China Taiping i-Secure Non-med

China Taiping's i-Secure
Whole of Life Critical Illness cover!

 

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China Taiping i-Secure
Sum Assured:
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Guaranteed Benefit Factor
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Initial Premium Payment by:(*)

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Receive Maturity Payout by:(*)

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Name of Bank and Branch
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Please upload a copy of your bank book or recent bank statement showing your name and account number.
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Confidential information e.g. bank balance can be blocked out.

 
About You
Name as in NRIC(*)
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NRIC/FIN Number
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Gender
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Date of Birth
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Resident Status
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Nationality
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Country of Birth
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Are you currently residing in Singapore?
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If you are currently not residing in Singapore, have you resided outside of Singapore continuously for 5 years or more preceding the date of this application?
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If Yes, please provide documentary proof such as work or student permit issued by relevant authorities in the foreign country where you are residing.
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Have you been residing in Singapore for a total of 183 days or more in the last 12 months preceding the date of this application?
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If No, please provide a copy of passport including pages with immigration stamps or similar travel documents.
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Do you have a pass or permit that has a duration longer than 90 days and you have been residing in Singapore continuously for 90 days or more in the last 12 months preceding the date of this application?
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If No, please provide a copy of passport including pages with immigration stamps or similar travel documents.
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Employment Status(*)

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Name of Employer(*)
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Address of Employer(*)
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Occupation(*)
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Previous occupation if unemployed, retired or a homemaker.

Nature of Work(*)
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Nature of Business(*)
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Annual Income S$(*)
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Last drawn salary if unemployed, retired or a homemaker.

 
Marital Status(*)
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Upload Picture of NRIC - Front(*)
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Upload Picture of NRIC - Back(*)
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Are you a smoker?(*)

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Has any application or reinstatement for a life, critical illness, disability, accident or hospital insurance policy ever been refused, postponed or accepted at special terms by any insurer?
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If Yes, please provide details below stating the Insurer, Type of Policy and Reasons.
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Have you ever made any claims or are you intending to make any claims on any policy with any insurer?
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If Yes, please provide details below stating the Insurer, Nature of Claim, Year of Claim and Reasons.
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Do you engage or expect to engage in any hazardous or potentially hazardous activity, such as automobile or motorcycle racing, power boat racing, scuba diving, parachuting and sky diving, professional sports or fl ying other than as a fare-paying passenger on a scheduled airline route?
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If Yes, please provide details below.
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Does your job nature involve working at heights (over 25 feet), working underground, handling explosives, commercial diving, armed with weapons (exclude police forces), working with or maintaining high voltage power lines and cables?
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If Yes, please provide details below.
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Have you travelled or do you travel or live away from current residence city location in any year? (For over 90 days)
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If Yes, please provide details: Countries, Purpose (business/pleasure), Duration of Stay, Frequency per Year
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Do you anticipate the pattern of frequency of travel will change substantially over the next 12 months? (for travel over 90 days)
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Source of Funds
Source of Funds to Pay Premiums(*)

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How did you accumulate your wealth?(*)

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Contact Details
Email(*)
Please specify your email address.

Handphone No.(*)
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Residential Address
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Postal Code
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Declaration of Health Details
Please state your current height (metres)(*)
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Please state your current weight (kilograms)(*)
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Do you have a regular doctor or has consulted any doctor in the last 24 months? (*)
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Number of doctor(s) consulted
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Doctor 1
Name of doctor(*)
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Address of clinic(*)
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Date of last consultation(*)
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Reason for consultation(*)
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Diagnosis / Results of consultation / Follow-up details(*)
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Type of tests done(*)
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Test date(*)
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Test Result(*)
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Details of treatment / medication(*)
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Doctor 2
Name of doctor(*)
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Address of clinic(*)
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Date of last consultation(*)
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Reason for consultation(*)
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Diagnosis / Results of consultation / Follow-up details(*)
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Type of tests done(*)
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Test date(*)
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Test Result(*)
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Details of treatment / medication(*)
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Doctor 3
Name of doctor(*)
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Address of clinic(*)
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Date of last consultation(*)
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Reason for consultation(*)
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Diagnosis / Results of consultation / Follow-up details(*)
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Type of tests done(*)
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Test date(*)
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Test Result(*)
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Details of treatment / medication(*)
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Are you currently experiencing symptoms or are you now receiving or considering receiving medical advice/treatment from a doctor?(*)
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In the past 5 years, have you had any surgical operation or hospital admission or had been advised to undergo or intend to have any medical test or investigations done such as X-ray, ultrasound, imaging scan, biopsy, mammogram, pap smear, prostate check, electrocardiogram (ECG), blood or urine test?(*)
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Please provide details if the answer to any of the questions above is YES.
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• Name of condition and date of diagnosis
• Name and address of each doctor/hospital
• Duration of illness/injury and date of recovery as appropriate
• Nature of tests done, dates, results and reason for tests
• Copy of the above test(s) result(s), if any
• Details of treatment, if any

