To get an initial quotation, you may supply your information with the following form.
TYPE
:
FAQ
Provide you with Life Insurance Proposal and Income Protection Plan.
Quotation Application Form
A.
Contact Information
Name
:
Mr
Ms
Email
:
Phone No.
:
Mobile No.
:
Fax No.
:
B.
Particular of insured data
Plan type
:
Life Insurance
Income Protection
Are you involved in one of the following occupations?
None of the following
Automobile racer
Boxer; judo or karate fighter, kung fu instructor/fighter or stuntman
Circus performer
Courier/Messenger service on motorcycle
Diver
Fisherman or fishing boat owner
Guard carrying arm; driving armored car; collecting cash
Handling explosives or fireworks
Horse rider or jockey
Labor worker in brick manufacturing industry
Labor worker in cement, gypsum & lime manufacturing industry
Labor worker in construction site
Labor worker in container site
Labor worker in dockyard
Labor worker in metal heating/melting industry
Labor worker in mining industry
Massage girl
Police of Special Duties Unit
Police on motorcycle duty
Private plane pilot
Public relation or dancer in night club or bar
Reporter at war zone or oversea
Snake catcher
Worker of lift or elevator installation and maintenance
Worker of town gas repair
Working in asbestos industry
Working in bricklaying industry
Working in highway or road construction
Working in ocean liner, barge and tug
Working in poisonous compound
Working in power line construction and maintenance
Working in tunnel, subway or underground
Working outdoor at height
Working outdoor of building maintenance
Name of Applicant
:
Mr
Ms
Date of Birth
:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
d
1
2
3
4
5
6
7
8
9
10
11
12
m
y
Sex
:
Male
Female
Smoking Status:
Non-smoker
Smoker
Occupation
:
You may use the following to give us further information such as the address, etc
:
My doctor has just told me that there is a big problem on my health. Will
it
be wise to buy a life policy immediately and not to tell insurance company about doctor's comment ?