MYEG Ace Insurance

	ACCIDENTAL HOSPITAL INCOME
	Coverage	Benefit
	Accident Hospital Income (payable up to 90 days)	RM100 per day	For terms and conditions click here
	Accidental Disability	Up to RM 10,000
	YEARLY PREMIUM PER ONLINE USER	RM 9.00
One full year Accident and Hospital protection for only RM9. Get covered NOW! From ACE Insurance

Personal Details

Title *

Full Name *

Please provide full name according to IC/Passport

Full Name

A Full Name is the proper name identifying an individual person, and usually comprises a given name best owed at birth or at a young age.

Date of Birth *

NRIC No. *

(malaysian)

NRIC No.

Examples of acceptable formats:

New IC No.	:	800620-12-5177
Old IC No.	:	A1234567

Passport No.

(non-malaysian)

Passport No.

Examples of acceptable formats:

Example 1

A1234567

Gender *

Male

Female

Occupation *

Address *

Postcode *

City *

State *

Contact No. *

(Mobile)

Example of acceptable formats:

(Home)

Example of acceptable formats:

(Office)

Example of acceptable formats:

Email *

Please provide active email.

Please key in your valid Email address here.

Declaration

DECLARATION: I hereby declare and agree that any personal data on this application may be held, used and disclosed by the Insurer for the purpose of processing this application and providing subsequent services for this and/or other insurance products and services, direct marketing, and data matching as the Insurer may consider necessary. NOTE: Pursuant to section 149(4) of the Insurance Act (Malaysia) 1996, you are to disclose in this proposal form, fully and faithfully, all the facts you know or ought to know, otherwise the policy issued hereunder may be void
Yes, I have read and understood the terms & conditions
Underwritten by: ACE Synergy Insurance Berhad

ACE INSURANCE