WHEREAS the Insured described in the Schedule hereto being desirous of insuring in the manner hereinafter mentioned with Berjaya Sompo Insurance Berhad (hereinafter called "The Company'') has made a proposal and declaration which proposal and declaration is agreed shall be the basis of the contract for the Insurance hereby intended to be made and incorporated herein and has paid to the Company the First Premium stated in the Schedule as a consideration for the Insurance for the period stated herein.

NOW THIS POLICY OF INSURANCE WITNESSES that if during the Period of Insurance the life Insured shall suffer Death or Loss or Disablement which is solely and directly occasioned by accidental bodily injury, the Company will subject to the terms provisos exclusions and conditions of and endorsed on this Policy (which terms provisos exclusions and conditions shall so far as the nature of them respectively will permit be deemed conditions precedent to the right to recover under this Policy) pay the life Insured or in the event of Death to the life lnsured's legal personal representative the sum or sums of money specified in the Table of Benefits.

DUTY OF DISCLOSURE

Where the life Insured has applied for this Insurance wholly for purposes unrelated to life lnsured's trade, business or profession, life Insured had a duty to take reasonable care not to make a misrepresentation in answering the questions in the Proposal Form (or when life Insured applied for this Insurance). life Insured should have answered the questions fully and accurately. Failure to have taken reasonable care in answering the questions may result in avoidance of life lnsured's contract of insurance, refusal or reduction of claim(s), change of terms or termination of contract of insurance in accordance with the remedies in Schedule 9 of the Financial Services Act 2013. Life Insured was also required to disclose any other matter that the Life Insured knew to be relevant to The company's decision in accepting the risks and determining the rates and terms to be applied.

Life Insured also has a duty to tell The Company immediately if at any time after Life lnsured's contract of insurance has been entered into, varied or renewed with The Company any of the information given in the Proposal Form (or when Life Insured applied for this insurance) is inaccurate or has changed.

TABLE OF BENEFITS

ULTIMA CARE PERSONAL ACCIDENT POLICY

NOTICE: For all intents and purposes where there is a conflict or ambiguity as to the meaning in the Bahasa Malaysia provisions of any part of the Contract, it is hereby agreed that the English version of the Contract shall prevail.

CASH BEFORE COVER It is a fundamental and absolute special condition of this contract of insurance that the premium due must be paid and received by the Company before cover commences. If this condition is not complied with, then this insurance is automatically null and void.

Basic Coverage described as below: -Percentage of Principle

Sum Insured

1 Death occurring within twelve calendar months of bodily injury as aforesaid....................................................... 100% 2 Permanent Disablement occurring within twelve calendar months of bodily injury as aforesaid. Loss of two limbs................................................................................................................................................................ 1000,; Loss of both hands, or of all fingers and both thumbs.................................................................................................. 100% Total loss of sight of both eyes......................................................................................................................................... 1000,; Total paralysis..................................................................................................................................................................... 1000,; Injuries resulting in permanently bedridden.................................................................................................................. 1000,4 Any other injury causing permanent total disablement from gainful employment of any and every kind.......... 100% Loss of arm at shoulder..................................................................................................................................................... 100% Loss of arm between shoulder and elbow...................................................................................................................... 1000,4 Loss of arm at elbow.......................................................................................................................................................... 100% Loss arm between elbow and wrist................................................................................................................................. 100% Loss of hand at wrist.............................................................................................................................................. 1000,;

(UC.PA/PW 0918)

12. CURRENCY OF PAYMENT

All payments under this Policy shall be made in Malaysia Ringgit. In the event that the life Insured is admitted into a hospitaland/or receives medical treatments outside Malaysia and renders bills in a currency other than Malaysia Ringgit, the Companyshall indemnify the life Insured or the lnsured's legal personal representative in Malaysia Ringgit based on the prevailingcurrency market rates on the date of seeking treatment/admitted or discharged whichever is lower.

