GEM TravelSure Application Form

Statement pursuant to Section 25(5) of the Insurance Act, you are to disclose in the Application Form, fully and faithfully, all the facts that you know or ought to know, otherwise this Policy issued hereunder may be void.

Eligibility of Cover

  • Students, teachers, lecturers and Staff/Employees
  • Insured must be domiciled in Singapore
  • The trip must start and end in Singapore within the period of Insurance

Please fill in all fields and payment instructions below before submission. You will receive an acknowledgement via your email. Your Travel Insurance Certificate and Policy will be issued within 5 working days and they will be sent to the registered email address. No hard copies will be sent.

Particulars

Payment Details

Please charge the premium to my credit/debit card:

Conditions

  • Pre-existing medical conditions are not covered by the Policy
  • The trip must not be for the purpose of seeking medical treatment
  • The Insured person must be domiciled in Singapore

Declaration

I hereby declare that I am in good health and am aware of and agree to abide by the Policy’s Terms, Conditions and Exclusions. I also understand that the issuance of the policy is based on all statements and answers set out in this Application Form which are complete and true. I am aware that I can seek advice from a qualified adviser before making a commitment to purchase the product. In the event that I choose not to seek advice from a qualified adviser, I take sole responsibility to ensure that this product is appropriate for financial needs and insurance objectives.

PDPA Clause

In accordance to the provisions of the Personal Data Protection Act 2012 ("PDPA"), the UOI’s Privacy Notice shall form part of the terms and conditions of this policy. A copy of UOI’s Privacy Notice can be found at www.uoi.com.sg.