 
Have you EVER had or been told to have or been treated for
a. Epilepsy, stroke, paralysis, weakness of limb, persistent headache, unconsciousness, nervous breakdown, depression or any other nervous/ mental disorders?(*)
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b. Diabetes, thyroid disorders or any other endocrine disorders?(*)
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c. Ear discharge, nose bleeds (intermittent or continuously longer than 1 week), double vision, impaired sight, hearing impairment, or speech disorder or any other disorders of ear, eye, nose or throat?(*)
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d. Asthma, persistent cough (longer than 4 weeks), coughing with blood, pneumonia, bronchitis, tuberculosis, breathing complaints/discomfort or any other lung diseases?(*)
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e. Raised cholesterol, high blood pressure, heart attack, heart murmur, cardiomyopathy, mitral valve prolapse or other heart valve disorders, breathlessness, irregular or fast heart rate, chest discomfort or pain, disease of or any other disorders of the heart or blood vessels?(*)
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f. Gastritis, stomach or duodenal ulcer, blood in stools, fi stula, piles or any other stomach or bowel disorders?(*)
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g. Jaundice, Hepatitis B or Hepatitis C carrier or any form of hepatitis, liver disorder or gall bladder disorder?(*)
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h. Blood, protein or sugar in urine, kidney stones, infection or any other disorders of the kidney, bladder or genital organs?(*)
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i. Slipped discs, gout, arthritis, osteoporosis, chronic back pain or deformity or disorders of the muscles, spine, limbs or joints or severe injury?(*)
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j. Cancers, tumours, cysts, polyps, fi broids, enlarged lymph nodes, unusual skin lesion, or growths of any kind?(*)
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k. Anaemia, thalassaemia, any other disorders of the blood, advised to abstain from donating blood or received blood transfusion or blood products on account of haemophilia or any other reason?(*)
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l. Systemic lupus erythematosus, rheumatic fever, rheumatic arthritis, Kawasaki’s disease, vasculitis, scleroderma, or any other disorders of the immune system?(*)
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m. Any other illness, disorder, operation, physical disability or accident not mentioned above?(*)
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Please provide details if the answer to any of the questions above is YES.
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• Name of condition and date of diagnosis
• Name and address of each doctor/hospital
• Duration of illness/injury and date of recovery as appropriate
• Nature of tests done, dates, results and reason for tests
• Copy of the above test(s) result(s), if any
• Details of treatment, if any

