Particulars of proposer
If you are purchasing HospitalWise for your child, please ensure that you (the proposer) and/or your spouse are purchasing this plan in the same application.
Particular(s) of insured person(s)
Eligible Entry Age:
- Adult(s) aged between 18 and 59 (both ages inclusive)
- Child(ren) aged between 1 and 17, or up to age 25 (all ages inclusive) if pursuing full-time education in a recognized tertiary education institution
Please select your preferred plan type and indicate the premium applicable for each Insured Person. The same plan type will apply to all Insured Person(s) in the proposal.
The premium is payable by Credit Card (Visa/MasterCard) only. A representative from Great Eastern will contact you to assist in completing the premium payment once the form is submitted.
1. Does the person(s) to be insured suffer or have suffered from any physical impairment or deformity or prolonged and/or recurring illness of any kind?
2. Have the person(s) to be insured undergone any surgical operation or been confined or treated in hospital/medical institution within the last 5 years, or is any treatment currently being performed or any operation/hospital confinement scheduled?
If your answer is “yes” to Question 1 and/or 2, please provide details of date/duration/place of hospitalisation, medical conditions, attending physician.
3. Has the application by the person(s) to be insured ever been declined or accepted at other than normal terms by any Insurance Company(ies) including Great Eastern General Insurance Limited?
If your answer is “yes” to Question 3, please provide details.
- I declare that I am aware that I can seek advice from a qualified adviser before I submit this proposal form. Should I choose not to, I take sole responsibility to ensure that this product is appropriate to my financial needs and insurance objectives.
- I declare that the information given in this application is true and that no material fact(s), that is, fact(s) likely to influence the assessment and acceptance of this application have been withheld and to the best of my knowledge and belief the information given herein is true and complete.
- I understand and agree that no insurance shall take effect until this application has been fully accepted, full payment is received and a policy is issued by Great Eastern General Insurance Limited (“GEG”).
- I understand and agree that the declarations and disclosures herein shall form the basis of the policy, and subject to the policy terms, conditions and exclusions.
- I hereby declare that I am aware that the benefits of this policy will not be payable if the losses in the policy occur as a result of pre-existing medical condition or disease declared/undeclared.
- I hereby declare that I am aware that the benefits of the policy will only be payable upon hospitalisation as a result of illness or an accident.
- I declare and agree that the policy shall not cover any bodily injury which arises in the course of the Insured Person's occupation if it falls within the following categories or involves the following activities:
- Police force personnel, fire service personnel, civil defence personnel, CISCO (the Commercial and Industrial Security Corporation) personnel or security officers or security guards or military personnel of any country or international authority, including National Service under Section 10 of the Enlistment Act Cap 93 of the Republic of Singapore, other than for reservist training under Section 14 of the Enlistment Act, Chapter 93 of Singapore.
- A chauffeur, despatch rider or a bus, taxi, delivery van or heavy vehicle driver, whether Part-time or Full-time.
- Professional divers, ship crews, workers on board vessels, oil and gas rig workers, offshore workers, stevedores, shipbreakers.
- Pilots, aircrew or any occupation involving aviation activities or air travel.
- construction workers, unskilled workers or any occupations involving height and/or works underground and/or travel beyond normal speed on land and/or handling of hazardous chemical/electricity, woodworking related occupations, welders or any occupations involving heat.
- I declare that no such insurance has been terminated in the last 12 months due to breach of any premium payment condition.
- I agree that the policy is issued as a Singapore policy expressed in Singapore dollars and all payments under the policy, whether to or by GEG will be payable in Singapore dollars. I also agree that the policy will be entered in the register of Singapore policies.
- I understand and agree that an electronic record of this proposal form shall have the same effect as that of an original.
Policy Application, Service and Administration
Where the proposer(s) is/are an individual or individuals, by providing the information set out above, the proposer(s) agree and consent to Great Eastern and its related corporations (collectively, the "Companies"), as well as their respective representatives, agents, the Companies' authorised service providers and relevant third parties (the Companies and all the other foregoing parties, collectively, “Great Eastern Persons”), collecting, using and/or disclosing the proposer(s)' personal data, for purposes reasonably required by the Companies to evaluate the proposer(s)' proposal and to provide the products or services which the proposer(s) is/are applying for (including any policy renewals and policy upgrades, substitutions or replacements) and such other purposes as described in Great Eastern's Privacy Statement (collectively, the “Purposes”) which is accessible from Great Eastern Singapore's website, which the proposer(s) confirm the proposer(s) has/have read and understood.
Where the proposer is not an individual, the proposer hereby confirms and represents to Great Eastern and its related corporations (collectively, the "Companies"), as well as their respective representatives, agents, the Companies' authorised service providers and relevant third parties (the Companies and all the other foregoing parties, collectively, “Great Eastern Persons”), that the insured individuals of the Policy the proposer is applying for (“Insured Individuals”) have agreed and consented to the disclosure of their personal data to the Great Eastern Persons, for purposes reasonably required by the Great Eastern Persons to evaluate the proposal and to provide the products or services which the proposer is applying for, and such other purposes as described in Great Eastern's Privacy Statement (collectively, the “Purposes”) which is accessible from Great Eastern Singapore's website, and which the proposer confirms it has read and understood. In respect of the Insured Individuals who are subsequently enrolled into the Policy, the proposer further undertakes that it shall ensure and procure that each Insured Individual has provided such agreement and consent in relation to his/her personal data for the Purposes.
OCBC Marketing consent
Before submitting your application, please read and understand the following:
- HospitalWise is offered and provided by GEG, and not OCBC.
- I authorise the transfer of the above information provided by me from OCBC to GEG for my application.
- I have reviewed and confirm that the information I have provided in this application is true, accurate and complete.
We have received your submission.
A representative from Great Eastern will contact you by email or phone call within the next working day to assist you in completing your application for the HospitalWise policy.
Date and time: