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.
Please fill in all fields below before submission. You will receive an acknowledgement via your email. An invoice will be sent within 5 working days to the registered email address along with payment instructions. No hard copies will be sent.