13. MISREPRESENTATION/FRAUD

If the proposal or dedaration of the Insured is untrue in any respect or if any material fact affecting the risk be incorrectly statedherein or omitted there from, of if this insurance, or any renewal thereof shall have been obtained through any misstatement,misrepresentation or suppression, or if the claim in any respect is fraudulent or if any false declaration be made or used insupport thereof or if any fraudulent means or devices are used by the Insured or any one acting on his behalf to obtain anyBenefit under this Policy; or if the Death or Loss or Disablement be occasioned by the willful act or with the connivance of thelife Insured; or if the claim be made and rejected and an action or suit not commenced within three months after suchrejection or (in case of an arbitration taking place in pursuance of the 13th condition of this Policy) within three months after thearbitrator or arbitrators or umpire shall have made their reward, all Benefits under this Policy shall be forfeited.

14. ARBITRATION

All differences arising out of this Policy shall be referred to the decision of an arbitrator to be appointed in writing by the partiesin difference or if they cannot agree upon a single arbitrator to the decision of two disinterested persons as arbitrators of whomone shall be appointed in writing by each of the parties within two calendar months after having been required so to do in writingby the other party. In case either party shall refuse or fail to appoint an arbitrator within two calendar months after receipt ofnotice in writing requiring an appointment, the other party shall be at liberty to appoint a sole arbitrator and in case ofdisagreement between the arbitrators the difference shall be referred to the decision of an umpire who have beenappointed by them in writing before entering on the reference and who shall sit with the arbitrators and preside at theirmeetings. The death of any party shall not revoke or affect the authority or powers of the arbitrator or arbitrators or umpirerespectively; and in the event of the death of an arbitrator or umpire another shall in each case be appointed in his stead by theparty or arbitrators (as the case may be) by whom the arbitrator or arbitrators or umpire so dying was appointed. The costs ofthe reference and of the award shall be in the discretion of the arbitrator or umpire making the award. And it is hereby expresslystipulated and declared that it shall be a condition precedent to any right of action or suit upon this Policy that the award by sucharbitrator or arbitrators or umpire if disputed shall be first obtained.

EXCLUSIONS

This Policy does not cover :-(1) Death or Disablement or any other loss caused directly or indirectly by:-

(a) by war, invasion acts of foreign enemies, hostilities or warlike operations (whether war be declared or not) civil war,rebellion, revolution, insurrection, riot, strike, civil commotion, or any act of terrorism insurrection military or usurpedpower of confiscation or nationalisation or requisition or destruction of or damage to property by or under the order of anygovernment or public or local authority.

For the purpose of this exclusion an act of terrorism means an act including but not limited to the use of force or violenceand/or the threat thereof of any person or group(s) of persons whether acting alone or on behalf of or in connection withany organization(s) or government(s) committed for political religious ideological or similar purposes including the intentionto influence any government and/or to put the public or any section of the public in fear. This exclusion also exdudes loss,damage cost or expense of whatsoever nature directly or indirectly caused resulting from or in connection with any actiontaken in controlling, preventing, suppressing or in any way relating to (a) above. If the Company alleges that by reason of thisexclusion any loss damage cost or expense is not covered by this insurance the burden of proving the contrary shall be uponthe Insured. In the event any portion of this exclusion is found to be invalid or unenforceable the remainder shall remain infull force and effect.

(b) Insanity, suicide (whether sane or insane), intentional self-inflicted injury or any attempt threat;

(c) pre-existing physical or mental defect or infirmity;

(d) bacterial or viral infections of any disease or sickness, medical or surgical treatment (except such as may be necessitatedsolely by injuries covered by this policy and performed within the time provided in the policy);

(e) HIV (Human Immunodeficiency Virus) and/or HIV related illnesses including AIDS and/or any mutant derivatives orvariations thereof;

(f) childbirth, miscarriage, pregnancy or any complications thereof;

(g) any bodily injury which shall result in hernia.

(2) Death or Disablement or any other loss sustained by the Life lnsured:-

(a) while riding or pillion riding on a two-wheeled motor vehicle as a sport;

(b) while using wood-working machinery driven by mechanical power except portable tools applied by hand and used solely forprivate without reward;

8

POLISI KEMALANGAN DIRI ULTIMA CARE

PEMBERITAHUAN:

Bagi tujuan dan maksud sekiranya terdapat konflik atau kekaburan berkenaan makna di dalam Bahasa Malaysia tentang mana-mana bahagian Kontrak, adalah dipersetujui bahawa kontrak versi Bahasa Jnggeris akan digunakan.

