I hereby:

1. Declare that the information provided by me/us in this form are true and correct and undertake to immediately inform Liberty General Insurance Berhad Formerly known as AmGeneral Insurance Berhad of any changes and allow Liberty General Insurance seven (7) business days to update my/our records with the company. I/We further confirm that I am /We are the Account holder/holders and has/have full power and authority to operate the Account (with respect to individual/sole proprietor/partnership/a corporate body). We further confirm that the person(s) signing this form is the authorised signatory for the Account, and has/have full power and authority to operate the account.

2. Declare that I/we am not an undischarged bankrupt (with respect to individual/sole proprietor/partnership/a corporate body). I/we declare that no order has been made, petition filed or resolution passed for my/our winding up, and dissolution or for the appointment of a liquidator, receiver, custodian or trustee for all or any part of our property or assets or for an administration order made against me/us.

3. Agree that the personal data provided in this form may be recorded, used, disclosed, processed and stored by Liberty General Insurance for purposes relating to the payment of goods/services and for the purposes of complying with any legal or regulatory requirement.

4. Consent that my personal information may be used, recorded, disclosed, processed and stored by Liberty General Insurance for the purposes of complying with any legal or regulatory requirement and where necessary, to share information in your company and financial institutions to facilitate payments.

5. Agree and undertake to indemnify and keep indemnified all the persons above against any and all, direct or indirect claims and demands, actions and proceedings, losses and expenses including legal costs and all other liabilities of whatsoever nature or description which may be made or taken or incurred or suffered by the me/us in consequence of or as a result of any of the addressees making payment(s) via direct credit payment to my/our nomination bank account as aforesaid and/or any subsequent amendments by my/our authorised personnel stated in the form.

6. At all times, Liberty General Insurance goal is to work collaboratively with our supply chain partners on sustainability. Liberty General Insurance reserves the rights to carry out regular assessments to ensure alignment to this Supplier Code of Conduct (Attachment A). This may include self- assessment, document submission and or site visit. Should a supplier be unable to meet and comply, Liberty General Insurance will work with the supplier on an improvement plan. If situation persist, Liberty General Insurance has the right to review the terms of the contract, including any reduction in the order and exiting of the relationship.

7. I acting as the authorized representative of supplier named above confirm that the supplier and its employees have read and understood the Liberty Mutual’s Supplier Code of Conduct and Liberty General Insurance’s Whistle Blowing Policy, for Business Associated and shall comply to it. The supplier is responsible to inform Liberty General Insurance immediately when there is any breach and or non-compliance to the Supplier Code of Conduct.