ONLINE QUOTATION FOR TRAVEL INSURANCE

The insurance will not be in force until the application and premium have been received and accepted by the company.



Important Notice:
Uder the Insurance Act, you must tell us all the facts that you know, or ought to know, about the risk that you are proposing. If you do not tell us everything that is relevant or if you mislead us, we may refuse to pay a claim or part of it, or cancel the policy.

	Particulars of Proposer/Company Title * Name of Insured * NRIC/Passport No. * e.g: S1234567A Correspondence Address * Contact No. * - (contact no.)               - (ext no.) Email Address  Client Type * Individual     Corporate Travel Details Total No. of Days *        From   To                               (DD/MM/YYYY)                 (DD/MM/YYYY) Geographical Area * Asia     Worldwide Place to Travel   Albania Algeria American Samao Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijian Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chile China Cocos (Keeling) Islands Colombia Comoros Cook Inlands Costa Rica Cote Divoire Croatia Cyprus Czech Republic Denmark Djibouti Ecuador Egypt Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Libya Liechtenstein Lithuania Luxemburg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Maritius Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaraqua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Philipines Poland Portugal Qatar Russia Saint Kitts And Nevis Saint Lucia Singapore South Korea Spain Sri Lanka Sweden Switzerland Taiwan Thailand Turkey UAE UK USA Vietnam Western Sahara Choice of Plan (Please select appropriate option) Super * Individual     Family Standard * Individual     Family Insured Persons 1.     Title  Name  NRIC  DOB 2.     Title  Name  NRIC  DOB 3.     Title  Name  NRIC  DOB 4.     Title  Name  NRIC  DOB 5.     Title  Name  NRIC  DOB 6.     Title  Name  NRIC  DOB Other Remark