Policy Loan Agreement Form - AXA Life Insurance Singapore

POLICY LOAN AGREEMENTASSURED/ASSIGNEE *……………………………………. OF NRIC NO.:…………………………..*delete as applicableAXA Life Insurance Singapore Pte Ltd hereinafter called “the Company” agrees to grant the policyloan(s) to the abovenamed Assured /Assignee* as Owner of the policy(ies) listed in the table below forthe respective Loan Amount given, subject to the terms and conditions listed below :POLICY NO. DATE OF LOAN. LOAN AMOUNTS S$Terms & Conditions :1 The Owner assigns / transfers to the Company as sole security for the repayment of the aboveloan(s), all rights, title and interest in the above numbered Policy(ies) together with all money thatmay hereafter become payable.2 In signing this Loan Agreement, the Owner certifies that each of the above numberedPolicy(ies) is not assigned to any other third party (other than the Company if an earlierpolicy loan had been granted and is now outstanding) and agrees that it shall not be assigned toanyone unless all indebtedness secured have been fully repaid. The Owner also certifies thatno bankruptcy proceedings have been instituted by anyone against him / her.3 The Owner shall have the right to repay any of the loan(s) in part or in full at any time while thepolicy on which it is secured is in force and upon such repayment in full with interest for any oneloan listed in the table above, this Agreement is automatically deemed to be cancelled for thatloan. When all loans listed above have been fully repaid with interest, the Agreement becomesvoid.4 Interest on each loan shall be payable from the date of loan. The interest rate applicable as at thedate of this Agreement is 6.75% per annum and compounded on each policy anniversary. Suchinterest rate is subject to change at the sole discretion of The Company and this Loan shall besubject to all such changes in interest rates.AXA Life Insurance Singapore Pte Ltd (Company Reg. No. 199903512M)8 Shenton Way #27-02 AXA Tower Singapore 068811AXA Customer Centre #B1-01 Tel: 6880 5500 Fax: 6880 5501Website: www.axalife.com.sgPOLICY LOAN MAR 11 Page 1 of 2

5 Whenever the principal of each loan plus the interest and other amounts outstanding on eachrespective policy accumulate to the level of the cash surrender value of that policy, the policyshall become void without any notice, formality or other proceedings whatsoever on the part ofthe Company.6 Any written correspondence on the subject of this Agreement which has been addressed andmailed to the last known address of the Owner shall be deemed to have been duly served.7 Any policy benefits due to be payable shall first be reduced by the amount of any outstandingloans plus interest due or accrued, before the balance, if any, is paid to the Owner or his assigns.This Agreement is signed by the Owner and an Officer of The Company, and duly witnessed, to takeeffect as from the date of loan whereupon this Agreement shall be attached to and form part of each ofthe policies listed in the table above. A Certified True Copy of this Agreement is deemed to be as goodas the original Agreement as long as the certification is done by an authorised officer of The Companyand bears the stamp of The Company.In signing this Agreement, the Owner acknowledges receipt of the Loan Amount for each loan listed inthe above table and gives his discharge for it.Please tick () option below:Sent to me by postI will collect it from your office on ………………………I authorise …………………………………………(name), …………………….(NRIC no.),………………………… (relationship) to collect the cheque on my behalf.(Note: Only account payee cheques can be collected by a third party who has to show hisidentification card and acknowledge receipt of such cheque).Dated ……………..………….…. day of ………...……………………. (month) …...……………….. (year)..........................................…............................................….Signature of Owner /TrusteeWitness (Beneficiary if any)Date : Name :NRIC no. :Date :…………………………..Authorised OfficerAXA Life Insurance Singapore Pte LtdDate :______________________________________________________________________________For office use only :Handled by : _____________________ Cheque No. _____________________________ Cash A/C PayeeApproved by : _____________________ Acknowledged by : _______________________Date : _____________________ Name : ________________________NRIC No.DateMailed on: ________________________: ________________________: ________________________POLICY LOAN MAR 11 Page 2 of 2