Individual Personal Accident Insurance - HLB

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Please make sure you meet the following conditions:

  1. You are between {{productMinAge}} and {{productMaxAge}} years old at the time of application.
  2. You must be a Malaysian, Permanent Resident of Malaysia, Work Permit/ Employment Pass Holder or otherwise legally employed person residing in Malaysia.
For policy renewal:

i. 

You may renew until you are 80 years old.

Please enter the details of Insured Person

* Complete the Country field.
* Complete the Passport No field.
* Complete the NRIC field. Please check NRIC number. Policyholder age must be between {{productMinAge}} and {{productMaxAge}} years.
* Complete the Passport No field.
* Complete the date field. Main policyholder age must be between {{productMinAge}} and {{productMaxAge}} Years.
* Oops, looks like you haven't ticked the box yet. Please do so to proceed.

Question 1 of 2

Question 2 of 2

Let's Check Your Eligibility

Have you suffered from any injury, sickness or received medical or surgical treatment during the last 3 years which have prevented you from attending to your normal occupation, business or pursuits for a period longer than 7 days?

* Complete the Question 1.

Have you ever made a claim against any insurer in respect of any accidental bodily injury during the past 3 years?

* Complete the Question 2.

My healthcare insurance is with:

{{ selected }}
×
  • {{ country }}
* Complete the Question 2.

Type of Coverage

?
* Please choose a Coverage Type.
* Complete the Occupation field. * Please enter a valid Occupation.

Period of Coverage

Start Date:

?
* Complete the Start Date. Policy start date must be within 1 year starting from today.

End Date:

Please Select your Preferred Plan

* Please Choose a Coverage Plan.

Personal Details

* Complete the Name as per NRIC field. Please enter only alphabet, "-", "@", "/" and " ' " for Name Member name cannot be greater than 70 characters.
* Complete the Email field. Please enter a valid email address.
* Complete the Mobile field. Please check mobile number.
* Complete the Address field.
* Complete the Postcode field. Please enter a valid Postcode.

Company Details

* Complete the Name as per Corporate field. Please enter only alphabet, "-", "@", "/" and " ' " for Name Corporate name cannot be greater than 70 characters.
* Complete the Registration No field. * Please enter valid Registration No.
* Complete the Category field.
* Complete the Sector field.
* Complete the Email field. Please enter a valid email address.
* Complete the Address field.
* Complete the Postcode field. Please enter a valid Postcode.

Personal Details

* Complete the Country field.
* Complete the Name as per Passport field. Please enter only alphabet, "-", "@", "/" and " ' " for Name Member name cannot be greater than 70 characters.
* Complete the Email field. Please enter a valid email address
* Complete the Mobile field. Please check mobile number.

Gender:

* Complete the Gender field.
* Complete the Address field.
* Complete the Postcode field. Please enter a valid Postcode.

Company Details

* Complete the Name as per Corporate field. Please enter only alphabet, "-", "@", "/" and " ' " for Name Corporate name cannot be greater than 70 characters.
* Complete the Registration No field. * Please enter valid Registration No.
* Complete the Category field.
* Complete the Sector field.
* Complete the Email field. Please enter a valid email address.
* Complete the Address field.
* Complete the Postcode field. Please enter a valid Postcode.

Personal Details

Country (as per Passport):

{{ findCountryByCode(formData['4'].policyHolderCountry).name }}

Name (as per {{step4PassportOrNric}}):

{{ formData['4'].policyHolderName }}

{{step4PassportOrNric}} No.:

{{ formData['1'].policyHolderNric }}

Email:

{{ formData['4'].policyHolderEmail }}

Mobile No.:

{{ formData['4'].policyHolderMobileNo }}

Gender:

{{ formData['4'].policyHolderGender == 'M' ? 'Male' : 'Female' }}

Date of Birth:

{{ displayDateFormat }}

Address:

{{ fullAddress }}

Occupation:

{{ formData['2'].policyHolderOccupation }}

Company Details

Corporate Name (as per SSM):

{{ formData['4'].policyHolderCorporateName }}

Business Registration No.:

{{ formData['4'].policyHolderCorporateRegistrationNo }}

Business Category:

{{ findCategoryByCode(formData['4'].policyHolderCorporateCategory) }}

Business Sector:

{{ findSectorByCode(formData['4'].policyHolderCorporateSector) }}

Email:

{{ formData['4'].policyHolderCorporateEmail }}

Mobile No.:

{{ formData['4'].policyHolderMobileNo }}

Corporate Address:

{{ fullCorporateAddress }}

Banker's Details
?

* Complete the Banker's Name as per NRIC field. Please enter only alphabet, "-", "@", "/" and " ' " for Name Banker name cannot be greater than 70 characters.
* Complete the Banker's Branch field.
* Invalid promo code.

MY.SHOP.COM Privileged Card ID

* Complete your Privileged Card ID. * Please enter at least 7 digits for your Privileged Card ID. * Please only enter a maximum of 10 digits for your Privileged Card ID.

Note: Please enter your Privileged Card ID number only.

* Oops, looks like you haven't ticked the box yet. Please do so to proceed.
* Oops, looks like you haven't ticked the box yet. Please do so to proceed.
* Oops, looks like you haven't ticked the box yet. Please do so to proceed.
* Oops, looks like you haven't ticked the box yet. Please do so to proceed.

Payment

Payment Method:

Bank:

Please select a valid bank.

Note: You need to have an active internet banking account with any of the FPX performing banks to use FPX.

Email Address: (For transaction status)

* Complete the Email field. Please enter a valid email address.

Credit / Debit Card:

* Please select a Credit/Debit Card provider.

Select Your Preferred E-Wallet:

* Please select an e-Wallet Provider.

By clicking "Pay Now" button, you agree to FPX's Terms & Conditions.

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By clicking "Pay Now" button, you agree to FPX's Terms & Conditions.

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Sorry, we are unable to proceed with your application online.

Please download and fill out the application form here and submit it to us here.

If you have any enquiries you may contact our Customer Service Hotline at:
{{supportTel}} or Contact us from Monday to Friday 9.00 am to 5.00 pm excluding public holidays. Monday to Friday 9.00 am to 6.00 pm excluding public holidays. Monday to Friday 9.00 am to 6.15 pm excluding public holidays. Monday to Friday 8.30 am to 5.00 pm excluding public holidays. Monday to Friday 8.30 am to 5.30 pm excluding public holidays.

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