China Taiping Group Website
 
 
Personal Accident Safe Quotation

IMPORTANT NOTES
  1. 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.
  2. 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)

 

>> For More Information

Please e-mail us at e-pa-health@sg.cntaiping.com or call the following personnel:

  Jane Low at (65) 6389 6151
 

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