Acknowledgment and Confirmation of Statements or Answers Given in the Insurance Application

Confirmation statement or response in the insurance application:

I hereby consent and authorize Generali Life Assurance (Thailand) Public Company Limited and Generali Insurance (Thailand) Public Company Limited (hereinafter collectively referred to as “the Company” or “we”), as the data controller, to collect, use, and disclose my personal data under the following conditions:

1. I confirm that every answer in the insurance application and any related documents, including statements provided to medical examiners, are true and accurate to my knowledge. I understand that if I provide false information, the Company may reject my insurance application and deny any claims under the insurance policy.

2. I, and/or my legal representative, consent to doctors, insurance companies, hospitals, or any other individuals possessing my and/or my minor’s health information, disabilities, sexual behaviors, biometric data, genetic information, and ethnicity, past or future, to disclose such information to the Company or its representatives for insurance application, underwriting, or payment under the insurance policy.

3. I, and/or my legal representative, consent to the Company collecting, using, or disclosing my and/or my minor’s health information, disabilities, sexual behaviors, biometric data, genetic information, and ethnicity, past or future, to other insurance companies, reinsurance brokers, reinsurance companies, competent authorities, hospitals, medical professionals, medical personnel, or insurance brokers, and/or insurance agents for insurance application, underwriting, or payment under the insurance policy.

4. I understand that withdrawing consent under clauses 2 or 3 provided to the Company may affect the assessment of insurance applications, payment under the insurance policy, or any related service, which may result in the Company’s inability to comply with the terms of the insurance policy, thereby affecting my coverage under the insurance policy.

5. I acknowledge that the Company will collect, use, disclose, and/or transfer personal data, including sensitive data, for insurance application, underwriting, or payment under the insurance policy, in accordance with the Company’s personal data protection policy as stated on [https://www.generali.co.th/privacy-information]. I further acknowledge that the Company may disclose my personal data to the Office of the Insurance Commission (OIC) for regulatory oversight and promotion of insurance business under insurance and OIC regulations. Details of data collection, usage, and disclosure by the OIC are as stated in the OIC’s personal data protection policy available at [www.oic.or.th].

6. When I disclose personal data of any other person besides myself to the Company for insurance application, underwriting, or payment under the insurance policy.

1. • 1) I certify and guarantee that I have verified the accuracy and completeness of such personal data of the other person provided to the Company and will inform the Company of any changes in such personal data (if any)
   • 2) I certify and guarantee that I have obtained consent or relied on other legal basis for the collection, use, disclosure, and/or transfer of personal data of such other person in accordance with applicable law
   • 3) I certify and guarantee that I have informed such other person of the Company’s personal data protection policy as stated at [https://www.generali.co.th/privacy-information], which outlines the purposes of collecting, using, disclosing, and/or transferring personal data to the Office of the Insurance Commission (OIC) for regulatory oversight and promotion of insurance business under insurance and OIC regulations. The details of data collection, usage, and disclosure by the OIC are as stated in the personal data protection policy of the Office of the Insurance Commission (OIC) available on [www.oic.or.th].
   • 4) I certify and guarantee that the Company and the Office of the Insurance Commission (OIC) are able to collect, use, disclose, and/or transfer personal data of such other person for the purposes specified in the Company’s and the Office of the Insurance Commission’s personal data protection policy related to insurance business, which may be amended from time to time, including all purposes stated in this document and related to insurance.

7. Warning from the Office of the Insurance Commission: The insurance applicant must truthfully answer every question. Any misrepresentation may cause the insurance company to reject the claim for indemnity under the insurance contract pursuant to the Civil and Commercial Code Section 865.