Corporate Travel Insurance

IMPORTANT NOTE A minimum of 5 employees are required to enrol for the plan. Please note that all policies, renewal certificates, endorsement for policies carry a Premium Warranty Clause which requires the premium to be paid in full within 60 days or period of cover whichever is shorter, failing which, there would be no liability under the policy, renewal certificate, cover note and endorsements etc. No insurance is in force until this application is accepted by the Company. Policy is subjected to $10 million coverage per conveyance. Maximum length of each business trip is 120 days. This plan is applicable for standard class 1&2 risk occupation only.
insured details
Business Name	A value is required.*
Business Address	A value is required.*A value is requi
Business Postal Code	A value is required.*
Person In Charge	A value is required.*
Contact No.	A value is required.* (Mobile) (Office) (Fax)
Email Address
Nature of Business	A value is required.*
No. of Employees	A value is required.*
Effective Date of Cover (Subject to Approval)	A value is required. * (ddmmyyyy)

No.	Name of Employees (As in Passport/NRIC)	Designation / Classification	Date of Birth	Type of Plan	Coverage/Area	Incl. Leisure
1			(ddmmyyyy)
2			(ddmmyyyy)
3			(ddmmyyyy)
4			(ddmmyyyy)
5			(ddmmyyyy)
Claims History (Last 3 years) Please provide details on a separate sheet.