E-Payment (Life Premiums Only)

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Card Holder's First Name *

Card Holder's Last Name *

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I hereby declare that I am the policyholder and I hereby authorise Zurich Life Insurance Malaysia Berhad and its authorised data processor to process my personal data as disclosed herein for the purposes in relation to the insurance premium payment and charge my Credit/ Debit Card account as indicated above.
Saya dengan ini mengisytiharkan bahawa Saya merupakan pemegang polisi dan Saya dengan ini membenarkan Zurich Life Insurance Malaysia Berhad dan pemproses data yang sah untuk memproses data peribadi saya yang dinyatakan di sini untuk tujuan yang berkaitan dengan pembayaran insurans dan caj akaun Kad Kredit / Debit saya seperti yang tercatat di atas.

I hereby declare that I am the immediate family members of the applicant/ policy owner of the application/policy and I hereby authorise Zurich Life Insurance Malaysia Berhad and its authorised data processor to process my personal data as disclosed herein for the purposes in relation to the insurance payment and charge my Credit/ Debit Card account as indicated above.
Saya dengan ini mengisytiharkan bahawa Saya merupakan ahli keluarga terdekat kepada pemohon / pemilik polisi untuk permohonan / polisi dan Saya dengan ini membenarkan Zurich Life Insurance Malaysia Berhad dan pemproses data yang sah untuk memproses data peribadi saya yang dinyatakan di sini untuk tujuan yang berkaitan dengan pembayaran insurans dan caj akaun Kad Kredit / Debit saya seperti yang tercatat di atas.

Note: Immediate family member refers to Spouse, Parents, Children, Parents-in-law or Sibling

Your Transaction Information

Transaction Information
Order No.
Amount (RM)

I confirm that the information provided herein is complete and accurate. I have read and consent to the processing of my personal data in accordance with the NOTICE TO CUSTOMERS RELATING TO THE PERSONAL DATA PROTECTION ACT 2010 as published on Zurich Malaysia’s website.

We comply with all applicable privacy laws. All Information collected on our web pages will remain private and confidential. Please note that by submitting your personal information to us, you consent to our privacy statement that governs your account.

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Browser compatiblility: Internet Explorer 6.0 or above, Mozilla Firefox 17 and above, Chrome 23 and above.

NOTE: Upon clicking Submit, you will be redirected to Payment Gateway Provider System. Please do not refresh or close your browser until the transaction is completed.

Please click here for more information.

Chrome
1) Click the Chrome menu icon. (top right)
2) Click on Settings.
3) At the bottom of the page, click "Show advanced Settings".
4) In the Passwords and Forms section, uncheck "Enable Autofill to fill out web forms in a single click".

Mozilla Firefox
1) Click on the Firefox menu icon. (top right)
2) Click on Options.
3) Choose the Privacy icon.
4) In the History section choose Firefox will: "Use custom settings for history".
5) Uncheck "Remember search and form history".
6) Click OK.

Internet Explorer
1) Click on the Tools menu icon. (top right)
2) Click on Internet Options.
3) Select the Content tab.
4) In the AutoComplete section click on Settings.
5) Uncheck Forms and User Names and Passwords on Forms.
6) Click OK in the AutoComplete Settings Window.
7) Click OK in the Internet Options Window.

Safari
1) Click on the Safari menu. (top of the screen)
2) Click on Preferences.
3) Choose AutoFill.
4) Uncheck "Using info from my Contacts Card/Address Book Card" and "Other Forms".
5) Click Done.

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