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Personal Travel Insurance Quotation

Important Notice
1) To get accurate quotes, please kindly provide detail and accurate information as the accuracy of premium depend on the accuracy of information given.

2) All data or information given will be kept confidential and only use for our company data usage and quotation.

Insured 1 Particular

Insured 1 Name (As in NRIC) : *
NRIC No : *		Date of Birth :
Gender :	Male Female	Contact No : *
Address :		Postal Code :
Email Address :		(Original Policy doc can be email to you if email is provided)

Insured 2 Particular (Applicable for Family Plan Only)

Insured 2 Name (As in NRIC) :
NRIC No :		Date of Birth :
Gender :	Male Female
Address :		Postal Code :
Email Address :		Contact No :
No. of Accompanying children :
(For per trip plan, each child must be related to at least one insured adult. For annual plan, each child must be the legal child of the insult adults(s))
(Children must unmarried/unemployed and must be less than 18 years old or less than 23 years old for full time student)
1) Under family plan, there is no limit to the no. of accompanying children 2) For Family Plan, each child must be related to at least one insured adult. 3) Children must be unmarried/unemployed and must be less than 18 years old or 23 years old years old for full time student in a recognized institution 4) For Annual plan, each child must be the legal child of the insult adult(s)

Insurance Information

Choice of Type :
Choice of Plan :
Choice of Area :
Choice of Country : (Applicable for Per Trip plan only)	(If there are more than two countries to travel , select the furthest country from Singapore)
Per Trip Date of Departure :		Date of Arrival :
Annual Effective Date :		Expiry Date :
	(Per trip plan : Max of up to 182 days per trip, Annual plan : Max of up to 90 days per trip)
Remark :

How You get to know about us :
Your friend/Relative/Associate Name :

Modified on 01 August 2005