Insured's Details

Campaign ID (leave it blank if not applicable)
 
Start Coverage on... (renewable annually)
 
Name as per NRIC
   
NRIC - -
   
Nature of Work
   
Contact No: (e.g: 012-1234567)
   
Email:
   
Mailing Address:
Postcode



Nomination Details

1st Nominee
Name as per NRIC
   
NRIC - -
   
Relationship (e.g. Spouse)
   
Share Percentage % (100% if there's no second nominee)
   
Mailing Address:
   
 
 
2nd Nominee (if any)
Name as per NRIC
   
NRIC - -
   
Relationship (e.g. Spouse)
   
Share Percentage % (100% if there's no second nominee)
   
Mailing Address:



All payments are made directly to
the underwriting Insurance Company.

RM510.00
(inclusive of stamp duty)

 Benefits (RM)

Plan 3

  Identity Theft - To Recover Credit Worthiness
30,000
  Identity Theft - To Recover Lost Wages
15,000
  Identity Theft - Fraudulent Charges
15,000
  Loss of Cash & Personal Valuables - Due to Theft or Robbery (lump sum per event)
5,000
  Medical Reimbursement - For treatment of injury due to Snatch Theft or Robbery
10,000
  Accidental Death & Disablement (AD&D) (lump sum)
100,000
  Double Indemnity on AD&D due to Snatch Theft or Robbery
200,000
  ATM Withdrawal Protection - Reimbursement Basis
5,000
  Home Protection (Burglary)
50,000
  Key Replacement Cover
2,000