StudySecure 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.
All fields are mandatory
PARTICULARS OF PROPOSER
Name: (As shown in NRIC/ Passport)
ID Number: (eg: S1234567A/ G1234567A)
Nationality:
Singapore PR Nationality:
Country of Residence:
Gender:
Date of Birth:
(dd-mm-yyyy)
Address 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:
Life Insured same as proposer
PARTICULARS OF LIFE ASSURED
Name: (As shown in NRIC/ Passport)
ID Number: (eg: S1234567A/ G1234567A)
Nationality:
Singapore PR Nationality:
Country of Residence:
Gender:
Date of Birth: (dd-mm-yyyy)
Contact No: (Home) (Office) (Mobile)
Please provide at least one contact no
Email:
Relationship to Proposer:
PARTICULARS OF INSURANCE
Effective Date of Insurance: (dd-mm-yyyy)
Period of Insurance:
Institution:
Country:
City of overseas residence:
 
Policy Period Premium
Plan A Plan B
12 months $872.00 $1,308.00
24 months $1,656.80 $2,485.20
36 months $2,354.40 $3,531.60
Premium rates are inclusive of GST, non-guaranteed and may be reviewed from time to time.
Plan Type:
+ Table of Cover
Section Benefit Maximum benefit limit
Plan A Plan B
1 Medical expenses $200,000
Sub-limit
25 outpatient visits		 $200,000
Sub-limit:
25 outpatient visits
2 Emergency medical
evacuation		 Unlimited Unlimited
3 Sending you home Unlimited Unlimited
4 Overseas hospital allowance $1,000
Sublimit:
$100 per day		 $2,000
Sublimit:
$200 per day
5 Personal accident $$150,000
(See the scale of compensation table)		 $$250,000
(See the scale of compensation table)
6 Accidental burns Overall section limit: $30,000 Overall section limit: $50,000
7 Hospital visit Overall section limit: $10,000
Sub-limit for hotel accommodation
expenses:
$500 per day		 Overall section limit: $10,000
Sub-limit for hotel accommodation
expenses:
$500 per day
8 Compassionate visit Overall section limit: $10,000
Sub-limit for hotel accommodation
expenses:
$500 per day		 Overall section limit: $10,000
Sub-limit for hotel accommodation
expenses:
$500 per day
9 Home visit Overall section limit: $5,000 Overall section limit: $10,000
10 Study interruptions $15,000 $30,000
11 Education fund $50,000 $75,000
12 Kidnap and hostage Does not apply $3,000
Sub limit: $300 per day
13 Trauma counseling Does not apply $3,000
14 Criminal assault $75,000 $150,000
15 Loss or damage of personal
belongings		 Overall section limit: $3,000
Sub-limit for each item, set or pair: $350		 Overall section limit: $3,000
Sub-limit for each item, set or pair:
$500
16 Loss or damage of laptop $1,000 $1,500
17 Losing travel documents $1,000 $2,000
18 Losing money $500 $500
19 Cancelling your trip $1,000 $2,000
20 Travel delay
- While overseas
- While in Singapore		 Overall section limit: $500
$100 for every six hours of delay
$150 (after six hours of delay)		 Overall section limit: $750
$150 for every six hours of delay
$200 (after six hours of delay)
21 Baggage delay
- While overseas
- While in Singapore		 Overall section limit: $500
$100 for every six hours of delay
$100 (after six hours of delay)		 Overall section limit: $750
$150 for every six hours of delay
$200 (after six hours of delay)
22 Personal liability $300,000 $500,000
23 Home contents cover for
overseas residence		 Overall section limit: $3,000
Sub-limit for laptop: $1,000
Sub-limit for each item, set or pair: $300		 Overall section limit: $5,000
Sub-limit for laptop: $1,500
Sub-limit for each item, set or pair: $500
24 Alternative accommodation Does not apply $3,000,
Sub-limit: $500 per day
25 Full terrorism cover Up to the limits in the relevant section Up to the limits in the relevant section

Campaign Code: