HomeSecure Online Application

Statement under section 25(5) of Insurance Act, Cap. 142 (Or any future amendments to it)
You must reveal all facts you know, or ought to know, which may affect the insurance cover you are applying. Otherwise, the insurance policy may not be valid.

IMPORTANT
Please note that the liability of Income does not commence until this proposal has been accepted by Income.
PARTICULARS OF PROPOSER All fields are mandatory
Name: Name as per shown in NRIC/FIN/Passport
Gender:
Date of Birth:
DD-MM-YYYY
Nationality:
Singapore PR Nationality:
Country of Residence:
ID Number: eg: S1234567A
Address Type:
Dwelling Type:
Postal Code: Unit No:
Please click here after you have entered postal code and unit no.
Mailing Address:
Contact No: (Home) (Office) (Mobile)
Please provide at least one contact no.
Email:
^Please note that personal particulars keyed in this form will not overwrite any existing records that you have with
Income. For changes to be made to your particulars, please log into me@income , 'Manage My Particulars' section.
PARTICULARS OF PREMISES TO BE INSURED
Insured Premises same as Home Address:
Address Type:
Type of Dwelling:
Please specify
Postal Code: Unit No:
Please click here after you have entered postal code and unit no.
Address:
Ownership:
DETAILS OF INSURANCE COVER REQUIRED
Effective Date:
DD-MM-YYYY
Choice of Plan:
Section Sum Insured(Rollover for Rates Table)
1. Building insurance info
S$
2. Home contents info
S$
3. Valuables and personal possessions (Worldwide) info a) Unspecified items S$2,500 and below per item/ set of pair

Total Value of Items
S$

b) Specified items above S$2,500 per item/ set of pair info

Name of Item(s) Value of Item(s)
S$
 
4. Personal and Home Occupiers' Liability S$2,000,000
5. Personal Accident S$50,000 each for policyholder & spouse S$10,000 for each child
Please click here for Summary of Benefits
QUESTIONNAIRE

1. 		Have you ever made any claims under similar insurance during the past 3 years? If "Yes", please give details. If yes: a) What is the cause of the loss or damage? b) When did the loss or damage occur? c) Was a claim made for the loss or damage? Please give details on the claim amount.

2. 		Has your proposal or renewal for home insurance ever been declined, withdrawn or required to impose special terms? If "Yes", please provide details.
Campaign Code:
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