Insure Health Form
Statement pursuant to Section 25(5) of Insurance Act, you are to disclose in this electronic form fully and faithfully, all the facts that you know or ought to know, otherwise this Policy issued hereunder may be void.

Applicant's Particulars

Occupation Class*

Class 1 - Occupations which are mostly indoor desk-bound such as clerical, administrative or other similar non-hazardous.  Examples, but list not exhaustive, are accountant, lawyer, bank, doctor, teacher, nurse, secretary, homemaker, etc.

Class 2 - Occupations where some degree of risk is involved, such as supervision of manual workers, administrative job in an industrial environment, professions of an outdoor nature, work involving overseas travel or work involving the occasional use of tools or machinery.  Examples, but list not exhaustive, are foreman, grocer, hairdresser, salesman, tailor, surveyor, tour guide, etc.

If your Occupation Class is not listed above, please call UOI at 1800-221 6588

Contact

Mailing Address

-

-

Spouse's Particulars

Occupation Class*

Class 1 - Occupations which are mostly indoor desk-bound such as clerical, administrative or other similar non-hazardous.  Examples, but list not exhaustive, are accountant, lawyer, bank, doctor, teacher, nurse, secretary, homemaker, etc.

Class 2 - Occupations where some degree of risk is involved, such as supervision of manual workers, administrative job in an industrial environment, professions of an outdoor nature, work involving overseas travel or work involving the occasional use of tools or machinery.  Examples, but list not exhaustive, are foreman, grocer, hairdresser, salesman, tailor, surveyor, tour guide, etc.

This Policy is subject to Premium Before Cover Warranty,ie. full premium payment must be made before policy inception at the time of documentation.

A UOI Customer Service Officer will contact you in 2 business days to assist you with the payment. Please note full payment of premium must be made prior to policy inception.

* Mandatory field

 

Applicant's Particulars

Contact

-

-

Spouse's Particulars

  • I declare that I did not travel overseas against travel advice (including non-essential travel) by the Ministry of Foreign Affairs or the Ministry of Health of Singapore in the last 14 days.
  • I declare that I do not have any fever, flu-like or respiratory symptoms for the last 14 days.
  • I declare that I am in good health and I do not have any physical or mental defect or infirmity, deformity, disability or illness nor any impairments requiring medical treatment, investigation or observation by a doctor.

 

I am aware that this Policy does not cover any Pre-existing conditions prior to the effective date of this insurance. I am aware and that there is a waiting period of 30 days from the effective date of this insurance for any hospital confinement as a result of illness.

 

 

I understand submission of this electronic application form does not constitute to an automatic confirmation of insurance cover. I hereby declare that the above statements and particulars are complete and correct and that no facts have been suppressed or mis-stated. I agree that this proposal shall form the basis of the contract between me and United Overseas Insurance Limited (“UOI” or “Company”). I am aware that I can seek advice from a qualified advisor before making a commitment to purchase the product. In the event that I choose not to seek advice from a qualified adviser, I take sole responsibility to ensure that this product is appropriate to my financial needs and insurance objectives.

 

I acknowledge and agree that UOI may collect, use, disclose, transfer my/our personal data for the Purposes stated in UOI's Privacy Notice which can be found at www.uoi.com.sg. I also acknowledge by providing personal data relating to a third party (eg. Information of my dependent, spouse, children, parents and/or employees), I represent and warrant that the consent of that third party has been obtained for the collection, use and disclosure of the personal data for the Purposes stated in UOI’s Privacy Notice. I further acknowledge and agree to the disclosure of my personal data to United Overseas Bank Limited and its related corporations for the collection, use and disclosure of my personal data for marketing and analytics purposes. I further acknowledge that by providing personal data relating to a third party (eg. Information of my dependent, spouse, children, parents and/or employees), I represent and warrant that the consent of that third party has been obtained for the collection, use and disclosure of the personal data for marketing and analytics purposes.

 

I am aware that UOI may disclose personal data collected to its third party service providers or agents (including lawyers/ law firms), which may be sited outside of Singapore, for one or more of the above Purposes, as such third party service providers or agents, if engaged by UOI, would be processing the personal data for UOI for one or more of the above Purposes. This may include disclosure to industry association.

 

Enter the one-time password (OTP) you received.

SMS OTP service is currently unavailable.

Did not receive? 

Thank you for your InsureHealth application. Please take note of your Proposal Form No. above.

By submitting this form, you confirmed that you have read the Declaration and agreed to the Terms and Conditions of the Policy. Please be advised that the submission of this form does not constitute an acceptance of your proposal by UOI.  We will contact you within 2 business days to assist you with your application.

If you require any assistance, please call us at 1800-221 6588 during UOI’s business hours or .

UOI’s business hours

Monday to Thursday         8.45am to 5.45pm

Friday                                8.45am to 4.45pm

Closed on weekend and public holidays.