Assistance Centre (65)

Transcription

1 In an Emergency Situation, call the Assistance Centre (65) Personal Accident Insurance POLICY OWNERS PROTECTION SCHEME 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 your insurer or visit the GIA / LIA or SDIC websites ( or or Tokio Marine Insurance Singapore Ltd. 20 McCallum Street #09-01 Tokio Marine Centre Singapore Tel: (65) tmis@tokiomarine.com.sg Website: GST Reg. No.: M Company Reg. No.: M

2 PERSONAL ACCIDENT INSURANCE Accident can strike when you least expect. Getting yourself and your family covered for personal accident can help you and your family members deal with the contingency and associated adverse financial impact. Our Personal Accident Insurance is just what you need offering 24-hours worldwide comprehensive coverage for you and/or your family. It has the flexibility of allowing you to select the type and level of covers you want. Applying for your Personal Accident Insurance is also hassle free and does not require any pre-acceptance medical examination. BASIC COVER Accidental death Pays for death of the insured person resulting from an accident Permanent disability Pays for permanent disability resulting from an accident in accordance with the Scale of Benefits A limited war and acts of terrorism cover applies to the basic cover subject to a limit of 10% of the capital sum/sum insured or $100,000 whichever is the lower. OPTIONAL COVERS Temporary total or partial disability Pays in the event that accidental injury temporarily stop the insured person form performing each and every duty of their usual occupation Reimburses medical expenses necessarily incurred by the insured person as a result of accidental injury Hospital Cash Pays in the event that the insured person is hospitalised as a result of an accident Optional Covers Temporary total/partial disability (up to 104 week per period of insurance) (per period of insurance) Sum Insured Options Multiples of $10,000 Multiples of $100 per week/ $50 per week Multiples of $1,000 Scale of Benefits Hospital cash (up to 30 days any one accident) $100 per day Disabilities Death or permanent total disability Loss of one or more limbs loss of sight in one eye or both eyes Loss of lens of one eye Loss of hearing in both ears Loss of hearing in one ear Loss of speech Loss of four fingers and thumb of one hand Loss of four fingers and one hand Loss of thumb (both phalanges) Loss of thumb (one phalanx) Loss of index finger (three phalanges) Loss of index finger (two phalanges) Loss of index finger (one phalanx) Loss of middle finger (three phalanges) Loss of middle finger (two phalanges) Loss of middle finger (one phalanx) Loss of ring finger (three phalanges) Loss of ring finger (two phalanges) Loss of ring finger (one phalanx) Loss of little finger (three phalanges) Loss of little finger (two phalanges) Loss of little finger (one phalanx) Loss of all toes of one foot Loss of great toe (two phalanges) Loss of great toe (one phalanx) Loss of other toe (one or more phalanges) Percentage of Sum Insured 75% 15% 40% 25% 10% 15% 8% 10% 8% 7% 3% 17% 5% 3% Notes Where permanent disability is not indicated in the Scale of Benefits above (other than loss of sense of taste or smell for which no benefit is payable), we will adopt a percentage of disability based on the assessment by our appointed doctor that is consistent with the Scale of Benefits above and without regard to the your occupation. If an injury or a disability forms part of another injury or disability, the highest of either benefit will be payable and the total benefits payable unde the policy will not exceed the sum insured. WIDE COVERAGE Our Personal Accident Insurance covers the following events: Strikes, riots or civil commotion Assault, hijack or murder Drowing, suffocation by smoke, poisonous fumes or gas Exposure to natural elements Disappearance following an accident Peace-time military training Motor cycling MAIN EXCLUSIONS Death or injury as a result of the following will not be covered: Pregnancy, childbirth, miscarriage or any complications thereof Pre-existing physical defects or infirmity Intentional self-inflicted injury, suicide or any attempt thereat (whether sane, insane or under any metal distress) Criminal or illegal act committed by you Flying or any other aerial activities except as a fare paying passenger in a licensed aircraft Mountaineering which requires the use of ropes or guides, racing or any kind other than on foot, ice or winter sports, water ski-jumping, underwater activities that requires the use of underwater breathing apparatus Participating in professional sports or training for professional sports of any kind Taking part in naval, air force or military operations other than peacetime operations as a national serviceman, military personnel or NSman All illness or disease howsoever contracted, even if through injury (this, however, does not apply to disease directly resulting from medical treatment rendered necessary by injury or infections directly resulting from an injury) Sexually transmitted disease including Acquired Immune Deficiency Syndrome (AIDS) disease or Human Immunodeficiency Virus (HIV) infection War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or unsurped power or confiscation or nationalisation or requisition or destruction of property by or under the order of any government or public or local authority Use, existence or escape of nuclear weapons material or ionising radiation from or contamination by radioactivity from any nuclear fuel or nuclear waste from the combustion of nuclear fuel.

3 YOUR POLICY OBLIGATIONS To make a claim under the policy, you: have to complete and send to us a claim form within 3 months from the date of the accident must, at your own expense, submit all medical certificates, information and evidence required by us in support of your claim must undergo examination when and as often as we may reasonably require or subject to an autopsy (in the case of death) as part of the claim evaluation process WHO CAN APPLY If you and the persons to be insured are a Singapore citizen, Singapore permanent resident or work permit or employment pass holders residing in Singapore and are between the age of 18 and 65 on the next birthday you are eligible to apply for our Personal Accident Insurance. However, if the persons to be insured fall within the list of special risks, we may decline the insurance application or accept the application on certain additional conditions and at non-standard premium rates. The policy issued is for a period of one year and is subject to annual review. Unless otherwise informed, the policy can be renewed until the insured person reaches the age of 75 years old. HOW MUCH PREMIUM DO YOU PAY The level of premium you pay depends on the Plan you select and the occupational class that best describes your employment duties, viz. Class I Occupation that is indoor and sedentary in nature. E.g. white-collar worker performing office or showroom duties, accountants, lawyers, office executives, secretaries, clerks, etc. Class II Occupation that requires occasional manual work (skilled or semi-skilled). E.g. outdoor sales executives, factory supervisors, surveyor, etc. Class III Occupation that substantially involves manual work. E.g. carpenters, cooks, chefs, plumbers, mechanics, electricians, machinists, drivers, etc. CANCELLATION RIGHTS You have a free look period of 14 days from the date you receive your policy documents, during which you can cancel the policy and we will refund all premium paid by you in full. Your receipt of the policy will be assumed 3 days after we dispatch the policy. You have to inform us in writing that you do not want the policy within the 14 days, and we will cancel the policy from the commencement date of the policy. We will not have any liabilities from the commencement/ inception date when you exercise this right. After the free look period, you or we may cancel the policy by giving each other 14 days prior notice in writing. If you cancel the policy and no claims have been made, the premium will be computed on the short period basis and the remainder of premium if any will be refunded. The full year premium will be charged when any claims had been made. If we cancel the policy, the premium for the policy will be pro-rated, based on the period for which the policy was in forced. When the policy is cancelled, no liability will be assumed by us from the date of cancellation. Special risks Aircrew, shipcrew, stuntman, actor (actress), occupation involving the handling of firearms, explosives or hazardous chemicals, diver, occupation involving underground works, professional sportsman (sportswoman), construction worker, occupation involving works at heights, jockey, stevedores, occupation involving works on board vessels or oil-rigs, policeman, military personnel, firearm. We offer family discounts if you insure with your spouse and/or children. Please contact us or the intermediary who services you for further details PROVIDING YOU WITH BETTER SERVICE We support the general insurance code of pratice developed by the General Insurance Association of Singapore (GIA) to enhance the standard of service in the insurance industry. You can obtain more information on the code of practice and how it benefits you by contacting us at or You can also obtain details about the code of practice from our website at This product is covered under the Policy Owner s Protection Scheme (PPRSch) administered by the Singapore Deposit Insurance Corporattion (SDIC). Details can be obtained from Cover (for every $10,000 sum insured) Optional Cover Temporary total/partial disability (for every $100/$50 per week sum insured) For the first $1,000 Premium Rates Class I Class II Class III $7.00 $10.00 $14.00 $15.00 $19.00 $28.00 $12.00 $15.00 $18.00 IMPORTANT This brochure is not an insurance policy and does not contain the full details of the insurance cover. The specific terms, conditions and exclusions applicable to the insurance are contained in the policy which will be issued to you upon acceptance of your application. A copy of the specimen policy can be made available to you upon request. For every subsequent $1,000 sum insured $7.00 $10.00 $12.00 Hospital cash $25.00 $30.00 $45.00 Premium shown above is further subject to Goods and Services Tax (GST). Premium rates are non-guaranteed, i.e. at our sole discretion, we may amend the premium rates from time to time. TWIN/Jan k

