Date:

Liberty Insurance Pte Ltd

51 Club Street
#03-00 Liberty House
Singapore 069428

Dear Sir

LETTER OF APPOINTMENT

CASA MERAKI PTE LTD (A1767)

I/We confirm that effective from the date of this letter, I/we have appointed ____________________
as my/our new Agent to administer, handle, review and service all matters in connection with my/our
insurance requirements with Liberty Insurance (“Liberty”).

I/We give consent to Liberty, its employees, agents, affiliates and appointed third-parties (collectively,
“representatives”) to collect, use and disclose all personal data that I/we have furnished to them, the
ex-Agent and new Agent, previously and in the future, for one or more of the purposes described in
Liberty’s Data Protection Policy, including but not limited to considering whether to provide insurance,
underwriting, administering and servicing policies/your relationship, collections, claims, accounting,
audit, compliance, information-sharing, research, analysis, and dispute resolution. I/We have read
and agreed to the terms of the full Policy at www.libertyinsurance.com.sg/data-protection-policy/. If
any personal data I/we have furnished is not about me/us, I/we warrant that I/we have obtained
consent from the data subject (or if lacking in legal capacity, his/her legal representatives, guardians
or parents as the case may be) for Liberty and its representatives to collect, use and disclose his/her
personal data for the above purposes and on the terms in this document. I/We warrant that all
personal data I/we have provided are accurate and complete, and I/we shall inform Liberty of any
changes to the personal data to my/our knowledge as soon as practicable.

Yours faithfully,

_______________
Name
IC No:
HP:
Date