PRODUCER'S INFO
Producer Name: Producer Code:

APPLICANT'S INFORMATION
First Name: Salutation:
Last Name: Nationality
Date of Birth: NRIC/FIN No.:
Email: Passport No.:
Name of Employer: Occupation:
Home Phone: Mobile Phone:
Mailing Address:  
Block / House No: Street Name:
Floor / Unit No: Building Name:
Country: Postal Code:
       

SPOUSE'S INFORMATION
First Name: Last Name:
Date of Birth: NRIC/FIN No.:
Passport No.:
Name of Employer: Occupation:

RISK LOCATION DETAILS
Insured Risk Location:  
Block / House No: Street Name:
Floor / Unit No: Building Name:
Country: Singapore Postal Code:
Dwelling Type:


 
Is the Property above 50 Years Old?
Year Built: Year Renovated:
Occupancy Type:

 

SECURITY DETAILS
Any Domestic Helper(s) living at the Premises?
Is the Property likely to be unoccupied for 30 consecutive days?
Type of Safe available:
Other Security features avaliable:

 
   

COVERAGE OPTIONS
Figures to be indicated in Singapore dollars only      
Coverage  
Building - $800,000 Deductible: $200
Additions and Alteration $50,000 - Deductible: $200
Contents $150,000 $250,000 Deductible: $200
Valuable Articles      
  • Jewellery - Unscheduled*
$8,500 $12,000 Per Article Limit: $10,000
  • Fine Art - Unscheduled*
$8,500 $12,000 Per Article Limit: $10,000
Worldwide Personal Liability $1,000,000 $2,000,000  
Total Premium Payable (Incl. 7% GST) $880.00 $1620.00  
* Get a discount when you provide a scheduled listing of your valuable articles.

Coverage
Building
Additions and Alterations
Contents
Deductibles
   
Valuable Articles Please Complete Private Collections Listing Below
Worldwide Personal Liability

PRIVATE COLLECTIONS LISTING

NoClassDescriptionScheduled
Items
Coverage Limit
(S$)
Unscheduled
Items
Coverage Limit
(S$)
Unscheduled
Per Article Limit
(S$)
 
1 Delete
       

PERIOD OF INSURANCE
Propose Coverage to take effect from:

LOSS HISTORY
Have you made any claims on similar insurance in the last 3 years?
Has any insurer ever refused to accept, renew or continue with your insurance cover?
If the answer is "Yes" to any of the above questions, please provide details.