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Corporate Travel Insurance Quotation

Important Notice
1) To get accurate quotes, please kindly provide detail and accurate information as the accuracy of premium depend on the accuracy of information given.

2) All data or information given will be kept confidential and only use for our company data usage and quotation.

Corporate Profile

Company Name : *
Office / Handphone : *		Fax No :
Email Address :		Contact Person : *
Description of Business/Trade :
	Others, please Specify:

Insurance Information for Annual Plan

Choice of Type :	(Minimum 2 employees to sign up Annual Plan)
Choice of Plan :
Choice of Area :
Annual Effective Date :		Expiry Date :
	(Per trip plan : Max of up to 182 days per trip, Annual plan : Max of up to 90 days per trip)

Employee Information (Applicable for Annual Plan only)

Name of Employee (As in NRIC)	Designation	Birthdate

Insurance Information for Per Trip Plan

Choice of Type :
Choice of Plan :
Choice of Area :
Choice of Country :	(If there are more than two countries to travel , select the furthest country from Singapore)
No. of employee to be included for Per Trip :	(Monthly Billing based on no. of trips)
Per Trip Date of Departure :		Date of Arrival :
	(Per trip plan : Max of up to 182 days per trip, Annual plan : Max of up to 90 days per trip)

Others

Remark :

How You get to know about us :
Your friend/Relative/Associate Name :

Modified on 01 August 2005