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- Kindly print a copy of the completed Proposal Form for your file records. Fax us the signatory page (Declaration Section below Question 8) of the Proposal Form in order for us to start processing the invoice. This signatory page bearing the original signature needs to be posted to us at :-
Address:
Jardine Lloyd Thompson Sdn Bhd
Suite 10.2 10th Floor
Faber Imperial Court
21A Jalan Sultan Ismail
50250 Kuala Lumpur
Tel no. : 03 - 2723 3388
Fax no. : 03 - 2723 3301/02/03/27
AUTHORITY TO INSURERS AND OTHER PARTIES
Authorisation: I/We hereby authorise the Insurers and/or adjusters and/or claims managers to disclose to the Bar Council of the Malaysian Bar, from time-to-time such information arising from any claim under the insurance cover issued to me/us to enable the Bar Council to have access to the complete claims information and/or data for the sole purpose of the management of the Mandatory Master Policy Scheme and its Risk Management objectives.
I/We hereby authorise representatives of the Bar Council of the Malaysian Bar together with representatives of JLT and/or the Insurers to review the Firm's process and procedures at the Firm's offices for the purposes of advising on the enhancement of its Risk Management processes measures.
Provided always that it is expressly understood and agreed between the Bar Council and the Firm that such information as disclosed by the Insurers and/or adjusters and/or claims managers shall not render the Firm and/or the Legal Practitioners concerned to any disciplinary action by the Bar Council.
DECLARATION:
I/We warrant that all the above statements are true and complete and, in relation to the details to
Questions 6 and 7, I/we have obtained written confirmation from each of the legal practitioners named in
Questions 2 (a) and 2 (b). I/we agree that this completed Proposal form shall be the basis of the contract between
the Firm and the Insurers.
Please tick the checkbox if you agree with the statement above. You may only submit the Proposal Form to JLT if the checkbox is ticked.
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