5-Year eEndowment Life Insurance Plan

General Terms:

• I, as Applicant and payment Account Holder, confirm that I am not acting on behalf of any other person.
• I authorize Hang Seng Bank Limited ("HASE") to debit from my specified account for initial and subsequent premiums due as instructed by Hang Seng Insurance Company Limited ("HSIC") and/or any applicable levies on behalf of the Insurance Authority (“IA”) from time to time.
• I understand that the application confirmation does not contain the full terms of the policy and the full terms can be found in the policy document.
• I acknowledge and understand that this application is submitted by me with no advice has been given by HASE on this application.

Customer Information:

• All the statements and answers in this application are to the best of my knowledge and belief, true and complete and that the application will form the basis and become part of any policy issued by HSIC. I acknowledge if any of the statements and answers given in the application are inaccurate or any material facts* have not been disclosed or verification of my identity cannot be completed within a reasonable time as determined by HSIC (during which HSIC will have the sole discretion to suspend or defer any transactions under the policy), HSIC will be entitled to cancel, terminate or suspend the policy or where HSIC considers it appropriate, to re-issue the policy with modifications even after the policy has been issued.
  * Note: If you are in doubt as to whether or not particular information or facts are material, they should be disclosed.
• I am in Hong Kong at the time of making this online application.
• I confirm I am not a United States citizen, a United States resident for federal income tax purpose or a United States Green Card holder.
• I have prior experience in using online platform(s) such as internet banking or online shopping platforms, and I am capable of making this application using this online platform.
• All statements and information I have provided in this application are complete, true and up-to-date. I will immediately inform HSIC and correct them if they have become incomplete, untrue or inaccurate subsequently before any policy is issued.
• I understand that HSIC will approve or decline any future claims based on the declaration and information I have provided during the online application.

Personal Information Collection:

• All personal information that I have most recently provided to HASE such as ID documents, nationality, mobile number and payment account correspondence address is accurate and up to date and I consent to HASE providing my personal information to HSIC or any member of the HSBC Group (“HSBC Group” means HSBC Holdings plc, its affiliates, subsidiaries, associated entities and any of their branches and offices (together or individually) and “member of the HSBC Group” has the same meaning) and any agents, contractors, sub-contractors, service providers for the purpose of evaluating and processing this application. I understand that updated personal information such as ID documentation may be requested by HSIC if necessary, and the policy may not be issued if any such requested information or documents are not provided within a specified time.
• I understand that any updated personal information I have provided to HSIC in the application will not automatically be updated in HASE’s records and therefore I must make a separate request to change my information if required.
• I understand that my personal information supplied in this application will be used in accordance with Personal Information Collection Statement of HSIC (“PICS”) and that any request to change my personal information in HSIC's records must be made through branches of HASE or as specified under Clause 5 of the PICS.

Suitability and Affordability Declaration:

• I understand I am applying for a life insurance plan with savings elements and it is designed to fulfill my insurance need to save up for the future.
• I understand the policy term is 5 years and I will need to make premium contributions to the policy and applicable levy payments for 2 years / 24 months (depending on the payment mode).
• With my income and /or liquid assets, I declare that I can afford the premium payments and applicable levies required for the life insurance policy during the policy term.

Application Approval Conditions:

• I understand submitting this application does not guarantee its approval, and HSIC will only approve the policy after (i) HSIC is satisfied I have met HSIC’s prevailing eligibility and underwriting requirements and (ii) HSIC has proceeded my first premium payment and applicable levy(ise).
• I acknowledge that if HSIC does approve my application, the policy will be made effective from the date my valid application was submitted.

Risk from the delay or missing the payment of premium due:

• I understand that I should pay the premium for the entire premium payment term when due. Any delay or missing of the payment of premium due may lead to policy lapse, and the amount (if any) I get back may be significantly less then my premium paid.

Risk from surrender:

• I understand that if I surrender the policy after the expiry of the cooling-off period, the surrender proceed to be received may be significantly less than the Total Premiums Paid.
• Please refer to the Illustration Summary of this Plan for the surrender values. All details regarding policy surrender should be referred to the relevant policy provision.

Policy Currency Risk:

• I understand that, by choosing the plan denominated in currencies other than local currency, I will subject to exchange rate risk. Exchange rate fluctuates from time to time. Upon the currency conversion, I may suffer a loss of the benefit values, due to the exchange rate fluctuations, the initial premium payment may be higher / lower than the quoted premium and the subsequent premium payment (if any) may be also higher / lower than the initial premium payment.
• If I select to pay premiums and receive policy benefits in Renminbi. HSIC reserves the right in determining the currency in which I pay or receive. Renminbi is currently not freely convertible and conversion of Renminbi may be subject to certain policy, regulatory requirements and/or restrictions (which are subject to changes from time to time without notice). The actual conversion arrangement will depend on the policy, regulatory requirements and/or restrictions prevailing at the relevant time. As Renminbi is currently not freely convertible and is subject to exchange controls by the Chinese government, Renminbi currency is subject to availability and HSIC may not have sufficient Renminbi at the relevant time.
  
