Travel Insurance Application

ENQUIRY | PAYMENT Contact : (+65) 6534 4740 Email : info@ja-travel.com

Steps to Apply for Travel Insurance:

Complete the form below and submit it. Kindly enter the following data exactly as it appears in your passport.
We will process the application and revert to you within the same working day.
For application on a weekend, do bear with us, we will revert back on the next working day.
For urgent application please contact us @ (+65) 65344740 and we will process it within the next 3 hours.
Upon confirmation of the insurance, we will email you a Confirmation and for payment.
Payment maybe made via the following ways : Bank transfer to DBS, UOB or SCB or Credit Card
Upon payment, the Insurance policy will be email to you.

Contact Details
NAME : Name is required.
CONTACT NO : Contact is required.Invalid format.
EMAIL : Email is required.Invalid format.
REMARKS :

Choice of Plan & Benefits

Preferred Plan

AXA Insurance
CHARTIS

Individual
Family- Number of Accompanying Children:
Area of Cover :
Asean* Asia Global

* Asean not applicable to Annual Multi-Trip Plan

Travel Information & Period of Insurance - Select Single or Multi Trip.

Single Trip :Maximum for any trip is 182 days

DEPARTURE DATE : NO.OF DAYS :
RETURN DATE : FURTHEST DESTINATION
from Singapore :

Annual Multi-Trip :Maximum coverage per trip is 92 days

EFFECTIVE DATE :

Insured person 1

NAME (as per passport) : NATIONALITY :
OCCUPATION : GENDER: Female Male
DATE OF BIRTH : NRIC / FIN NO :

HOME ADDRESS :

Insured person 2

NAME (as per passport): NATIONALITY :
OCCUPATION : GENDER: Female Male
DATE OF BIRTH : NRIC / FIN NO :

HOME ADDRESS :

Insured person 3

NAME (as per passport): NATIONALITY :
OCCUPATION : GENDER: Female Male
DATE OF BIRTH : NRIC / FIN NO :

HOME ADDRESS :

Insured person 4

NAME (as per passport): NATIONALITY :
OCCUPATION : GENDER: Female Male
DATE OF BIRTH : NRIC / FIN NO :

HOME ADDRESS :

Insured person 5

NAME (as per passport): NATIONALITY :
OCCUPATION : GENDER: Female Male
DATE OF BIRTH : NRIC / FIN NO :

HOME ADDRESS :

Insured person 6

SURNAME NAME : NATIONALITY :
OCCUPATION : GENDER: Female Male
DATE OF BIRTH : NRIC / FIN NO :

HOME ADDRESS :

JA Travel