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PLEASE SELECT
BRUNEI
FOREIGN COUNTRY
JOHOR DARUL TAKZIM
KEDAH DARUL AMAN
KELANTAN DARUL NAIM
LABUAN
MELAKA
NEGERI SEMBILAN DARUL KHUSUS
PAHANG DARUL MAKMUR
PERAK DARUL RIDZUAN
PERLIS INDERA KAYANGAN
PULAU PINANG
PUTRAJAYA
SABAH
SARAWAK
SELANGOR DARUL EHSAN
SINGAPORE
STATE CODE (FOR AD-HOC USE ONLY)
TERENGGANU DARUL IMAN
THAILAND
WILAYAH PERSEKUTUAN
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Country
AFGHANISTAN
ALBANIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARTICA
ANTIGUA & BARBUDA
ARCTIC OCEAN
ARGENTINA
ARMENIA
ARUBIA
ASHMORE AND CARTIER ISLANDS
ATLANTIC OCEAN
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BAKER ISLAND
BANGLADESH
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BARCELONA ESPANA
BASSAS DA INDIA
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
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BRITISH VIRGIN ISLANDS
BRUNEI
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BURUNDI
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CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
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COCOS (KEELING) ISLANDS
COLOMBIA
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ECUADOR
EGYPT
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IRAQ
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ITALY
IVORY COAST
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LATVIA
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MALTA
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MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA, FEDERATED STATES
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MOLDOVA
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MONGOLIA
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MYANMAR
NAMIBIA
NAURU
NAVASSA ISLAND
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
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NEW ZEALAND
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NIEU
NIGER
NIGERIA
NORFOLK ISLAND
NORTEHRN IRELAND
NORTH KOREA
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PACIFIC OCEAN
PAKISTAN
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PALMYRA ATOLL
PANAMA
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ST LUCIA
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VENEZUELA
VIETNAM
VIRGIN ISLANDS
WAKE ISLAND
WALES
WALLS AND FUTUNA
WEST BANK
WESTERN SAHARA
WESTERN SAMOA
WORLD
WORLD WIDE
YANGON
YEMEN
ZAIRE
ZAMBIA
ZIMBABWE
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State
PLEASE SELECT
BRUNEI
FOREIGN COUNTRY
JOHOR DARUL TAKZIM
KEDAH DARUL AMAN
KELANTAN DARUL NAIM
LABUAN
MELAKA
NEGERI SEMBILAN DARUL KHUSUS
PAHANG DARUL MAKMUR
PERAK DARUL RIDZUAN
PERLIS INDERA KAYANGAN
PULAU PINANG
PUTRAJAYA
SABAH
SARAWAK
SELANGOR DARUL EHSAN
SINGAPORE
STATE CODE (FOR AD-HOC USE ONLY)
TERENGGANU DARUL IMAN
THAILAND
WILAYAH PERSEKUTUAN
PLEASE SELECT
Country
AFGHANISTAN
ALBANIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARTICA
ANTIGUA & BARBUDA
ARCTIC OCEAN
ARGENTINA
ARMENIA
ARUBIA
ASHMORE AND CARTIER ISLANDS
ATLANTIC OCEAN
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BAKER ISLAND
BANGLADESH
BARBADOS
BARCELONA ESPANA
BASSAS DA INDIA
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRITISH VIRGIN ISLANDS
BRUNEI
BULGARIA
BURKINA FASO
BURUNDI
CAMBODIA
CAMEROON
CANADA
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
CLIPPERTON ISLAND
COCOS (KEELING) ISLANDS