TUNAI SEBELUM PERLIN DUNGAN Jni adalah asas dan mutlak keadaan kontrak insurans ini bahawa premium mestilah dibayar dan diterima oleh Syarikat sebelum perlindungan bermula. Jika keadaan ini tidak dipatuhi, maka kontrak insurans in secara automatiknya terbatal dan tidak sah lagi.

BAHAWASANYA Orang Diinsuranskan yang dihuraikan di dalam Jadual dalam dokumen ini berikutan dengan profesion atau

pekerjaan yang dinyatakan di dalam Jadual berhasrat untuk diinsuranskan dalam cara yang disebutkan dengan Berjaya Sompo Insurance Berhad (dinamakan sebagai "Syarikat" kemudian dari ini) telah membuat cadangan dan akuan yang mana cadangan dan akuan tersebut telah dipersetujui, akan menjadi asas kepada kontrak lnsurans tersebut dengan ini bertujuan untuk dibuat atau dimasukkan dalam perjanjian ini dan telah membayar kepada Syarikat Premium Pertama yang dinyatakan di dalam Jadual sebagai balasan kepada insurans tersebut untuk tempoh yang telah dinyatakan dalam perjanjian ini.

MAKA POLISI JNSURANS JNI MEMPERSAKSIKAN bahawa jika pada masa Tempoh lnsurans tersebut, Orang Diinsuranskan mengalami Kematian atau Kerugian atau Ketidakupayaan yang secara tunggalnya dan secara langsungnya diakibatkan oleh kecederaan anggota akibat daripada kemalangan, Syarikat akan tertakluk kepada terma, proviso, pengecualian dan syarat padanya dan yang diendorskan pada polisi ini (yang mana terma, proviso, pengecualian dan syarat hendaklah sejauh mana keadaan asal masing-masing dibenarkan untuk dianggap sebagai syarat terdahulu kepada hak untuk mendapatkan semula Palisi ini) membayar jumlah atau jumlah-jumlah wang yang dinyatakan dalam Jadual Manfaat kepada Orang yang Diinsuranskan atau kepada wakil peribadi Orang yang Oiinsuranskan di sisi undang-undang sekiranya berlaku kematian.

KEWAJIPAN PENDEDAHAN

Apabila anda telah memohon lnsurans ini, anda mempunyai kewajipan untuk mengambil langkah yang munasabah untuk tidak salah nyata di dalam Borang cadangan. Dalam kata lain, anda haruslah menjawab soalan-soalan dengan penuh dan tepat. Kegagalan dalam mengambil langkah munasabah dalam menjawab soalan-soalan boleh mengakibatkan pembatalan kontrak insurans, keenggangan atau pengurangan gantirugi, perubahan kepada terma atau penamatan kontrak insurans anda selaras dengan remedi di Jadual 9 Akta Perkhidmatan Kewangan 2013. Anda juga dikehendaki mendedahkan perkara-perkara lain yang anda tahu akan mempengaruhi keputusan pihak kami dalam menerima risiko dan menentukan kadar dan terma yang akan dikenakan.

Anda juga mempunyai kewajipan untuk memberitahu kami dengan serta-merta jika pada bila-bila masa selepas kontrak insurans anda ditandatangani, diubah atau diperbaharui dengan kami, apa-apa maklumat yang diberikan di dalam Borang cadangan yang

tidak tepat atau telah berubah.

JADUAL MANFAAT-MANFAAT

Perlindungan asas dihuraikan seperti di bawah : -Peratusan daripada jumlah

Prinsip diinsuranskan

1 Kematian yang bertaku dalam masa dua belas bulan kalendar disebabkan oleh kecederaan anggota seperti yang disebutkan sebelumnya......................................................................................................................................................................... l0OOAi 2 Ketidakupayaan Kekal yang berlaku dalam masa dua belas bulan kalendar disebabkan oleh kecederaan anggota seperti yang disebutkan sebelumnya Kehilangan dua anggota........................................................................... .......................................................................... 1000,; Kehilangan dua tangan, atau kesemua jari atau kedua-dua ibu jari............................................................................. 1000,; Kehilangan penglihatan kedua-dua belah mata............................................................................................................. 1000,; Kelumpuhan menyeluruh................................................................................................................................................. 100% Kecederaan yang mengakibatkan terlantar di atas katil secara kekal......................................................................... 100% Mana-mana kecederaan lain yang mengakibatkan ketidakupayaan secara menyeluruh dan kekal daripada menjalankan mana-mana dan setiap jenis pekerjaan............................................................................. ...................................... l0OOAi

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Manfaat Pelan 1 Pelan 2 Pelan 3

JUMLAH 011/ISURANSKAll (RM]

Pelan 4 Pelan 5 Pelan6 Pelan 7 Pelan 8

PERUNDUNGAN TAMBAHAN (PILIHAN) (SMEUNGAN)

RIDER 2 Setiap Downsa I 1,600 Koguguran Al<i:lat Kanak-kanak Komalangan SetiapKoluarga 4,600 Kenderaan Bermotor

Dcroh yang Toroomar / Setiap Downsa / 6,000 12,000 18,000 26,000 36,000 60,000 76,000 100,000 PG!11iooahan Damh Kanak-kanak

Setiap Koluarga 16,000 36,000 64,000 76,000 108,000 160,000 226,000 300,000

Kernandulan atau Setiap Dow,isa / 6,000 12,000 18,000 26,000 36,000 60,000 76,000 100,000 Kotidaksubt.ran akibat Kanak-kanak Komalangan Setiap Koluarga 18,000 36,000 64,000 76,000 108,000 160,000 226,000 300,000

P<rlindungan Kowangan Setiap Downsa 2,000 3,000 4,000 6,000 6,000 7,000 8,000 0,000

Pampasan Ragut Setiap Downsa / 600 Kanak-kanak Setiap Koluarga 1,600

RIDER 3 P<rlindungan Tindakan SetiapD91wsa/ 60,000 100,000 120,000 120,000 160,000 200,000 220,000 260,000

Koganasan (koouali Kanak·kanak nUkloar, bahan kiria & Setiap Koluarga 160,000 300,000 360,000 360,000 460,000 600,000 660,000 760,000 biologikal)

NOTICE TO All POLICYHOLDERS/ NOTIS KEPADA SEMUA PEMEGANG POLIS/

If you have any complaints relating to this insurance policy, please contact our local branch manager or our complaints unit officer at: Jika anda mempunyai aduan berhubung dengan polisi insurans ini, sila hubungi pengurus cawangan kami atau pegawai unit aduan di:

CUSTOMER SERVICE CENTRE BERJAYA SOMPO INSURANCE BERHAD Level 36, Menara Bangkok Bank105, Jalan Ampang50450 Kuala Lumpur.

Tel.: 03-2170 7300 Fax: 03-2170 4800 Email: info@bsompo.com.my

Website: www.berjayasompo.com.myOr/ Atau

The following bodies who are authorised to oversee public enquiries and complaints on insurance related matters:

Pihak-pihak yang diberi kuasa untuk mengendalikan soalan-soalan umum dan pengaduan mengenai perkaro-

perkara berkenaan insurans:

1. OMBUDSMAN FOR FINANCIAL SERVICES

OMBUDSMAN PERKHIDMATAN KEWANGAN

Level 14, Main BlockMenara Takaful MalaysiaNo. 4, Jalan Sultan Sulaiman50000 Kuala LumpurTel. / Tel. : 03-2272 2811 Fax/ Faks : 03-2272 1577 E-mail / E-mel : enquiry@ofs.org.my Website/ Loman Web : www.ofs.org.my

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2. LAMAN INFORMASI NASIHAT DAN KHIDMAT (LINK)PengarahJabatan LINK & Pejabat WilayahBank Negara MalaysiaP.O Box 1092250929 Kuala Lumpur

Tel./ Tel. : 1-300-88-5465 Fax/ Faks : 03-2174 1515 E-mail/ E-mel : bnmtelelink@bnm.gov.my