YF Life’s certified plans under the Voluntary Health Insurance Scheme:

Subscribe to VHIS and enjoy a 2-month premium discount
  • TaxVantange Medical Plan (Standard Plan)
  • Guaranteed renewals for life
  • No lifetime benefit limit
  • Freedom to choose
  • Extensive coverage
  • Coverage of unknown pre-existing conditions
  • Tax deductible
  • Free quote before you commit
  • TaxVantange Plus Medical Plan (Flexi Plan)
  • Guaranteed renewals for life
  • No lifetime benefit limit
  • Freedom to choose
  • Extensive coverage
  • Coverage of unknown pre-existing conditions
  • No claim premium discount
  • Tax deductible
  • Free quote before you commit
  • Optional supplementary benefits
Personal Information
1.Name of Proposed Insured in English (Same as the name in ID document)
Title
Mr. Mrs. Ms. Miss
Family Name
Given Name
English Name
2.Name of Proposed Insured in Chinese (Same as the name in ID document)
Chinese Name
You are Insured?
Hong Kong ID no.
Please enter first/first 2 alphabet(s) and first 4 digits of ID number in the blank spaces provided e.g. A1234 or AZ1234
Please input Proposed Owner’s information
Title
Mr. Mrs. Ms. Miss
Family Name
Given Name
English Name
Chinese Name
Hong Kong ID no.
Please enter first/first 2 alphabet(s) and first 4 digits of ID number in the blank spaces provided e.g. A1234 or AZ1234

Please enter your phone number

Area
+852
Mobile Number

Mobile Phone Verification

Please input the verification code
Mobile Number
SMS Verification Code -

DECLARATION & AGREEMENT

Duty of Disclosure

I/We declare and agree on behalf of myself/ourselves that: (1) I/We have read the above Important Note and understand my/our responsibility to disclose all material facts to YF Life Insurance International Ltd. (“the Company”); and (2) All statements and answers made in all parts of the Application are full, complete and true to the best of my/our knowledge and belief whether or not they are in my/our handwriting; (3) If there is any subsequent change to the information provided, I/we undertake to notify the Company as soon as possible and # (4) By purchasing this policy and signing for this section, I/we (being the Proposed Policy Owner) declare that I am/we are not a U.S. citizen/resident or a U.S. person for the purposes of U.S. federal income tax, and that I am/we are not acting for or on behalf of a U.S. citizen/resident or a U.S. person for the purposes of U.S. federal income tax.

# Only applicable to investment linked plan.

Declaration & Agreement

I/We understand that I am/we are required to provide valid documentation proofs (such as identity document and address proof) to the satisfaction of YF Life Insurance International Ltd. (“the Company”) for the Company to conduct due diligence on myself/ourselves, the ultimate beneficial owner of the policy to be issued (if any) and the beneficiary under this application (“the Policy”) and my/our authorized signatory(ies) (if applicable) pursuant to the relevant laws and regulations, including Anti-Money Laundering and Counter-Terrorist Financing (Financial Institutions) Ordinance, Cap. 615. If I/we fail or refuse to do so, the Company shall have the right to suspend all transactions of the Policy, or to deem the Policy surrendered.

I/We, being the ultimate beneficial owner of the policy to be issued under this application (“the Policy”), am/are acting on behalf of myself/ourselves to own and control all the rights of the Policy. If this is not the case, I/we shall put down the relationship and the personal particulars of the ultimate beneficial owner of the Policy in the “Special Remarks” of this application and provide valid documentation proofs (such as his/her identity document and address proof) to the satisfaction of the Company.