COLOMBIA
COMOROS
CONGO DEMOCRATIC REPUBLIC
CONGO REPUBLIC
COOK ISLANDS
CORAL SEA ISLANDS
COSTA RICA
COTE D'IVOIRE
CROATIA
CUBA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SAVADOR
ENGLAND
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPHIA
EUROPA ISLAND
FALKLAND ISLANDS
FAROE ISLAND
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN & ANTARCTIC LANDS
GABON
GAMBIA
GAZA STRIP
GEORGIA
GERMANY
GHANA
GIBRALTAR
GLORIOSO ISLANDS
GREAT BRITAIN
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HCARD ISLAND & MCDONALD ISLANDS
HOLY SEE (VATICAN CITY)
HONDURAS
HONG KONG
HOWLAND ISLAND
HUNGARY
ICELAND
INDIA
INDIAN OCEAN
INDONESIA
IRAN
IRAQ
IRELAND
ISLE OF MAN
ISRAEL
ITALY
IVORY COAST
JAMAICA
JAN MAYEN
JAPAN
JARVIS ISLAND
JERSEY
JOHNSON ATOLL
JORDAN
JUAN DE NOVA ISLAND
KAZAKHSTAN
KENYA
KINGMAN REEF
KIRIBATI
KOREA NORTH
KOREA SOUTH
KUWAIT
KYRGYSTAN
LABUAN MALAYSIA
LAOS
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LIECHTENSTEN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MAN ISLE
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA, FEDERATED STATES
MIDWAY ISLANDS
MOLDOVA
MONACO
MONGOLIA
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NAVASSA ISLAND
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIEU
NIGER
NIGERIA
NORFOLK ISLAND
NORTEHRN IRELAND
NORTH KOREA
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PACIFIC OCEAN
PAKISTAN
PALAU
PALMYRA ATOLL
PANAMA
PAPUA NEW GUINEA
PARACELL ISLANDS
PARAGUAY
PERU
PHILIPPINES
PITCAIRN ISLANDS
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIA
RUSSIAN FEDERATION
RWANDA
SAINT KITTS AND NEVIS
SAINT LUCIA
SAMOA
SAN MARINO
SAU TOME AND PRINCIPE
SAUDI ARABIA
SCOTLAND
SENEGAL
SERBIA AND MONTENEGRO
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA & SOUTH SANDWICH ISLANDS
SPAIN
SPRATLY ISLANDS
SRI LANKA
ST HELENA
ST LUCIA
ST VINCENT & THE GRENADINES
SUDAN
SURINAME
SVALBARD
SWAZILAND
SWEDEN
SWITZERLAND
SWITZERLAND
SYRIA
TAIWAN
TAJIKISTAN
TANZANIA
THAILAND
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TROMELIN ISLAND
TUNISIA
TURKEY
TURKMENISTAN
TURKS & CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIETNAM
VIRGIN ISLANDS
WAKE ISLAND
WALES
WALLS AND FUTUNA
WEST BANK
WESTERN SAHARA
WESTERN SAMOA
WORLD
WORLD WIDE
YANGON
YEMEN
ZAIRE
ZAMBIA
ZIMBABWE
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Benefit
Benefit Description
Silver (RM)
Gold (RM)
Diamond (RM)
1.
Accidental Death
50,000
200,000
500,000
2.
Accidental Permanent Disablement
50,000
200,000
500,000
3.
Accidental Hospital Benefit (maximum up to 60 days) (Per day)
50
200
500
4.
Academic Achievement Award
50
200
500
5.
Common Illnesses (maximum up to 15 days) (Per day)
50
200
500
6.
Kidnap Benefit
10,000
20,000
50,000
7.
Exam and Tuition Fees
500
2,000
5,000
8.
Double Indemnity on Public Conveyance
50,000
200,000
500,000
9.
Loss/Damage to Gadget
100
300
500
DISCLAIMER
I / We hereby give my / our unconditional and unequivocal consent to you and all your related companies to process my / our personal data revealed hereto. You are at liberty to process the data and share the i nformation thereto with any of your service providers and your other related companies provided that the revelation of my / our personal data strictly for the purposes in relation to the insurance which I / We have applied hereto. The consent given hereto is in line with the requirement set forth in the Personal Data Protection Act 2010.
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