 
Have you or your spouse been told to have, received any medical advice, counselling or treatment in connection with Sexually Transmitted Diseases (STDs), AIDS, AIDS related Complex or any other AIDS related conditions?(*)
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Please provide details:
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Have any of your biological parents or siblings, before age of 60, died or suffered from Cancer, Diabetes, Stroke, Polycystic Kidney disease, Heart disease, Parkinson’s disease, Dementia/Alzheimer’s disease, or any other hereditary diseases?(*)
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Condition(*)
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Relationship(*)
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Age at onset(*)
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Age at death (if deceased).
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Do you drink beer, wine or other alcohol?(*)
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If Yes, please indicate average daily consumption and type of alcohol.
1 standard alcoholic drink equates to 330ml beer, 125ml glass of wine or 30ml of glass of spirits. (*)
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Have you ever smoked or used tobacco/nicotine products including cigarettes, cigars, cigarillos, pipe, chewing tobacco, nicotine patches, gum or shisha? (*)
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If Yes, please state type, average consumption per day.(*)
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If you are a former smoker, when was the last time you smoked?(*)
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Have you ever taken addictive drugs or substances, or been treated or counselled for alcoholism or the use of addictive drug or substances?(*)
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Please provide details:
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Additional Questions for Females Only
(Skipped for males)
a. Have you suffered from or are aware of any breast lumps or any other disorders of your breasts?(*)
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b. Have you suffered from irregular or painful or unusually heavy menstruation, fibroids, cysts or any other disorders of the female organs?(*)
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c. Have you ever had any abnormal pap smear test or been told by any doctor to have a repeat pap smear within the next 6 months?(*)
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d. Have you been advised to have a mammogram, biopsy, operation of the breasts, ultrasound pelvis, colposcopy or any other gynecological investigations?(*)
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Please state type, reason, date and results (*)
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Please state reason(*)
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Diagnosis date(*)
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Results(*)
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Copy to be submitted if available
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e. For females who have conceived, were there any complications during pregnancy such as gestational diabetes, high blood pressure, ectopic pregnancy, eclampsia, protein in urine, etc.? (*)
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Diagnosis date(*)
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please provide diagnosis details(*)
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f. Are you now pregnant?(*)
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How many weeks?(*)
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Is the life insured below 18 years old?(*)
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a. Does either of the child’s parents have equivalent cover as proposed in this application?(*)
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Please provide reason below(*)

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Please provide details:(*)
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b. Are all siblings (if any) equally insured (including pending application with other insurers)? (*)
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Please provide reason below(*)

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Please provide details(*)
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Is the juvenile below 2 years old?(*)
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a. Is the child a premature baby (i.e. less than 37 weeks of gestation)?(*)
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Gestation period (weeks)(*)
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APGAR score at 1 minute(*)
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APGAR score at 5 minutes(*)
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Length at birth (cm)(*)
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Weight at birth (kg)(*)
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Date discharge from hospital(*)
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b. Were there significant events during pregnancy/delivery such as but not limited to birth diffi culty, infection, congenital deformities, respiratory distress syndrome, prolonged jaundice that lasted more than 2 weeks, G6PD deficiency, respiratory disorder, intrauterine growth retardation?(*)
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c. Any special care needed after birth?(*)
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d. Has the child been advised, or been told to go for further follow up, or further evaluation, or monitoring after each routine assessment?(*)
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e. Has the child had any physical, congenital or developmental defects, or shown any sign of physical or mental disorder, any growth or developmental delay or any learning diffi culties?(*)
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Declarations
I confirm that I am solely a tax resident of Singapore and do not have a foreign tax residency. My Singapore TIN is my NRIC or FIN. I am not currently residing outside Singapore and have not resided outside Singapore for 5 or more years. For PRs: I have been residing in Singapore for 183 days or more in the last 12 months preceding the date of this application.
I am not a Politically Exposed Person (PEP).
I do not have any existing insurance policies. I am not currently applying for any other Life Insurance policies and I do not intend to replace any of my existing policies with this policy.
I would not like my dependant(s) to be taken into consideration for the needs analysis and recommendation(s).
I wish to receive product advice only and do not need my other insurance plans to be considered for needs analysis.
I am not an undischarged bankrupt
I am the payor, applicant and the insured of this policy.
Declarations(*)
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Where did you hear about us?
Where did you hear about us?

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Enter your friend's Referral Code or email address
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Key features for
China Taiping's i-Secure Plan

 

 

Guaranteed Returns

 

Whole of Life Critical Illness Cover

Capital Guaranteed


Early to Advanced Stage Critical Illness

3 year term


Surrender Value available

InsureDIY Capital Plus Promotions


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InsureDIY Online Application


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Application
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Why Apply i-Secure?

 

Life expectancy is increasing. Critical Illness Covers that end at age 75 are no longer sufficient. i-Secure provides:

 

green tick circle Lifelong critical illness cover

 

green tick circle Early stage to late stage critical illnesses cover

 

green tick circle Pay for a limited period then enjoy your cover without further premium payments thereafter

 

green tick circle A surrender value should you want to terminate your policy.

 

 

InsureDIY is the only adviser platform offering China Taiping Insurance plans with an online process. We are an online financial adviser licensed by MAS and we are an approved adviser by China Taiping.  

 

 

 

InsureDIY is an online financial adviser licensed by Monetary Authority of Singapore and we are an approved adviser by our panel of insurance companies. This advertisement has not been reviewed by the Monetary Authority of Singapore.