MEDICAL ENQUIRY
k
indly fill up the entire form to allow us to serve you better.

name:   *
email:   *
contact no:   *
age   * male   female*

In event of hospitalization, which Type of Hospital / Ward would you like to be admitted?*

Do you need or have coverage against all types of
sickness / injuries?

yes   no*

If the sickness is more serious (critical illnesses like cancer, kidney failure etc..) Would you like to have extra coverage?
yes   no*

If as a result of an accident, and, after treatment you are disabled ( loss of 1 leg) would you like to have extra coverage?
yes   no*

For  critical illnesses like Cancer, kidney failure etc.
*

When you are sick / injured and have made a claim, would you like to remain insured?
yes   no*

When you are under treatment and is unable to work, would you like the plan to pay you a monthly income
yes   no*

    *fields which are compulsary to fill up

  Alternatively, you may also contact us at

tel:      (65) 9109 5374
           (65) 9040 9122
           (65) 8188 8588 
           (65) 6456 6456
fax:     (65) 6458 6458

email:
ask@financialhub-sg.com

Address:
1 Yishun Ave 9 #01-03
Nee Soon East Community Club
Singapore 76889
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