Main Policyholder's Details

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

Main Policyholder's Nomination Details

Name as per NRIC
   
NRIC - -
   
Relationship (e.g. Spouse)
   
Mailing Address:
   

 

Insured Spouse's Details

Spouse's Name
   
NRIC - -
   
Nature of Work
 

Spouse's Nomination Details

Name as per NRIC
   
NRIC - -
   
Relationship (e.g. Spouse)
   
Mailing Address:
   


All payments are made directly to
the underwriting Insurance Company.

RM250.00
(inclusive of stamp duty)

 Benefits (RM)

Plan 1

  Identity Theft - To Recover Credit Worthiness
10,000
  Identity Theft - To Recover Lost Wages
5,000
  Identity Theft - Fraudulent Charges
5,000
  Loss of Cash & Personal Valuables - Due to Theft or Robbery (lump sum per event)
1,000
  Medical Reimbursement - For treatment of injury due to Snatch Theft or Robbery
5,000
  Accidental Death & Disablement (AD&D) (lump sum)
50,000
  Double Indemnity on AD&D due to Snatch Theft or Robbery
100,000
  ATM Withdrawal Protection - Reimbursement Basis
1,000
  Home Protection (Burglary)
15,000
  Key Replacement Cover
500