I/We hereby on behalf of myself/ourselves irrevocably authorize: (1) any medical attendant, hospital, insurance company, or other organization, institution or individual, who has any records or knowledge of, or has been or may in the future be consulted by me/the Proposed Insured to disclose to the Company or its reinsurers or any legal tribunal any information he or she may have acquired with regard to me/the Proposed Insured for the purpose of evaluating the insurance risk of my application. This authorization shall bind my/the Proposed Insured's successors and assigns and remains valid notwithstanding my/the Proposed Insured's death or incapacity in so far as legally possible. A photocopy of this authorization shall be as valid as the original; (2) the Company or any of its approved medical examiners or laboratories to perform the necessary medical assessment and tests to underwrite and evaluate my/our condition of health in relation to this application and any claim arising therefrom. These tests may include, but are not limited to, tests for blood lipids, diabetes, liver or kidney disorders, acquired immunodeficiency syndrome (AIDS), immune disorders or the presence of medications, drugs, nicotine or their metabolites. I/We hereby grant my/our consent to the Company to collect, use and transfer the above health information in accordance with the Personal Information Collection Statement.

I/We have read the product brochure before signing this application form and I/we fully understood the contents thereof including the key product risks, key exclusions (if applicable), premium adjustment (if applicable) of the insurance plan(s) that I am/we are applying in this application.

I/We understand that any payment made in connection to this application does not guarantee immediate effective of coverage being applied, the effective date of coverage will be on the latest date of (i) sign date of application; (ii) sign date of any supplementary form(s); (iii) all the required premium and levy is received by the Company; or (iv) my/our request effective date.

Personal Information Collection Statement

Purposes of Personal Information Collection

Your personal information (including a record of your image or voice by whatever means and your health information) collected by or held by YF Life Insurance International Ltd. (“YF Life”) may be used for the purposes of: (1) approving, evaluating or processing your insurance application/policy service request; (2) administering, maintaining or reinsuring your policies; (3) adjudicating your claims, or conducting any investigation or analysis of your claims; or (4) data matching; (5) investigation or prevention of crime; or (6) fulfilling legal or regulatory requirements.

Please note that failure to provide any information requested by YF Life may result in YF Life not being able to process your insurance application/policy service request.

Transfer of Personal Information

Your personal information collected by or held by YF Life may be transferred or disclosed by YF Life to any of the following persons (whether within or outside Hong Kong) for the purposes as specified above or to governmental/regulatory bodies (whether within or outside Hong Kong) for them to carry out their governmental/regulatory functions: (1) YF Life group companies and their associated/affiliated companies; (2) financial institutions, insurance companies, intermediaries and reinsurers; (3) claims investigation companies or any companies/persons necessary for claims assessment/investigation; (4) industry associations/federations and their members; (5) governmental/regulatory bodies and law enforcement agencies; (6) crime prevention organizations and their members/participants ; and (7) service providers and selected persons which are under a duty of confidentiality to YF Life.

Access to or Correction of Personal Information

You have the right to access to, and to correct, any of your personal information held by YF Life by writing to our Personal Data Protection Officer. (Address: 27/F, 33 Lockhart Road, Wanchai, Hong Kong). YF Life may charge a reasonable fee for the processing of such request.

“e-Policy Service” Account

I/We agree to apply for an “e-Policy Service” Account (if not yet applied for) and be bound by the Online Terms & Conditions set out in the Privacy Statement/Legal Notice of the website of YF Life Insurance International Ltd. at www.yflife.com and as amended from time to time without prior notice.

Using e-platform

It is my/our responsibility to read the declarations on all the forms uploaded/submitted by me/us, including, without limitation, the following forms in e-platform of the YF Life Insurance International Ltd (YF Life). I/We understand and confirm that my/our use of the e-platform will signify my/our consent to all the declarations and information provided in the said forms: Insurance Application Form, Illustration Documents, Financial Needs Analysis Form, Customer Protection Declaration Form and Amendment to Application Form.

As part of the e-platform process, the YF Life consultant will take photo(s) of my/the proposed insured’s identity documents and required documents and/or do the verification process.

The information related to my/our insurance application will be submitted to YF Life through the e-platform. YF Life will rely on the information uploaded/submitted in the e-platform to YF Life server to process my/our insurance application.

