AIA SINGAPORE
LARGE AMOUNT QUESTIONNAIRE
Particulars of Insured and Policy Owner
Name of Insured
NRIC/Passport/FIN No.
Name of Policy Owner
NRIC/Passport/FIN No.
Policy Numbers
Part 1: For the product applied, please refer to the Financial Evidence limits for requirements.
*
For Applicant/Owner application, please complete this document based on the Insured’s profile.
** Where the Insured is a juvenile, please complete this document based on Applicant/Owner’s profile.
All figures in this document are

S$

US$

Other
Please specify
1. Details of Purpose of Insurance
Purpose of
Insurance
No. of children
Age
Details of Residence
Address


Sole ownership
Owned by others


Jointly owned with
Rented
Monthly rental
Paid by
Date of Purchase
Purchase Price
Current Value
Outstanding Mortgage
2. Details of Income and Assets
Annualised for Current
Year
Last Year
Year before Last
Earned Income (salary/director fees)
Other Earned Income (bonuses/Commissions)
Annual Perks and Allowances
Unearned Income
Dividends from shares/investment income/interests
from fixed bank deposits
Income from rental of properties
Other Income
Please specify
Estimated value of Assets and Liabilities
Assets
Liabilities
3. Details of Source of Funds
Source of funds
AIA Singapore Private Limited (Reg No. 201106386R)
AIA Customer Service Centre, 1 Finlayson Green, Singapore 049246
Monday to Friday: 8.45am – 5.30pm
AIA Customer Care Hotline: 1800 248 8000 AIA.COM.SG
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PART 2: For the product applied, please refer to the Financial Evidence limits for requirements.
4. Details of Properties Other Than Primary Residence.
Please list the properties in Singapore first, followed by properties in other country(ies) (The latter in descending order of current value).
a. Property Address


Sole Ownership
Jointly Owned with
Purchase Price
Outstanding Mortgage
Current Value
Land Area (sq feet)
b. Property Address


Sole Ownership
Jointly Owned with
Purchase Price
Outstanding Mortgage
Current Value
Land Area (sq feet)
c. Property Address


Sole Ownership
Jointly Owned with
Purchase Price
Outstanding Mortgage
Current Value
Land Area (sq feet)
5. Details of Assets and Liabilities
Assets
Approx. Current Value
Liabilities
Approx. Current Value
Properties (residence and investment)
Mortgage Loans
Stocks/Bonds/Unit Trust/Fixed Deposits
Personal Loans
Others
Other Personal Liabilities
Please specify
Please specify
6. Details of Banks (In descending order of savings/investment values)
Bank Name
Country
Exclusive Banking Service
(E.g. private, premier, priority
banking)
Approx. Savings/Fixed
Deposit/Investment
Values
Approx. Loans Values
7. Details of Main Business Interest
Name of company
Nature of business
Paid-up capital
Percentage of ownership
Insured’s
responsibilities &
duties
When started / brought
into business
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8. Details of Company Accounts
Audited Company Accounts
Last Year
2 Years ago
3 Years ago
Revenues
Gross Profit
Profit before Tax
Total Assets
Total Liabilities
9. Details of any projects/contracts currently being handled and their values
10. Details of other business interests (if any)
Company Name
Position
Date of appointment
Percentage ownership
Confidentiality and Confirmation
AIA Singapore Private Limited (“AIA Singapore”) shall at all times maintain all information provided in this Questionnaire in strict confidence and shall not in the ordinary
course of its business disclose this information or any part thereof without the express authority of the Applicant.
I, the Policyowner/Insured confirm that the information provided herein is full, complete and true, and I agree that the information provided forms a part of any policy
issued, amended or reinstated where this information is relied upon by AIA Singapore. I will supply adequate proof of the statements made in this document as and when
requested by AIA Singapore.
Signature of Insured/Policy Owner
Signature of FSC/IR
Date
Date
FSC/IR’s Name
FSC/IR’s Code
FSC/IR Unit Name
Mobile No.
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