Apply for Travel Insurance
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DECLARATION AND WARRANTY
By submitting this application form, I/We, the Insured Person(s) hereby warrant and declare on the following details:
  1. I am / We are not travelling contrary to the advice of a Medical Practitioner, or for the purpose of obtaining medical treatment.
  2. I am / We are Singapore Citizen, Singapore Permanent Resident, Employment Pass Holder, Work Permit Holder, Student Pass Holder or Dependent Pass Holder.
  3. I am / We are aware that no insurance is in force until this application form is accepted by insurer and the premium paid.
  4. I am / We are aware of and agree to abide by the Policy's terms, conditions and exclusions.
  5. If I / We have opted for the 0% Interest Installation, I / We agree to be bound by OCBC / UOB / DBS/ POSB's Terms and Conditions governing the Installment Payment Plan posted on the bank's website.
IMPORTANT NOTES
  1. Statement pursuant to Section 25(5) of the Insurance Act (Cap.142) or any subsequent amendments thereof. You are to disclose on this Proposal Form fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder may be void and you will receive nothing from the Policy.
  2. Refund is not allowed once the Certificate or Insurance is issued.
  3. Payment either by Cash/Cheque/Credit Card must be submitted with this application.
  4. Pre-existing medical conditions are not covered by the Policy.
  5. Specific terms, conditions and exclusions applicable to the insurance are set out in the Policy.
  6. This policy is protected under the Policy Owners' Protection Scheme which is administered by the Singapore Deposit Insurance Corporation (SDIC). Coverage for your policy is automatic and no further action is required from you. For more information on the types of benefits that are covered under the scheme as well as the limits of coverage, where applicable, please contact your insurer or visit the GIA or SDIC websites (www.gia.org.sg or www.sdic.org.sg)
PERSONAL DATA
I confirm that the information I have provided is my personal data and, where it is not my personal data, that I have the consent of the owner of such personal data and to provide such information. By providing this information, I understand and give my consent for AXA Insurance Pte Ltd and their respective representatives or agents to:
  1. Collect, use, store, transfer and/or disclose the information, to or with all such persons (including any member of the AXA Group or any third party service provider, and whether within or outside of Singapore) for the purpose of enabling AXA to provide me with services required of an insurance provider, including the evaluating, processing, administering and/or managing of my or our relationship and policy(ies) with AXA, and for the purposes set out in AXA's Data Use Statement which can be found at http://www.axa.com.sg("Purposes").
  2. Collect, use, store, transfer and/or disclose personal data about me or us and those whose personal data I or We have provided from sources other than myself or us for the Purposes.
  3. Contact me or us to share information about products and services from AXA that may be of interest to me or us by post and e-mail and by
Anda Insurance Agencies Pte Ltd may, from time to time, contact you in relation to other products or services that may interest you. Please tick the box if you do not wish to receive this information.