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

  • The applicant must be domiciled in Singapore i.e. the person must be studying or working in Singapore under a valid Student, Employment or Dependent Pass Permit.
  • Students on full-time overseas study must be a Singapore Citizen or Singapore Permanent Resident.
  • Age enrolment for full-time student is from 16 to 45 years old.
  • Age enrolment for academic staff is from 18 to 70 years old.
  • Age shall mean the age of the Insured Person on his/her next birthday on the start date of the Period of Insurance and/or Policy.

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.


Payment Details

Please charge the premium to my credit/debit card:


  • Pre-existing medical conditions are not covered by the Policy.
  • The trip must not be for the purpose of seeking medical attention.
  • The Insured Person(s) must be domiciled in Singapore.


I/We hereby declare that I am/we are in good health and am/are aware of and agree to abide by the Policy's Terms, Conditions and Exclusions. I/ We 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/ We are aware that I/we can seek advice from a qualified advisor before I/we purchase this insurance. Should I/we choose not to, I/we take sole responsibility to ensure that this product is appropriate to my/ our financial needs and insurance objectives.

I/We acknowledge and agree that UOI may collect, use, disclose, transfer my/our personal data for the Purposes stated in UOI's Privacy Notice which can be found at

I/We further acknowledge by providing personal data relating to a third party (eg. Information of my dependent, spouse, children, parents and/or employees), I/we represent and warrant that the consent of that third party has been obtained for the collection, use and disclosure of the personal data for the Purposes stated in UOI's Privacy Notice.

I/We am/are aware that UOI may disclose personal data collected to its third party service providers or agents (including lawyers/ law firms), which may be sited outside of Singapore, for one or more of the above Purposes, as such third party service providers or agents, if engaged by UOI, would be processing the personal data for UOI for one or more of the above Purposes. This may include disclosure to industry association.

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