Submit your online travel claim
Claimant information

Policy Number

Please enter 8 character policy number starting with ‘T’

Policyholder’s name as per NRIC

Please enter valid Policyholder’s Name

Is the claimant the policyholder?

Yes
No

Is the claimant a Singapore resident?

Yes
No

Claimant’s name as per NRIC

Claimant’s name as per Passport

Please enter valid Claimant’s Name

Claimant NRIC/FIN number

Claimant Passport number

Please enter valid NRIC/FIN Please enter valid Passport number

Email ID

Please enter valid Email

Mobile number

+65
Please enter valid Mobile Number
Upload proof of travel
Trip documents

Below is a list of minimum documentation required to process your claim. Additional information may be required for further assessment.

{{x.description}}

Please attach address proof in .jpg, .png, .jpeg, .pdf format only not more than 10MB

Select document name

Trip start date

Please enter valid Start Date

Trip end date

Please enter valid End Date Trip cannot exceed 90 days or policy expiry date

Have you made a claim against any other party in respect of this event? If yes, please provide:

Yes
No

Name of other party/insurance company

Please enter valid name of other party/insurance company

Policy number/reference number of other party/insurance company

Please enter valid reference number of other party/insurance company

Description of claim made against other party/insurance company

Please enter valid description of other party/insurance company
Select the claim type you wish to submit
Select if you have more to claim
Travel claim type
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{{ x.Description }}

Select the claim type you wish to submit
Travel claim category
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Upload supporting documents
Claim documents

Below is a list of minimum documentation required to process your claim. Additional information may be required for further assessment.

{{x.description}}

Please attach address proof in .jpg, .png, .jpeg, .pdf format only not more than 10MB

Select document name

Review and modify the claim information
Claimant Information

Please review the claimant information

Policy Number

Policyholder's name

Claimant's name

Claimant NRIC/FIN number

Passport number

Email ID

Please enter valid Email

Mobile number

+65
Please enter valid Mobile Number

Trip start date

Trip end date

Claim documents uploaded

{{x.description}}

Edit Upload

{{y.Description}}
{{z.CoverageDetailName}}
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Claim details

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DONE EDIT

Date of Accident

Date of Accident or Onset of Illness

Please enter valid Date

Date of First Consultation

Entered date should be between date of occurrence and 2 days after trip end date. Please enter valid Date

Location of Accident

Location of Accident or Onset of Illness

Please enter valid Location

Nature of Accident

Nature of Accident (Official Cause of Death)

Nature of Accident or Illness (Official Cause of Death)

Nature of Accident or Illness

Please enter valid Nature

Admission Date

Please enter valid Admission Date Admission period must be more than 5 consecutive days.

Admission time (HH:mm)

Please enter valid Admission time Admission period must be more than 5 consecutive days.

Discharge Date

Please enter valid Discharge Date Please enter valid Discharge Date

Discharge time (HH:mm)

Please enter valid Discharge time As per policy wordings, you are eligible to claim for every twenty-four (24) consecutive hours of stay in hospital. Admission period must be more than 5 consecutive days. Future discharge time is not allowed.

Add Medical Detail

Type of doctor

Type of doctor

Please enter valid Type of doctor

Receipt Date

Please enter valid Date

Claim Amount

Please enter valid claim amount. Benefit’s claim limit is S${{ Medical[x.DetailID].MaxAmount | number}}. When treated by a physician, you can only claim up to S${{ Medical[x.DetailID].maximunClaimAmount | number}} (includes previous claims). When treated by a physician, you can only claim up to S${{ Medical[x.DetailID].maximunClaimAmount | number}} (includes previous claims).
 Add

Medical Detail List

Medical Type Receipt Date Claim Amount Remove
{{ medicalDetail.medicalTypeDesc }} {{ filterDateFormatToDMY(medicalDetail.receiptDate) }} S${{ medicalDetail.claimAmount | number}}

Total GP/Specialist Claim Expenses

Total Physician Claim Expenses

Name of Injured Travelling Companion

Please enter valid Name of Injured Travelling Companion

NRIC of Injured Travelling Companion

Please enter valid NRIC of Injured Travelling Companion

Hotel Check-in Date

Please enter valid Hotel Check-in Date

Hotel Check-out Date

Please enter valid Hotel Check-out Date

Nature of Injury or Illness

Please enter valid Nature of Injury or Illness

Date of Accident or Onset of Illness

Please enter valid Date of Accident or Onset of Illness

Add Mobility Aid Expenses

Mobility Aid

Please enter valid Mobility Aid

Date of Purchase

Please enter valid Date of Purchase

Purchase/Rental Amount

Please enter valid Purchase/Rental Amount

Refund Amount

Please enter valid Refund Amount

Net Amount

Please enter valid Net Amount Total item net amount limit S${{ Medical[x.DetailID].MaxAmount | number}}.
 Add

Medical Detail List

Mobility Aid Date of Purchase Purchase/Rental Amount Refund Amount Net Amount Remove
{{ medicalItem.desc}} {{ medicalItem.datePurchase | date:'dd/MM/yyyy' }} S${{ medicalItem.purchaseAmount | number}} S${{ medicalItem.refundAmount | number}} S${{ medicalItem.netAmountClaimed | number}}

Estimated Due Date

Please enter valid Estimated Due Date

Receipt Date

Please enter valid Receipt Date

Total Medical Expenses

Please enter valid Total Medical Expenses

Refund Amount

Please enter valid Refund Amount Please enter valid amount and make sure Refund is less than Total Medical Expenses

Quarantine Start Date

Please enter valid Quarantine Start Date

Quarantine End Date

Please enter valid Quarantine End Date

Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Medical[x.DetailID].MaxAmount | number}}. Please enter valid amount. For claim more than 900,000,000. Please contact Customer Care.

Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Medical[x.DetailID].MaxAmount | number}}. Please enter valid amount. For claim more than 900,000,000. Please contact Customer Care. You are eligible to claim for every (24) consecutive hours of delay. You are eligible to claim for every (24) consecutive hours of delay.

Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Medical[x.DetailID].MaxAmount | number}}. Please enter valid amount. For claim more than 900,000,000. Please contact Customer Care.

Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Medical[x.DetailID].MaxAmount | number}}. You are eligible to claim for at least 1 day of extension. Please enter valid amount. For claim more than 900,000,000. Please contact Customer Care.

Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Medical[x.DetailID].MaxAmount | number}}. Please enter valid amount. For claim more than 900,000,000. Please contact Customer Care.

Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Medical[x.DetailID].MaxAmount | number}}. Please enter valid amount.

Claim documents uploaded

{{y.description}}

Edit Upload

{{z.CoverageDetailName}}
{{ CurrentClaimTypeDetail }}
Claim details

{{x.CoverageDetailName}}

DONE EDIT

Original Flight Number

Please enter valid Original Flight Number

Actual Flight Number

Please enter valid Actual Flight Number

Original Flight Date

Please enter valid Original Flight Date

Original Flight Time (HH:mm)

Please enter valid Original Flight Time Original flight time cannot be later than actual flight time.

Actual Flight Date

Please enter valid Actual Flight Date

Actual Flight Time (HH:mm)

Please enter valid Actual Flight Time Future flight time is not allowed.

Original Flight Origin

Please enter valid Flight Origin Cannot originate from Singapore. Origin & Destination cannot be the same.

Actual Flight Origin

Please enter valid Actual Flight Origin Cannot originate from Singapore.

Origin Country

Flight Origin

Other Flight Origin

Please enter valid Flight Origin

Destination Country

Flight Destination

Other Flight Destination

Please enter valid Flight Destination.

Original Flight Destination

Please enter valid Original Flight Destination. Return to Singapore is not covered. Origin & Destination cannot be the same.

Actual Flight Destination

Please enter valid Actual Flight Destination. Return to Singapore is not covered. Original flight destination & actual flight destination cannot be the same.

Actual Arrival Date

Please enter valid Actual Arrival Date

Actual Arrival Time (HH:mm)

Please enter valid Actual Arrival Time Future actual arrival time is not allowed.

Actual Baggage Arrival Date

Please enter valid Actual Baggage Arrival Date

Actual Baggage Arrival Time (HH:mm)

As per policy wordings, you are eligible to claim for every six (6) consecutive hours of delay. Please enter valid Actual Baggage Arrival Time Future baggage arrival time is not allowed.

