‘AXA Affin General Insurance Berhad’)
Bank Cheque No. Amount (RM)

Visa MasterCard
Card No. - - - Expiry Date: m m y y

Cardholder’s Name:

Cardholder’s Signature: Date: dd/mm/yy

I/We hereby declare that the above answers and statements are true, and that I/we have withheld no information
whatever regarding this application.

I/We understand that it is my/our duty to take reasonable care not to make a misrepresentation in answering the
questions in this Proposal Form and I/we hereby declare that I/we have fully and accurately answered the
questions above.
Signature of Proposer: Date: dd/mm/yy

7. DECLARATION BY INTERMEDIARY/INSURER

I/We hereby confirm that I/we have sighted the original copy of the NRIC/Passport/Business Registration
documents and verified the identity of the Proposer.
Signature of Intermediary/Insurer: Date: dd/mm/yy
Name: Agency Code:

Note: Please attach a copy of the Proposer’s NRIC/Passport/Business Registration documents where the premium
is more than RM50,000.
AXA: a world leader in financial protection

AXA Affin General Insurance Berhad

• one of the top general insurers in Malaysia
• over 130 years of local experience in Malaysia
• about 800 professional, well-trained and caring employees in 23 offices nationwide
• wide range of products for individual, small medium enterprise (SME) and business
needs that include Motor, Household, Health, Accidental, Travel and many more.

motor
property
leisure & travel
healthcare
personal accident
business packages
liability
marine

Ask your insurance agent for more details

(603) 2170 8282 SBPSS/BRPR-ENG (09/18)

[email protected]
www.axa.com.my

AXA Affin General Insurance Berhad (23820-W)

Ground Floor, Wisma Boustead, 71 Jalan Raja Chulan
50200 Kuala Lumpur, Malaysia
Tel: (603) 2170 8282 Fax: (603) 2031 7282
Email: [email protected]

This brochure is not a contract of insurance. The precise terms, conditions and definitions are specified in the insurance policy.
In the event of differences arising between the English, Bahasa Malaysia and Chinese versions, the English version shall prevail.