MaleFemale

SingleMarried

Aaland IslandsAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDemocratic Republic of CongoDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFrance, skypolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesFYROMGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and Mc Donald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak RepublicSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth SudanSpainSri LankaSt. BarthelemySt. HelenaSt. Martin (French part)St. Pierre and MiquelonSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnitUruguayUzbekistanVanuatuVatican City State (Holy See)VenezuelaViet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and Futuna IslandsWestern SaharaYemenZambiaZimbabwe

Type of Property
Semi-detachedTerraceBungalow /Detached1-Bedroom Private Apartment2-Bedroom Private Apartment3-Bedroom Private Apartment4-Bedroom Private Apartment5 (or more)-Bedroom Private ApartmentStudio Private Apartment3-Room HDB4-Room HDB5-Room HDBStudio HDBExecutive HDB & HUDCExecutive Condominium

Occupancy Type
TenantOwnerLandlord

Under Mortgage
YesNo

To insure for Building
YesNo

Renovations,Fixtures,Fixings
$50,000$100,000$150,000$200,000

Household Contents
$20,000$40,000$60,000$80,000

1. Are there any other insurance(s) held on this property? *
YesNo

2. Have you ever suffered damage by fire or any peril at this property or any other properties owned or occupied by you?*
YesNo

3. Has any company or insurer ever declined to insure you or your property, imposed special terms of cancelled or refused to renew your insurance?*
YesNo

I agree to be contacted and consent to the collection, use and disclosure of my personal data for the purposes as stated in the Data Protection Notice

MaleFemale

SingleMarried

Aaland IslandsAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDemocratic Republic of CongoDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFrance, skypolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesFYROMGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and Mc Donald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak RepublicSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth SudanSpainSri LankaSt. BarthelemySt. HelenaSt. Martin (French part)St. Pierre and MiquelonSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnitUruguayUzbekistanVanuatuVatican City State (Holy See)VenezuelaViet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and Futuna IslandsWestern SaharaYemenZambiaZimbabwe

SB Transmission Reference No

Duration of Coverage
14 Months26 Months

Benefits to be included
Personal AccidentHospital and Surgical ExpensesLetter of Guarantee to Ministry of Manpower, Singapore - Without Counter IndemnityLetter of Guarantee to Ministry of Manpower, Singapore - With Counter IndemnityWages & Levy ReimbursementRehiring ExpensesEmployer's LiabilityInsurance Bond to Philippines Embassy - $7,000Insurance Bond to Philippines Embassy - $2,000

Documents required - Employer's NRIC /Employment Pass, Maid Passport and In-Principle Approval Letter or Renewal Notice from Work Permit Department*

I agree to be contacted and consent to the collection, use and disclosure of my personal data for the purposes as stated in the
Data Protection Notice

MaleFemale

SingleMarried

IndoorOutdoor

Licence Pass Date

Owner Driving
YesNo

CarMotorcycleOthers

PersonalPrivate Hire / GrabOff-Peak

ComprehensiveThird Party Fire & TheftThird Party Only

Claims in the last 3 Years

NCD%0101520Fleet

YesNo

MaleFemale

I agree to be contacted and consent to the collection, use and disclosure of my personal data for the purposes as stated in the Data Protection Notice

MaleFemale

OwnHire

BusCommercial TruckLorryPickup TruckPrime MoversTractorVanOthers

Attachments

ComprehensiveThird Party Fire & TheftThird Party Only

NCD%0101520Fleet

YesNo

Non Parrallel ImportParrallel Import

Fully PaidStill under loan

YesNo

Will this vehicle carry goods which are flammable, corrosive or explosive in nature
YesNo

Will this vehicle be driven to Malaysia
YesNo

Important Declaration

In the past 3 years, has this vehicle been involved in any motor accidents
YesNo

Is there any driver of this vehicle who has been convicted of driving offences (excluding parking) in the past 3 years
YesNo

Is there any driver of this vehicle who has a record of revoked/suspended dricing licence in the past 10 years
YesNo

Is there any driver of this vehicle who has a disability of illness that may impair dirving
YesNo

Has any insurance company declined to insure this business entity
YesNo

Has any insurance company cancelled or refused to renew an existing Motor Insurance Policy held by this business entity
YesNo

I agree to be contacted and consent to the collection, use and disclosure of my personal data for the purposes as stated in the Data Protection Notice

MaleFemale

SingleMarried

Accidental Death Benefit /Permanent Disablement
Up to $100,000between $100,000 to $300,000between $300,000 to $500,000Above 500,000

Double Indemnity on Public Transport
YesNo

Double Indemnity on Public Transport
YesNo

Medical Expenses
OutpatientTCMChiropractorPhysiotherapistHospital Cash

Lifestyle Maintenance
Income ProtectionLoan ProtectorOthers

I agree to be contacted and consent to the collection, use and disclosure of my personal data for the purposes as stated in the Data Protection Notice

MaleFemale

SingleMarried

Aaland IslandsAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDemocratic Republic of CongoDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFrance, skypolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesFYROMGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and Mc Donald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak RepublicSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth SudanSpainSri LankaSt. BarthelemySt. HelenaSt. Martin (French part)St. Pierre and MiquelonSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnitUruguayUzbekistanVanuatuVatican City State (Holy See)VenezuelaViet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and Futuna IslandsWestern SaharaYemenZambiaZimbabwe

Type of Trip
Single-tripMulti-tripAnnual

I am travelling
by myselfwith my family

I am leaving Singapore to
Asean CountriesAsian CountriesGlobal

I agree to be contacted and consent to the collection, use and disclosure of my personal data for the purposes as stated in the Data Protection Notice