• I have considered the aforesaid exchange rate risk factors, conversion arrangement and the potential loss associated before applying the plan.
  

Policy Currency Risk:

• I understand that, by choosing the plan denominated in currencies other than local currency, I will subject to exchange rate risk. Exchange rate fluctuates from time to time. Upon the currency conversion, I may suffer a loss of the benefit values, due to the exchange rate fluctuations, the initial premium payment may be higher / lower than the quoted premium and the subsequent premium payment (if any) may be also higher / lower than the initial premium payment.
  
• I have considered the aforesaid exchange rate risk factors, conversion arrangement and the potential loss associated before applying for the Plan.

Credit risk:

• I understand that the benefits of this Plan are subject to the credit risk of HSIC. Policy benefits include Death Benefit, surrender benefit and maturity benefit (if applicable), etc. The premium that I pay will become parts of HSIC’s assets, and the life insurance plans of HSIC involve policy benefits such as Death Benefit, surrender benefit and maturity benefit payable to the Policyholders or Beneficiaries by HSIC. I should bear the credit risk associated with HSIC [i.e. the risk that HSIC may not be able to deliver its obligations bound by the policies (including the payment of policy benefits) due to financial difficulties].

Cancellation Rights and Refund of Premium(s) within Cooling-off Period:

• I, the Policyholder, understand that I have the right to cancel the policy and obtain a refund of any premium(s) paid (less any market value adjustment for investment-linked or non-linked single payment/ single premium policy) by returning the policy surrender form to Hang Seng Insurance Company Limited. I understand that to exercise this right, the policy surrender form must be signed by me and returned by mail to Hang Seng Insurance Company Limited at 18/F, Tower 1, HSBC Centre, 1 Sham Mong Road, Kowloon, Hong Kong or returned to any Hang Seng Bank branches (except MTR station outlets) ^ within the Cooling-off Period. I understand that the Cooling-off Period is the period of 21 calendar days* immediately following either the day of delivery of the policy or the Cooling-off Notice to me/ my nominated representative (whichever is earlier). I understand that the Cooling-off Notice is a notice that will be sent to me or my nominated representative to notify me of the Cooling-off Period around the time the policy is delivered.
  Note:
  ^Only applicable to personal customer.
  *If the last day of the period does not fall on a working day, the period will include the next working day.

Levy imposed by Insurance Authority

• I understand that the Insurance Authority (“IA”) will impose a prescribed levy on this insurance policy pursuant to section 134 of the Insurance Ordinance (Cap. 41). Such levy payment should be made together with the premium payment to HSIC for direct remittance to the IA within the remittance period as specified by the IA. Subject to the applicable levy cap, the amount of levy payable for each premium payment is the amount of premium multiplied by the applicable levy rate as prescribed by IA. All subsequent premiums to be paid will also be subject to the applicable levy rate and cap. I understand that it is the statutory duty of the policyholder to pay the prescribed levy to IA through HSIC. IA may impose on the policyholder concerned a pecuniary penalty not exceeding HK$5,000 for non-payment of levy.

Common Reporting Standards:

• I understand that the information supplied by me is covered by the full provisions of the terms and conditions governing the Account Holder’s relationship with HASE setting out how HASE may use and share the information supplied by me.
• I acknowledge and agree that the information contained in the Tax Residence section is collected and may be kept by HASE for the purpose of automatic exchange of financial account information provided under the Inland Revenue Ordinance (Cap.112).
• I also agree that the information contained in the Tax Residence section may be shared to and used by any member of the HASE Group (including any affiliates, subsidiaries and associated entities of HASE and their branches and offices) for the purposes of automatic exchange of financial account information provided under the Inland Revenue Ordinance as set out above.
• I certify that I am the Account Holder of all the account(s) to which the Tax Residence section relates.
• I declare that the information given and all statements made in the Tax Residence section and declarations are, to the best of my knowledge and belief, true, correct and complete.
• I undertake to advise HASE within 30 days of any change in circumstances which affects the Tax Residence status or causes the information contained herein to become incorrect, and to provide HASE with a suitably updated self-certification and Declaration within 90 days of such change in circumstances.

I have read and understood the Cooling-off Rights, Common Reporting Standards, Illustration Summary, the General Provisions, Unemployment Benefit Provision, Accidental Death Benefit Provision, the Hang Seng Bank Limited and its subsidiaries Privacy Principles and the Personal Information Collection Statement of HSIC and agree to be bound by the same.