e-Recruit Form

Agent Application

Liam Code of Ethics and Conduct

Declaration of Life Insurance Basic Product Overview, CFF and AML/CFT Training

Liam Movement of Agents

Nomination Form

Agent Application
Liam COE and Conduct
Product Overview, CFF & AML/CFT
Liam Movement
Nomination / Upload Documents

Welcome to MCIS Life Online Application

You can apply your agent application online now.

Please click Start to begin the application.

Appointment as

PERSONAL DATA PROTECTION ACT (PDPA) 2010

Personal data is any recorded information (including an expression of opinion) relating to a living individual from which his identity can be directly or indirectly ascertained. Common examples of customers’ personal data are their names, addresses, telephone numbers, identity card numbers, dates of birth, occupations, medical records, financial information, policy information, claims information, etc.

Under the PDPA, a data user, in processing personal data, must comply with the following principles:

(1) the General Principle;
(2) the Notice and Choice Principle;
(3) the Disclosure Principle;
(4) the Security Principle;
(5) the Retention Principle;
(6) the Data Integrity Principle; and
(7) the Access Principle.
(collectively referred as “Seven Data Protection Principles”)

Failure to abide by the above principles amounts to an offence. Upon conviction, the data user is liable to a fine not exceeding RM 300,000.00 or to imprisonment for a term not exceeding two (2) years or to both (Sec5(2) PDPA).

Under these principles, the collection and use of personal data must be consented to by the data subject and steps must be taken to ensure that they are stored securely. The processing of personal data cannot be excessive in relation to the purpose or related purpose of which the personal data is collected.

Adequate notice must be given to data subjects that their personal data will be processed, used, and the purpose of the same. Such notice must be in the Malay and English languages. Personal data no longer in use has to be destroyed.

As an Agent, you would in the course of your work have access to confidential information of clients especially when they fill in the proposal and fact find forms or even the claim forms or when you assist the policy holder with their medical assessment etc.

You should not disclose customers’ personal data to other companies for marketing their products, nor should you use customers’ data for purposes unrelated to the handling of the customers’ accounts with MCIS. Prescribed consent must be obtained from the relevant customer before any change of use of his data.

Documents containing personal data such as copies insurance application form or policy should be securely kept against access by unauthorized parties. Personal data stored electronically in computers or portable storage devices should be protected with adequate IT security measures and access control. File protect your communications via email if the content includes personal details of anyone.

If you are delivering any documents to or from the Policy holder please ensure that the documents are kept secure and delivered safely to the company/policy holder as soon as possible. Ensure all documents are delivered to the intended persons and no one else.

Further you need to ensure you maintain the highest professional standards at all times and do not engage in gossiping especially about your client’s confidential information nor disclose any information about a client over the telephone, social media or any other telecommunication modes unless you are sure that you know who you are disclosing the information to and they are authorised to have it.

MCIS Insurance Berhad has no tolerance for non compliance and would not hesitate to take actions against any individual who wilfully failed to comply with the requirements stated above.

As our Agent, you need to ensure that at all times you handle all personal information of policyholders as confidential, know and abide by company policy on Personal Data Protection and ensure full compliance to the Personal Data Protection Act 2010.

I have read and understood the above Policy.
I accept my responsibilities and will comply with this policy and the Personal Data Protection Act 2010.

DECLARATION OF COMPLIANCE RELIANCE ON THIRD PARTIES

I confirm to have read, understood and agree to fully comply with:

(a) MCIS Life Anti-Bribery & Corruption Policy (available on MCIS Life Corporate Website at here);
(b) MCIS Life Anti-Bribery & Corruption Pocket Policy (available on MCIS Life Corporate Website at here); and
(c) Malaysian Anti-Corruption Commission (MACC) Act 2009 / Corporate Liability Act
(d) the need to report to MCIS Life of any breaches related to item (a) to (c) via email to whistleblowing@mcis.my

I have read and understood the above Declaration.
I accept my responsibilities and will comply with this Declaration of Compliance Reliance on Third Parties.

Personal Details

Salutation *

Please select salutation.

Name as per NRIC *

Please enter name as per NRIC. Your name must be at least 2 characters.

NRIC No. *

Please enter 12 digits NRIC number. Please enter 12 digits NRIC number. Age less than 18 years, not allowed to proceed NRIC is invalid.

Old NRIC No.

Date of Birth *

This field is required.

Gender *

Please select gender.

Email Address *

Please enter a valid email address. Please enter a valid email address.

Agent Reappointment Application

Our record shows you were appointed before as our MCIS agency personnel. Please complete requirement below in order to proceed to next page.

Note: The agent has exhausted /utilized the one (1) time reinstatement opportunity per life time. For this situation, the agent can apply for reappointment at any time and not bound by the rule of terminated for more than 6 months (by day).

Name

Agent Code

Branch

Previous Rank

Appoinment Date

Terminate Date

Personal Details

Correspondence Address *

Please enter your correspondence address.

City *

Please enter city.

Postcode *

Please enter postcode. Please enter postcode.

State *

Please enter a state.

Country *

This field is required.

Assigned Branch *

Please select assigned branch.

Personal Details

Primary Handphone No. *

Please enter your primary handphone no.
Please enter a valid phone number starting with 0. Please enter a valid phone number.

Malaysian Citizen? *

Please specify. Only Malaysian Citizen are allowed to become an agent.

Marital Status *

Please select martial status.

Spouse Particulars

Salutation *

Please select salutation. Invalid gender.

Name as per NRIC *

Please enter name as per NRIC. Your name must be at least 2 characters.

NRIC No. *

Please enter 12 digits NRIC number. Please enter 12 digits NRIC number. Minimum age to apply is 18 years old. NRIC is invalid.

Old NRIC No.

Date of Birth *

This field is required.

Is your spouse/immediate family member an agent or have ever been an agent with MCIS INSURANCE or any other insurance companies? *

Please specify.

This field is required.

Current Occupation *

Please select occupation.

Personal Details

Religion *

Please specify.

This field is required.

Race *

Please specify.

This field is required.

Relationship with the Recruiter *

Please specify.

This field is required.

Relationship with the Immediate Leader *

Please specify.

This field is required.

Highest Education Qualification *

Please specify.

Choose Full Time / Part Time *

Please specify.

Please select bank *

Please specify.

Bank Account No. *

Please specify.

Licensing Details

Insurance Licensing

PCE/PCIL

Certification Date

PCE/PCIL Certification Date cannot be greater than system date

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Other qualification / Examination (Optional)

CEILLI

Certification Date

CEILLI Certification Date cannot be greater than system date

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BAMC

Certification Date

BAMC Certification Date cannot be greater than system date

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RFP

Certification Date

RFP Certification Date cannot be greater than system date

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Certification Date

Certification Date cannot be greater than system date

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Employment History

Have you been employed in the last 5 years?

Employment History

Income Tax Number

Please provide your income tax number(if any) and declare if the total income reported in CP58 is exceeded RM 100k in the preceding year. Under no circumstances will the Company be held responsible or liable in any way of claims, damages, losses, expenses, cost or liabilities whatsover resulting or arising directly or indirectly from the income tax number or total income reported by you incorrectly.

Income Tax Number

Yearly Income (RM)

Employment History 1

Company Name *

Please enter the company name.

Position Held *

Please enter your position held.

Employment Period From *

Please select month and year. Month and Year cannot be greater than system date From Date cannot be greater than To Date

Employment Period To *

Please select month and year. Month and Year cannot be greater than system date From Date cannot be greater than To Date

Reference Name *

Please enter the reference name.

Reference Contact Number *

Please enter your reference handphone no.
Please enter a valid phone number starting with 0.

Reference Email Address *

Please enter a valid email address. Please enter a valid email address.

Reasons For Leaving *

Please enter your reason for leaving.

Employment History 2

Company Name

Position Held

Employment Period From

Month and Year cannot be greater than system date From Date cannot be greater than To Date

Employment Period To

Month and Year cannot be greater than system date From Date cannot be greater than To Date

Reference Name

Reference Contact Number

Please enter a valid phone number starting with 0.

Reference Email Address

Please enter a valid email address.

Reasons For Leaving

Employment History 3

Company Name

Position Held

Employment Period From

Month and Year cannot be greater than system date From Date cannot be greater than To Date

Employment Period To

Month and Year cannot be greater than system date From Date cannot be greater than To Date

Reference Name

Reference Contact Number

Please enter a valid phone number starting with 0.

Reference Email Address

Please enter a valid email address.

Reasons For Leaving

Health & Other Information

Are you now in good health? *

Please Specify.

This field is required.

Do you have any physical deformity or health impairments? *

Please Specify.

This field is required.

Are you an un-discharged bankrupt and/or have criminal record what so ever and/or have undergone any disclipinary actions in any previous employment? *

Please Specify.

This field is required.

Have you ever held an Agency contract with MCIS INSURANCE or any other Insurance Company? *

Please Specify.

Insurance Company Details

Name of the Insurance Company *

Please enter the company name.

Position Held *

Please enter your position held.

Reasons for Leaving *

Please enter your reason for leaving.