4 PROPOSAL FORM Important Notice Under the Insurance Act, you must tell us the facts that you know, ought to know, about the risk that you are proposing. If you do not tell us everything that is relevant or if you mislead us, we may refuse to pay a claim or part of it, or cancel the policy. If your application is to replace an existing policy, you should consider whether you will incur any penalty, additional transaction cost when switching policy and that the benefits under the replacing policy are suitable for you and are not lower than your existing policy. Please answer all questions. If a question does not apply to you, please indicate NA. A. PARTICULARS OF PROPOSER Name (as in NRIC or passport for individual): Address: Telephone: NRIC/Passport No.: Sex : M / F * Marital Status : Occupation : * Delete where not applicable B. PARTICULARS OF PERSON TO BE INSURED (if different from proposer) If there are more than 1 person, please attach a separate piece of paper with details stated. Name (as in NRIC or passport for individual): Address: Telephone: Postal code Mobile: Date of Birth: Postal code Mobile: C. PROPOSED INSURANCE Period of insurance required : From : To: Select the cover you require : Optional Covers Temporary disability Hospital cash Total premium before GST Add : GST Total premium payable Sum insured you require Annual Premium ($) D. DECLARATION I declare that: I am not a bankrupt; the person(s) to be insured is/are in good health and free from any physical impairment (saved as disclosed herein) and residing in Singapore; statements made in this proposal form are true and complete and they shall form the basis of the contract between me and Tokio Marine Insurance Singapore Ltd; I am aware that the benefits under this insurance are conditional upon an accident occurring and that I can seek the advice of a qualified adviser to ensure that the insurance is appropriate to my insurance objective and for my financial needs before signing on this application form. NRIC/Passport No.: Sex : M / F * Marital Status : Occupation : Date of Birth: (Please your answer ) 1. Does the occupation of the person to be insured involve manual work? 2. Does the person to be insured engage in any hazardous activities in their occupation or leisure /recreation? 3. Is the person to be insured suffering from any illness, disease, physical defect or infirmity? Signature of Proposer Intermediary (If applicable) Date 4. Does the person to be insured has any other personal accident insurance? 5. Has the person to be insured ever had any insurance refused, cancelled, declined, renewal not offered, special conditions imposed or claim refused? 6. Has the person to be insured ever made a claim in respect of bodily injury against any insurance company? If any of the answer above is Yes, please provide details: Policy No. Agency Code Commission (%) Remarks: FOR OFFICE USE ONLY Approved by & Date TWIN/Jan2012-1k

5 IMPORTANT NOTICE Notice for Personal Data Protection Policy By signing this form: 1. I/We acknowledge and consent to TMiS collecting, using, processing and disclosing to third party service providers and/or intermediaries, within or outside Singapore, my/ our personal data for the purpose of processing and servicing my/our policies/claims; 2. I/We declare and confirm that I/we have obtained the consent of the person(s) and/or nominee(s) named herein, where applicable, and that he/she/they has/have authorized me/us to disclose their personal data and to give consent on their behalf for the above collection, use, process and disclosure; and 3. I/We acknowledge the detailed Privacy Policy Statement, governing the above, posted at Your Signature (Policy Holder) and Date On behalf of person(s) to be insured Your Full Name/Company Name Your NRIC/Passport No./Company Registration No. TMiS/PDPA/0614