Jan 2021 – Ordinary & Family Membership Bundle If you are human, leave this field blank.Details of Principal (Ordinary) MemberName of Ordinary Member as in NRIC *AA Membership No. *Ordinary Membership Expiry Date *Mobile no. *Email Address * Details of Family Member Name of Family Member (as in NRIC) *AA Membership No. *Family Membership Expiry Date *Must be the same as per Ordinary MemberMobile no. *Email Address *AA Family Membership is dependent and shall run concurrently with the membership term of the Principal member. We would like to update our address (if applicable)Block/House No.Street NameBuilding NameFloor LevelUnit No.CountrySingaporeUnited States (US)United Kingdom (UK)CanadaAustraliaAfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabwePostal Code We would like to renew our AA Ordinary & Family Bundle Membership: *3-year@SGD321.75Gift: SGD56 Off Motor Insurance + SGD68 Bactakleen Treatment Voucher + Choice of Gift worth up to SGD29 + 1 box of Surgical Mask + SGD10 AAShop Discount Coupon(Min Spend $20)1-year@SGD112.35Gift: 1 box of Surgical Mask + SGD5 AAShop Discount Coupon (Min Spend SGD15) DECLARATION & AUTHORISATION *I agree to the below Declaration & Authorisation Details on Declaration & Authorisation I have read and agree unconditionally to be bound by AA’s Constitution, Terms and Conditions, Service Policy and Privacy Policy. I understand that AA reserves the right to reject any application in its sole discretion without giving any reasons. I certify that the particulars and information furnished herein are true and accurate. I understand that my AA Membership e-card can be accessed from the AA Singapore App. I understand that the Terms and Conditions, Service Policy and Privacy Policy are available on AA’s website. I understand that RAS is handled by AA’s subsidiary, AutoSwift Recovery Pte Ltd (“ASR”). I consent to ASR accessing, collecting, using and disclosing my personal information for the purpose of verifying my identity and membership with AA and in connection with the carrying out of such RAS. I also consent to ASR communicating with me for the purposes of carrying out the RAS. In order for me to enjoy insurance services available to AA Members, I consent to AAS Insurance Agency, a subsidiary of AA and its partners, assessing, collecting, using and disclosing my personal information which I have furnished to AA. I also authorise and give consent to AAS-Insurance Agency and its partners to communicate with me via post , email, SMS text messaging and/or telephone on any insurance product, service, benefit and /or promotion. When I participate in any contests, activities or events organised by AA, I authorise and give consent to AA, its subsidiaries and partners to use photographs and/or video images taken at contests, activities or events in which I have been captured. The image(s) may be published in any of AA’s communication materials and collaterals and also in connection with any of AA’s business partners’ publicity purposes. In order for me to enjoy additional membership services or benefits that AA may extend to its members from time to time, I understand and consent that approved third party service providers may use my information in order to render the services or benefits extended by AA. I authorise and give consent to AA, its subsidiaries and partners to communicate with me in respect to this application and membership services, including benefits, insurance, campaigns, promotions, activities and events via post, email, SMS text messaging and /or telephone. I reserve the right to opt out of such communications if necessary. Captcha *reCAPTCHA is required.Submit Note:*Our online payment is accepted via PayPal. Do not have a PayPal account? No worries! Simply check out as a Guest to make payment using your credit card.
