I, the Policyholder warrant the truth and accuracy of the statements below and declare that all named insured(s) in this Policy:

• are Singapore citizens, Singapore permanent residents, holders of a valid work permit, employment pass, dependant's pass, long-term visit pass, S pass or student pass;


• have not travelled to Mainland China in the last 14 days;


• do not have any fever, flu-like or respiratory symptoms (e.g. cough, runny nose, sore throat);


• agree for this policy to be classified as a Singapore Policy for accounting purposes;


• understand and agree that no insurance is in force until this application is accepted by Chubb and a Policy is issued;


• are aware of and agree to abide by the Policy's terms, conditions and exclusions, as amended from time to time;


• understand that we should consider carefully if we intend to replace all insured persons’ existing accident & health policy with this policy;


• are aware that the cover of an insured person under this policy will terminate when he/she does not meet the eligibility of the policy;


• have provided complete, true and accurate information on the enrolment form and that no material information has been withheld. I/we also agree that the information provided forms part of the contract between Chubb and the Insured Person(s) and acknowledge that Chubb relies and acts on the information provided to issue a Policy;


• give consent and authorisation to Chubb to collect, use, disclose, and/or process the personal data or information supplied to Chubb, without further notification to me/us, confidentially with its affiliated companies, third party service providers, business partners and/or other parties which may be sited outside of Singapore, for the purposes stated in Chubb’s Purpose Statement including administering policies taken out with Chubb, handling claims and customer services. I agree that if I am submitting information relating to other individuals, I confirm they have consented to Chubb's collection, use and disclosure of their personal information as described above. A copy of Chubb’s Personal Data Protection Policy can be found www.chubb.com/sg-privacy and all are deemed to have read the same; and


• will write to Chubb’s Data Protection officer at 138 Market Street #11-01 CapitaGreen Singapore 048946 for any request to withdraw my/our consent, access to and/ or correct any information supplied to Chubb and Chubb reserves the right to charge a reasonable fee to offset the administrative costs in complying with access requests.

PLEASE TAKE NOTE :

• You must fully and faithfully disclose all facts which you know or should know in respect of your application for insurance. Otherwise, the Policy may be void.


• This Policy is protected under the Policy Owners’ Protection Scheme which is administered by the Singapore Deposit Insurance Corporation (SDIC). Coverage for your Policy is automatic and no further action is required from you. For more information on the types of benefits that are covered under the scheme as well as the limits of coverage, where applicable, please contact Chubb or visit the following websites:
  
  • General Insurance Association of Singapore, http://www.gia.org.sg/
  
  
  • Life Insurance Association of Singapore, http://www.lia.org.sg/
  
  
  • SDIC http://www.sdic.org.sg