Sangha Group Insurance Application Form

本表提供的信息真实完整。

如果我的信息有任何变更，我将及时通知 UBOM。

我的会员资格必须符合资格标准。

UBOM may disclose my personal data to 3rd parties as they may deem necessary. If necessary, such 3rd parties may disclose my personal data to selected parties in and outside Malaysia, in accordance with such 3rd parties' personal data protection policies.

The Sangha Group Insurance will be renewed yearly around the month of February. Monastics who join as UBOM's members after January will only be insured from next year onwards.

With regard to those monastics who are eligible for the Sangha Group Insurance, the coverage will cease if his/her membership with UBOM is discontinued for any reason whatsoever.

All claims are subject to the coverage limit(s), terms and conditions of the insurer concerned. I waive my rights to any compensation or indemnity against UBOM, its officers, servants and representatives, whether due to the insurer's non-acceptance of risk, refusal of claim or anything whatsoever relating to the Sangha Medical Assistance/the Sangha Group Insurance.

In the event that I pass away before the insurance proceeds are paid to me, UBOM shall have the sole and absolute discretion to deal with the said insurance proceeds in any way they deem fit.

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