    |
|
IMPORTANT NOTES
-
Under Section 25(5) of the Insurance Act (Chap142), you are required to
disclose in this proposal form, fully and faithfully all the facts which you
know, or ought to know, otherwise the Policy issued hereby may be void.
-
Please fill in all sections of this form (IN BLOCK LETTERS), in order to avoid
unnecessary delay in the processing of this proposal form.
DECLARATION
I declare that the dwelling is (a) constructed of brick, stone or concrete. (b)
not used for trade purpose and (c) occupied by me and under my control.
The information provided above is true and factual. I understand that all facts
may be material to the underwriter accepting this risk must be declared. I also
understand that no liability shall be accepted by the Company until this
Proposal Form is accepted by the underwriter.
|
| Promotion Code: |
(if
applicable) |
|
PROPOSER'S INFORMATION
|
| Name: |
|
| Date of Birth: |
*
 DD-MM-YYYY
|
| NRIC/Passport No.: |
*
E.g. S1234567A |
| Occupation: |
|
| |
Please Specify:
|
Subject to approval by the company, restricted
cover during off-duty hours may be considered for Air Crew, Pilot, NSmen and
Military / Navy / Airforce personnel.
All other professions and occupations not mentioned above must be referred to
the company for approval EXCEPT for the following occupations which will be
declined:
Industrial workers using heavy machinery; woodworking related or any occupation
involving aviation activities; armed services personnel; police force
personnel, fire fighters; painters; construction / unskilled workers; ship crew
or workers on board vessels, stevedores, shipbreakers; occupations involving
diving, platforms, oil and gas rig and / or offshore work; occupations
involving work at heights / underground and / or handling of hazardous chemical
/ electricity; professional sports teams; professional divers and jockeys;
welders and the like. |
| Marital Status: |
|
| E-mail: |
|
|
Plan Information
|
| Type of Plan: |
Titanium Plan is NOT APPLICABLE to CLASS III Occupation. |
| Policy Type: |
Individual
Family |
| With Spouse Insured? |
No
Yes |
| Spouse's Occupation: |
|
Subject to approval by the company, restricted
cover during off-duty hours may be considered for Air Crew, Pilot, NSmen and
Military / Navy / Airforce personnel.
All other professions and occupations not mentioned above must be referred to
the company for approval EXCEPT for the following occupations which will be
declined:
Industrial workers using heavy machinery; woodworking related or any occupation
involving aviation activities; armed services personnel; police force
personnel, fire fighters; painters; construction / unskilled workers; ship crew
or workers on board vessels, stevedores, shipbreakers; occupations involving
diving, platforms, oil and gas rig and / or offshore work; occupations
involving work at heights / underground and / or handling of hazardous chemical
/ electricity; professional sports teams; professional divers and jockeys;
welders and the like. |
| |
Please Specify:
|
| No. of Children: |
Children between 6 months to 21 years old or extended to
25 years old for those in full-time tertiary insitutions can also be enrolled
in the Family Plan. For children between 16 to 21 years who wants to enroll in
an Individual Plan, only Economy Plan is available.
|
| No. of Paternal Parents:
|
|
| No. of Maternal Parents:
|
|
| With Maid Insured? |
No
Yes |
Period of Insurance:
From DD-MM-YYYY
To (both
dates inclusive)
|
|
Please e-mail us at e-pa-health@sg.cntaiping.com
or call the following personnel:
|
| |
Jane Low |
at |
(65) 6389 6151 |