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Individual Personal Accident Insurance - HLB

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:

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

Type of Coverage

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

Period of Coverage

Start Date:

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* 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.

Choose Your Optional Benefit Add-On

?
?
* Please choose a Additional Benefit plan.

View the full Add-On benefits here.
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Personal Details
* Complete the Name as per NRIC field. * Please enter only alphabet, "-", "@", "/" and " ' " for Name. * Name cannot be greater than 70 characters.
* Complete the Email field. * Please enter a valid email address. * Email cannot be greater than 50 characters.
* Complete the Mobile field. * Please check mobile number.
* Complete the Address field. * Address field cannot be greater than 70 characters.
* Address 2 field cannot be greater than 70 characters.
* 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. * Email cannot be greater than 50 characters.
* Complete the Address field. * Address field cannot be greater than 70 characters.
* Address 2 field cannot be greater than 70 characters.
* Complete the Postcode field. * Please enter a valid Postcode.
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Personal Details

* Complete the Country field.
* Complete the Name as per Passport field. * Please enter only alphabet, "-", "@", "/" and " ' " for Name. * Name cannot be greater than 70 characters.
* Complete the Email field. * Please enter a valid email address. * Email cannot be greater than 50 characters.
* Complete the Mobile field. * Please check mobile number.

Gender:

* Complete the Gender field.
* Complete the Address field. * Address field cannot be greater than 70 characters.
* Address 2 field cannot be greater than 70 characters.
* 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. * Email cannot be greater than 50 characters.
* Complete the Address field. * Address field cannot be greater than 70 characters.
* Address 2 field cannot be greater than 70 characters.
* Complete the Postcode field. * Please enter a valid Postcode.
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Personal Details

Country (as per Passport):

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

Name (as per {{step4PassportOrNric}}):

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{{step4PassportOrNric}} No.:

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

Email:

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Mobile No.:

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Gender:

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

Date of Birth:

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Address:

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Occupation:

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

Cancel Save

Company Details

Corporate Name (as per SSM):

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

Business Registration No.:

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

Business Category:

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Business Sector:

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

Email:

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

Mobile No.:

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

Corporate Address:

{{ fullCorporateAddress }}

Cancel Save

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.

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.

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Payment

Payment Method:

Type of Coverage:

* Please choose a Coverage Type.

Bank:

* Please select a valid 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 here and submit it to us here.

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If you have any enquiries, you may contact our Customer Service Hotline at:

{{supportTel}}

enquiry_form

Or contact us through our

Online Enquiry Form

hour

Operating Hours

Monday - Friday

9.00am - 5.00pm (excluding public holidays)

Monday - Friday

9.00am - 6.00pm (excluding public holidays)

Monday - Friday

9.00am - 6.15pm (excluding public holidays)

Monday - Friday

8.30am - 5.00pm (excluding public holidays)

Monday - Friday

8.30am - 5.30pm (excluding public holidays)