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Attn : Serene Quek Email : serene.quek@ace-ina.com
ACE Insurance Limited
Copy : Ms Nancy Sin Email : nancy@macs-uib.com
MACS-UIB Insurance Brokers Pte Ltd
Date : _____________________
BUSINESS TRAVEL INSURANCE (AD-HOC TRAVELLING)
PROPOSAL / INSURED PERSON’S PARTICULARS
Company: SINGAPORE MANAGEMENT UNIVERSITY Policy No: 52 3 21 6 12
Name Insured Person Date of Birth NRIC or Period of Insurance No. of
No Destination
(dd/mm/yy) Passport No (dd/mm/yy) Days
1. 1
Aditya Harneja 15/01/88 G3514960R
From
To
2. 1
Ang Wei Diana 23/11/86 S8633889J
From
To
3.
CHIA Kevin 08/07/82 S8219774E
From
To
4.
Chiam Hui Ting 12/05/86 S8604046H
From
To
5.
CHO Lai Peng 01/06/83 S8518105B
From
To
6.
Corina Low Hui Ping 09/01/84 S8400214C
From
To
7.
Desmond Lim Huang Hui 14/07/85 S8520623J
From
To
8.
Gay Wen Xin Mervyl 07/02/83 S8303474B
From
To
9.
Goh Wee Meng 20/04/72 S7213242D
From
To
Hibatun Nasir Bin
From
10. Munawar 14/01/85 S8500546D
To
11.
Ho Kwong Kin 04/02/84 S8402897E
From
To
12.
Hui Kah Seng David 19/04/82 S8210704E
From
To
13. 23/02/85 S8502861H
Karen Koh Mei Ying From
52321612-declaration
To
14.
Kho Ting Ting Joanne 07/05/85 S8512603B
From
To
15.
Koh Ee Mei Corinne 05/05/85 S8512977E
From
To
16.
Lee JieGang 02/09/84 S8425003A
From
To
17.
Lee Mei Xian 30/06/86 S8617451J
From
To
18.
Lee Shun Man 28/07/87 751489381
From
To
19.
Lee Su Hui Karen 29/07/84 S8420921Z
From
To
20.
Mohit Garg 23/07/88 G3516674U
From
To
21.
Nguyen Hoang Minh 19/03/87 G3516302X
From
To
22.
Sumit Sharan 10/08/87 G3515330L
From
To
23.
Tan Kwee Lin Crystaline 16/02/85 S8506048A
From
To
24.
Tan Shi Yun Esther 04/05/85 S8513885E
From
To
25.
TENG Yee Wee, Alfred 29/07/76 S7623364J
From
To
26.
Utsav Somani 12/10/87 G3515027M
From
To
27.
Vijay Vadlamani 30/10/87 G3516011L
From
To
28.
Vivek Yogeendra Desai 28/10/88 G3524275P
From
To
29.
Yeo Weijing, Adrian 04/02/83 S8305300C
From
To
From
30. Yu Shuli 22/09/85 S8527037J
To
31.
Tan Huiyan Michelle 30/08/83 S8325640J
From
To
32.
Zhuang Zhirong Robin 16/12/82 S8242400H
From
To
52321612-declaration
33.
Jason C.Woodard 02/04/76 210558170
From
To
Territorial Limits : Regional - ASEAN countries (Brunei, Cambodia, Malaysia, Philippines, Thailand, Laos,
Myanmar, Indonesia and Vietnam) Australia, New Zealand, India, Sri Lanka,
North East Asia, South East Asia and China
International - Worldwide including USA and Canada
Premium is based on per person per trip. All premiums are in Singapore dollars.
Premium Per Insured Person Per Trip
Duration per Trip
Regional International
01 to 04 consecutive days S$15.00 S$20.00
05 to 07 consecutive days S$22.00 S$26.50
08 to 18 consecutive days S$33.50 S$42.00
19 to 21 consecutive days S$36.00 S$46.00
22 to 31 consecutive days S$45.00 S$55.50
Each additional week or part thereof S$12.00 S$15.00
(up to a maximum of 90 consecutive days per trip)
All other terms and conditions as per ACE’s Business Travel Policy – 5 2 32 1 61 2
52321612-declaration