CODE OF ETHICS AND CONDUCT

Life Insurance Association of Malaysia

Name as per NRIC:

Bearer of NRIC No.

being an

I hereby declare and confirm that I have read and understood the contents of the Code of Ethics and Conduct which are applicable to me, and further declare that I shall comply and abide by the rules contained therein.

I hereby agree that my e-signature is required as a consent to the Code of Ethics and Conduct

Click to view the Code of Ethics and Conduct details

Declaration of Completion for Life Insurance Basic Product Overview, Customer Fact Find Form and Anti-Money Laundering & Counter Financing of Terrorism Training

Name as per NRIC:

Bearer of NRIC No.

I hereby confirmed that I have completed the LIFE INSURANCE BASIC PRODUCT OVERVIEW, CUSTOMER FACT FIND FORM AND ANTI-MONEY LAUNDERING & COUNTER FINANCING OF TERRORISM training provided by

Declare Date cannot be greater than system date

I hereby agree that my e-signature is required as a consent to the Declaration of Completion for Life Insurance Basic Product Overview, Customer Fact Find Form and Anti-Money Laundering & Counter Financing of Terrorism Training

LIFE INSURANCE ASSOCIATION OF MALAYSIA

Procedures for the Movement Of Agent

Are you currently contracted with other insurers?

LIFE INSURANCE ASSOCIATION OF MALAYSIA

Procedures for the Movement Of Agent

Movement of Agent

Section A

Agent Name

Date:

Resigned From *

Please enter contracting company name.

NRIC No.

Resignation Letter Copy *

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with effect from

Movement Date cannot be greater than system date

I hereby agree that my e-signature is required as a consent for the Liam Movement of Agent Form

Applying for Nomination

Please tick the option where applicable:

Group Life Insurance Benefit

Agency Retirement Benefit

Commission

Please select at least 1 option

Applicant Information

Name as per NRIC

Agent Rank

NRIC No.

Unit Code

Agent Code

Mobile Number

Agency Name

Residential Address

Nominee(s) Information - Group Life Insurance Benefit

I hereby nominate the person(s) named below as Nominee(s) to receive the sum of all my Group Life Insurance Benefit:

No.

Relationship

Name of Nominee (as per IC)

NRIC No.

Share (%)

1 *

Please enter your relationship with the nominee. Invalid gender.

Please enter Name of Nominee (as per IC). Name must be at least 2 characters.

Please enter your nominee’s NRIC No. Please enter 12 digits NRIC number. Minimum age to apply is 18 years old. NRIC is invalid.

Please enter the Share (%). Nomination can't be less or more than 100%

2 *

Invalid gender.

Please enter your nominee’s NRIC No. Please enter 12 digits NRIC number. Minimum age to apply is 18 years old. NRIC is invalid.

Nomination can't be less or more than 100%

3 *

Invalid gender.

Please enter your nominee’s NRIC No. Please enter 12 digits NRIC number. Minimum age to apply is 18 years old. NRIC is invalid.

Nomination can't be less or more than 100%

4 *

Invalid gender.

Please enter your nominee’s NRIC No. Please enter 12 digits NRIC number. Minimum age to apply is 18 years old. NRIC is invalid.

Nomination can't be less or more than 100%

Note:

If you are a Muslim, kindly inform your Nominee of their duties in accodance to the applicable Islamic Inheritance Laws.
Nominee(s) must be at least 18 years of age.
Photocopies of I/C (front & back) are required for both applicant and each Nominee(s).
Photocopies of I/C in PDF, PNG, JPG or JPEG format only.

Nominee IC Copy *

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(Upload Front IC)

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(Upload Back IC)

Nominee 2 IC Copy *

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(Upload Front IC)

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(Upload Back IC)

Nominee 3 IC Copy *

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(Upload Front IC)

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(Upload Back IC)

Nominee 4 IC Copy *

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(Upload Front IC)

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(Upload Back IC)

Nominee Information - Agency Retirement Benefit

I hereby nominate the person named below as Nominee to receive the sum of all my Agency Retirement Benefit:

No.

Relationship

Name of Nominee (as per IC)

NRIC No.

1 *

Invalid gender. Please enter your relationship with the nominee.

Please enter Name of Nominee (as per IC). Name must be at least 2 characters.

Please enter your nominee’s NRIC No. Please enter 12 digits NRIC number. Minimum age to apply is 18 years old. NRIC is invalid.

Same as above

Note:

Nominee(s) must be at least 18 years of age.
Photocopies of I/C (front & back) are required for both applicant and each Nominee(s).
Photocopies of I/C in PDF, PNG, JPG or JPEG format only.

Nominee IC Copy *

BROWSE...

(Upload Front IC)

BROWSE...

(Upload Back IC)

Nominee Information - Commission

I hereby nominate the person named below as Nominee to receive the sum of all my of commission:

No.

Relationship

Name of Nominee (as per IC)

NRIC No.

1 *

Invalid gender. Please enter your relationship with the nominee.

Please enter Name of Nominee (as per IC). Name must be at least 2 characters.

Please enter your nominee’s NRIC No. Please enter 12 digits NRIC number. Minimum age to apply is 18 years old. NRIC is invalid.

Same as above

Note:

The arrangement can be referring to the Rules & Regulations in the latest Agency Handbook
Any future residual commissions (including overriding if deceased is a leader) for premium collected from block of business under the deceased's servicing before event date shall continue to be payable to the next of kin. Any bonus or Balanced Score Card (BSC) variable commission entitlement shall be subjected to the qualification of the bonus requirement accordingly.
Nominee(s) must be at least 18 years of age.
Photocopies of I/C (front & back) are required for both applicant and each Nominee(s).
Photocopies of I/C in PDF, PNG, JPG or JPEG format only.

Nominee IC Copy *

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(Upload Front IC)

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(Upload Back IC)

Upload Documents

Please ensure these required documents are uploaded before you complete your application:

1. Applicant IC Copy (Front IC) *

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2. Applicant IC Copy (Back IC) *

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3. Passport sized photo with light blue or white background *

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4. Certificate of highest education *

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5. Photocopy of bank account passbook or statement *

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6. Payment receipt of LIAM fees *

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7. Copy of CP58 from previous company (if applicable)

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Please enter name of document. Invalid file format. Please upload in PDF, PNG, JPG or JPEG format only. Please upload file size that is less than 5mb.

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Please enter name of document. Invalid file format. Please upload in PDF, PNG, JPG or JPEG format only. Please upload file size that is less than 5mb.

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I hereby agree that my e-signature is required as a consent for the nomination form

DECLARATION AND AUTHORIZATION

I certify that the answers given in this application are true, to the best of my knowledge and agree that should this declaration be false, MCIS INSURANCE BERHAD (“the Company”) reserves the right to terminate the agency agreement without any reference made to me.

I agree, consent, and allow the Company to process my personal data with the intention of entering into an agency contract, in compliance with the provisions of Personal Data Protection Act 2010. I understand and agree that any personal information collected or held by the Company (whether contained in this application or otherwise obtained) may be held, used, processed and disclosed by the Company against individuals and/or organizations related to and associated with the Company or any selected third party (within or outside Malaysia, including adjusters/ investigators, solicitors, industry associations, regulators, statutory bodies, government authorities, credit reporting agencies, previous /current employment) for the purpose of processing this application and providing subsequent service for this purpose and to communicate with me for such proposes.

I hereby authorize the Company to conduct a comprehensive review of my background through a reference check with current and former employer(s) for the past 7 years prior to this appointment.

I understand that the scope of reference checks report may include, and is not limited to, the following areas: names, dates and internal disciplinary records of previous/current employment, work experience, criminal history records (from local, state, federal, international and other law enforcement agencies’ records), business interest and directorship, financial checks with Credit Reporting Agencies and Bank Negara Malaysia Central Credit Reference Information System or CCRIS record, civil cases as well as any sanction lists.

I certify that all information provided at any other times are correct and to the best of my knowledge. Any false statements provided in this application and any other documents provided will be considered just cause for termination of agency contract at any time.

I understand that I have the right to obtain access and request modification of any personal information held by the Company concerning me. Such request can be made to the Company’s Head Office or any Branch Office. In accordance with the provisions of the Personal Data Protection Act 2010, I may contact the Customer Service Centre at 03-7652 3388 for the details of my personal data. Such information shall only be granted upon verification.

I have read and understood the above Policy.

I confirmed that I have completed LIFE INSURANCE BASIC PRODUCT OVERVIEW, CUSTOMER FACT FIND FORM AND ANTI-MONEY LAUNDERING & COUNTER FINANCING OF TERRORISM FORM voluntarily and without any prejudice.

Please click to view the Marketing Executive's Agency Agreement in order to proceed to the submission.

e-Signature

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Name as per NRIC: *

Please enter your name as per NRIC. Your name must be at least 2 characters

NRIC: *

Please enter 12 digits NRIC number Please enter 12 digits NRIC number Minimum age to apply is 18 years old. NRIC is invalid.

Date:

By confirming the below, I agree that my electronic signature will be the representation of my signature in which I am the witness for this MCIS LIFE online application – nomination form.

e-Signature

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Name as per NRIC:

NRIC:

Date:

By confirming the below, I agree that my electronic signature will be the representation of my signature for all the forms that I have filled in the MCIS LIFE online application.

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