Lifetime Critical Illness

for your Children

Lock in low premium rates.

Provide Early to Late Stage Critical Illness Cover.

 

China Taiping i-Secure Non-Med

The Life Insured will be

 

Please note that the sum of the total Early CI and Advanced CI sum assured cannot exceed the Basic Sum Assured selected. 

Initial Premium Payment by:

Guaranteed Benefit Factor

Email Address
Handphone No.
Name as in NRIC
NRIC/FIN Number
Gender
Date of Birth
Are you / life insured currently residing in Singapore?
If you / life insured are currently not residing in Singapore, have you / life insured resided outside of Singapore continuously for 5 years or more preceding the date of this application?
Have you / life insured been residing in Singapore for a total of 183 days or more in the last 12 months preceding the date of this application?
Do you / life insured have a pass or permit that has a duration longer than 90 days and you have been residing in Singapore continuously for 90 days or more in the last 12 months preceding the date of this application?
Employment Status
Name of Employer
Nature of Business

Last drawn salary if unemployed, retired or a homemaker.

Annual Income S$
Occupation
Nature of Work
Education Level
Marital Status
Are you a smoker?
Has any application or reinstatement for a life, critical illness, disability, accident or hospital insurance policy ever been refused, postponed or accepted at special terms by any insurer for you / life insured?
Have you / life insured ever made any claims or are you intending to make any claims on any policy with any insurer?
Do you / life insured engage or expect to engage in any hazardous or potentially hazardous activity, such as automobile or motorcycle racing, power boat racing, scuba diving, parachuting and sky diving, professional sports or fl ying other than as a fare-paying passenger on a scheduled airline route?
Does your / life insured's job nature involve working at heights (over 25 feet), working underground, handling explosives, commercial diving, armed with weapons (exclude police forces), working with or maintaining high voltage power lines and cables?
Have you / life insured travelled or do you / life insured travel or live away from current residence city location in any year? (For over 90 days)
Do you / life insured anticipate the pattern of frequency of travel will change substantially over the next 12 months? (for travel over 90 days)
Source of Funds to Pay Premiums
How did you accumulate your wealth?
Email
Handphone No.
Postal Code
Please state your current height (metres)
Please state your current weight (kilograms)
Please state your child's current height (metres)
Please state your child's current weight (kilograms)
Do you / life insured have a regular doctor or has consulted any doctor in the last 24 months?
Number of doctor(s) consulted

Doctor 1

Name of doctor
Date of last consultation
Reason for consultation
Test date
Test Result

Doctor 2

Name of doctor
Date of last consultation
Reason for consultation
Test date

Doctor 3

Name of doctor
Date of last consultation
Reason for consultation
Test date
Test Result
Are you / life insured currently experiencing symptoms or are you now receiving or considering receiving medical advice/treatment from a doctor?
In the past 5 years, have you / life insured had any surgical operation or hospital admission or had been advised to undergo or intend to have any medical test or investigations done such as X-ray, ultrasound, imaging scan, biopsy, mammogram, pap smear, prostate check, electrocardiogram (ECG), blood or urine test?

• Name of condition and date of diagnosis
• Name and address of each doctor/hospital
• Duration of illness/injury and date of recovery as appropriate
• Nature of tests done, dates, results and reason for tests
• Copy of the above test(s) result(s), if any
• Details of treatment, if any

 Have you / life insured EVER had or been told to have or been treated for

a. Epilepsy, stroke, paralysis, weakness of limb, persistent headache, unconsciousness, nervous breakdown, depression or any other nervous/ mental disorders?
b. Diabetes, thyroid disorders or any other endocrine disorders?
c. Ear discharge, nose bleeds (intermittent or continuously longer than 1 week), double vision, impaired sight, hearing impairment, or speech disorder or any other disorders of ear, eye, nose or throat?
d. Asthma, persistent cough (longer than 4 weeks), coughing with blood, pneumonia, bronchitis, tuberculosis, breathing complaints/discomfort or any other lung diseases?
e. Raised cholesterol, high blood pressure, heart attack, heart murmur, cardiomyopathy, mitral valve prolapse or other heart valve disorders, breathlessness, irregular or fast heart rate, chest discomfort or pain, disease of or any other disorders of the heart or blood vessels?
f. Gastritis, stomach or duodenal ulcer, blood in stools, fi stula, piles or any other stomach or bowel disorders?
g. Jaundice, Hepatitis B or Hepatitis C carrier or any form of hepatitis, liver disorder or gall bladder disorder?
h. Blood, protein or sugar in urine, kidney stones, infection or any other disorders of the kidney, bladder or genital organs?
i. Slipped discs, gout, arthritis, osteoporosis, chronic back pain or deformity or disorders of the muscles, spine, limbs or joints or severe injury?
j. Cancers, tumours, cysts, polyps, fi broids, enlarged lymph nodes, unusual skin lesion, or growths of any kind?
k. Anaemia, thalassaemia, any other disorders of the blood, advised to abstain from donating blood or received blood transfusion or blood products on account of haemophilia or any other reason?
l. Systemic lupus erythematosus, rheumatic fever, rheumatic arthritis, Kawasaki’s disease, vasculitis, scleroderma, or any other disorders of the immune system?
m. Any other illness, disorder, operation, physical disability or accident not mentioned above?

• Name of condition and date of diagnosis
• Name and address of each doctor/hospital
• Duration of illness/injury and date of recovery as appropriate
• Nature of tests done, dates, results and reason for tests
• Copy of the above test(s) result(s), if any
• Details of treatment, if any

Have you / life insured or your spouse been told to have, received any medical advice, counselling or treatment in connection with Sexually Transmitted Diseases (STDs), AIDS, AIDS related Complex or any other AIDS related conditions?
Have any of your / life insured's biological parents or siblings, before age of 60, died or suffered from Cancer, Diabetes, Stroke, Polycystic Kidney disease, Heart disease, Parkinson’s disease, Dementia/Alzheimer’s disease, or any other hereditary diseases?
Condition
Relationship
Age at onset
Age at death (if deceased).
Do you / life insured drink beer, wine or other alcohol?
If Yes, please indicate average daily consumption and type of alcohol.

1 standard alcoholic drink equates to 330ml beer, 125ml glass of wine or 30ml of glass of spirits.

Have you / life insured ever smoked or used tobacco/nicotine products including cigarettes, cigars, cigarillos, pipe, chewing tobacco, nicotine patches, gum or shisha?
 
If Yes, please state type, average consumption per day.
If you are a former smoker, when was the last time you smoked?
 
Have you / life insured ever taken addictive drugs or substances, or been treated or counselled for alcoholism or the use of addictive drug or substances?
Do you / life insured have any existing policy(ies) or applications pending with any insurance company?

Please include details on:

  1. Name of the Company
  2. Sum Assured for Life / TPD / Critical Illness / Others
  3. Annual Premium 4. Year Issued

I confirm that I am solely a tax resident of Singapore and do not
have a foreign tax residency. My Singapore TIN is my NRIC or FIN. I am not currently residing outside Singapore and have not resided outside Singapore for 5 or more years. For PRs: I have been residing in Singapore for 183 days or more in the last 12 months preceding the date of this application.

I am not a Politically Exposed Person (PEP). 

I am not currently applying for any other Life Insurance policies and I do not intend to replace any of my existing policies with this policy.

I would not like my dependant(s) to be taken into consideration for the needs analysis and recommendation(s).

I wish to receive product advice only and do not need my other insurance plans to be considered for needs analysis.

I am not an undischarged bankrupt

Agreement
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