Upon receipt of my/our insurance application/supplementary documents submitted via the e-platform by the YF Life, YF Life will notify me/us via SMS using my/our mobile phone number. If I/we do not receive the above notification from YF Life within seven working days after submitting the insurance application documents completed and signed by me/us via e-platform, I/we will contact my insurance consultant or the Customer Service Officer of YF Life (Tel: 2533-5533) for clarification.

My/Our use of the e-platform does not guarantee acceptance of my/our insurance application/supplementary documents by YF Life. My/Our insurance coverage will commence only after YF Life approves my/our insurance application submitted via e-platform and the Policy is issued to me/us, but subject to the terms and conditions of the Policy to be issued to me/us. YF Life will notify me/us in writing after my/our insurance application is accepted and the Policy is ready to be delivered to me/us.

In consideration of YF Life offering me/us the use of the e-platform, I/we will not hold YF Life liable or in any way responsible for any loss, damages or expenses that I/we may incur in connection with my/our use of e-platform unless caused solely and directly by YF Life’s gross negligence or wilful default.

Acknowledgement and Agreement relating to Reporting and Withholding Obligations under Applicable Requirements

(Only applicable to non investment linked plan)

I/We acknowledge that YF Life Insurance International Ltd.(“the Company”) may be obliged to comply with any applicable (local or overseas) requirements of whatever nature prescribed by any (local or overseas) authorities (regulatory, self-regulatory or otherwise) (the “Authorities” and each an “Authority”); and/or any (present or future) commitments or agreements with any Authority; and as amended from time to time (the “Applicable Requirements”), including but not limited to the implementation of the U.S. Foreign Account Tax Compliance Act pursuant to the intergovernmental agreement between Hong Kong and the U.S. and the implementation of the Common Reporting Standard issued by the Organisation for Economic Co-operation and Development pursuant to the Hong Kong Inland Revenue (Amendment) (No. 3) Ordinance 2016.

In this connection, notwithstanding anything contained in this form or any policies or agreements between me/us and the Company, I/we irrevocably agree to provide the Company with all assistance and/or to waive all applicable (legal, regulatory or otherwise) restrictions as may be necessary to enable the Company to comply with the Applicable Requirements. In particular (but without limitation), I/we irrevocably agree that:

  • (a) I/We will provide the Company with further information and/or prescribed documents within such time as may be required by the Company;
  • (b) The Company may disclose to any Authority (such disclosure may be effected via the Head Office of the Company if applicable) any information about (i) any of my/our policy(ies) (whether the policy(ies) is/are in force or otherwise); and/or (ii) me/us and any Consenting Person as defined hereinafter; and
  • (c) The Company may withhold any payments otherwise payable to me/us or to any Consenting Person as defined hereinafter (and pay the withheld amounts to the relevant Authorities if required).

The Company shall not be liable for any costs, loss or damages that I/we or any Consenting Person may incur because of the Company taking any actions for compliance with the Applicable Requirements. If I/we have any doubt on the impact of the aforesaid on me/us or my/our legal or tax position, I/we should seek independent professional advice.

This section shall survive the termination, cancellation and surrender of any of my/our policy(ies).

Confirmation of Levy Arrangement

The commencement date of the Insurance (Levy) Regulation and the Insurance (Levy) Order under the Insurance Ordinance is January 1, 2018#. The owners of the policies are required to pay the levy along with the premium to the relevant insurance companies, who will then pay the levy to the Insurance Authority (“IA”). Moreover, insurance companies are required to report to the IA any levy that remains overdue for more than six months. If an owner of a policy does not pay the required levy, the IA may impose penalty on the owner of the policy. For details, please visit IA website: www.ia.org.hk/en/levy.

I/We understand and agree that YF Life Insurance International Ltd. (YF Life) will apply the following procedures to this policy (“Policy”) in order to comply with the regulations (if applicable):

  • If I/we have designated an autopay account to settle the Policy premium, the respective levy of the Policy will be collected at the same time by autopay; and
  • If I/we have a Premium Deposit Account, any unsettled levy of the Policy will be collected from the Premium Deposit Account when due; and
  • If any Policy premium is to be paid by automatic policy loan (APL), the respective levy of the Policy shall also be paid by APL at the same time and become part of the APL where loan interest shall be charged; and
  • The Policy levy will be collected at the time any future premium(s) are made, subject to the respective levy rate and cap; and
  • In case of reinstatement, the respective levy of the Policy on the overdue premium(s) must also be paid at the time of reinstatement, subject to the respective levy rate and cap; and
  • Any outstanding levy of the Policy will be deducted from benefit proceeds in the event of claim/maturity/surrender; and
  • For flexible premium products (e.g., universal life insurance), the actual premium payment and levy will be based on the amount paid (subject to the prevailing administrative rules), if the amount paid by me/us is not the same as the planned premium and respective levy of the Policy; and
  • • If I/we cancel the Policy within the Cooling-off Period, the paid levy will be refunded except when the levy is paid by YF Life on behalf of me/us.

For details of Levy arrangement of YF Life, please visit www.yflife.com.

Direct Marketing

YF Life Insurance International Ltd. (“YF Life”) intends to use your name and any of your contact details for direct marketing activities in relation to health, medical, insurance, financial or retirement products or services. However we may not so use your personal data without your consent.

Should you find such use of your personal data not agreeable, please tick the box below.

I/We do not agree to the proposed use of my/our personal data in direct marketing by YF Life.

If you sign below without ticking the box above, it is an indication of your consent for YF Life to so use your personal data for direct marketing activities.

If you prefer not to receive any direct marketing promotions or materials from YF Life, please send your request in writing to our Personal Data Protection Officer. (Address: 27/F, 33 Lockhart Road, Wanchai, Hong Kong). We will, without any charge, cease to so use your personal data in direct marketing activities, upon receipt of your written request.

Cancellation Rights & Refund of Premium(s) & Levy

I understand that I have the right to cancel and obtain a refund of any premium(s) and levy paid (less any market value loss adjustment in case of investment linked plans* and non-linked single premium policies (if applicable)), by giving written notice. Such notice must be signed by me and received directly by the Company (address shown on above) within 21 days after the delivery of the policy or issue of a Notice to me or my representative, whichever is the earlier.

*This application form should only be issued in conjunction with the principal brochure (including the Investment Choice Brochure and the Product Brochure) and the illustration document. I have read and understood the principal brochure (including the Investment Choice Brochure and the Product Brochure) and the illustration document before signing this application form. The selection and allocation of Investment Choices are entirely my own decision. The insurance intermediary has not given me any investment advice or influenced me in any way in the selection of these Investment Choices and their respective allocation at all.

I confirm and agree that all statements and answers made in this application are full, complete and true to the best of my knowledge and belief.

Summary

Summary of Proposed Insured
Title
Name of Proposed Insured
Sex / Date of Birth
HK ID no.
Mobile Phone Number
Basic Insurance Plan
Planned Premium (Payment Interval)
Estimated Payment required
Disagree with direct promotion
Summary of Proposed Insured
Title
Name of Proposed Insured
Sex / Date of Birth
Summary of Proposed Owner
Title
Name of Proposed Policy Owner
HK ID no.
Mobile Phone Number
Basic Insurance Plan
Planned Premium (Payment Interval)
Estimated Payment required
Disagree with direct promotion
I confirm and agree that all statements and answers made in this application are full, complete and true to the best of my knowledge and belief.

Thank You!

Thank you for choosing MassMutual Asia. Our consultant will contact you shortly for assisting you to complete the application. If you do not hear from our consultant a week from today, please contact our Customer Service Hotline.
Telephone Number
Hong Kong:
(852) 2533-5533
Macau:
(853) 2832-2622