Actual Destination

Please enter valid Actual Destination. Return to Singapore is not covered.

Name of airline that you have lodged a claim against

Please enter valid Name of airline you have lodged a claim against

Name of airline you have lodged a claim against

Airline Name

Please enter valid Airline Name

Flight Number

Please enter valid Flight Number

Flight Date

Please enter valid Flight Date

Flight Boarding Time (HH:mm)

Please enter valid Flight Boarding Time (HH:mm) Future flight boarding time is not allowed.

Flight Origin

Please enter valid Flight Origin

Flight Destination

Please enter valid Flight Destination Return to Singapore is not covered.

Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Flight[x.DetailID].MaxAmount | number}}. Please enter valid amount.

Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Flight[x.DetailID].MaxAmount | number}}. Please enter valid amount. You are eligible to claim for every (6) consecutive hours of delay. You are eligible to claim for every (3) consecutive hours of delay. You are eligible to claim for every (6) consecutive hours of delay. You are eligible to claim for every (6) consecutive hours of delay.

Claim documents uploaded

{{y.description}}

Edit Upload

{{z.CoverageDetailName}}
{{ CurrentClaimTypeDetail }}
Claim details

{{x.CoverageDetailName}}

DONE EDIT

Give full particulars of circumstances giving rise to the loss or damage.

Give full particulars of circumstances giving arise to the loss

Please enter valid particulars particulars

Date of Loss or Damage

Date of Loss

Please enter valid Date of Loss or Damage Please enter valid Date of Loss

Time of Loss or Damage (HH:mm)

Time of Loss (HH:mm)

Please enter valid Time of Loss or Damage Please enter valid Time of Loss Future time of Loss or damage is not allowed. Future time of Loss is not allowed.

Place of Loss or Damage

Place of Loss

Please enter valid Place of Loss or Damage Please enter valid Place of Loss

If the loss or damage occurred whilst baggage was in transit or otherwise in the custody or control of others, have any steps been taken to claim against these persons? Please identify them and attach any correspondence and advise outcome of your claim against them.

Please enter valid Description

Date reported to Police

Please enter valid Date reported to Police

Add Loss / Damaged Item Add Loss Item Add Card Details

Description Make & Model

Type of Card

Please enter valid Description Make & Model Please enter valid Type of Card

Card Issuer

Please enter valid Card Issuer

Date reported to Credit Card Company

Please enter valid Date reported to Credit Card Company

Time reported to Credit Card Company

Please enter valid Time reported to Credit Card Company Future time reported to Credit Card Company is not allowed.

Date Purchased

Please enter valid Date Purchased

Purchase Cost

Please enter valid Purchase Cost

Value of Lost Item

Please enter valid Value Before Loss or Damage, Allowing for Wear and Tear Please enter valid Value of Lost Item Total lost item value limit S${{ Loss[x.DetailID].MaxAmount | number}}.

Credit Card Charges/Expenses

Total credit card charges/expenses limit S${{ Loss[x.DetailID].MaxAmount | number}}.

Purchase receipt provided?

Yes
No

Loss / Damaged Item List

 Add
Item Description Card Issuer Date Purchased Purchase Cost Value Before Loss Purchase Receipt Provided? Date and time reported to Credit Card Company Net Amount Claimed Credit Card Charges/Expenses Remove
{{ lossItem.itemDesc}} {{ lossItem.modelDesc }} {{ lossItem.issuer}} {{ lossItem.datePurchase | date:'dd/MM/yyyy'}} S${{ lossItem.replacementCost | number}} S${{ lossItem.valueBeforeLoss | number}} {{{true: 'Yes', false: 'No'}[lossItem.IsReceiptProvided]}} {{ lossItem.dateReported | date:'dd/MM/yyyy'}} {{ lossItem.timeReported }} S${{ lossItem.netAmountClaimed | number}}

{{x.CoverageDetailName}}

DONE EDIT

Reason for Claim

Reason for cancellation of Holiday

Reason for curtailment of Holiday

Reason for postponement of Holiday

Please enter valid Reason

Date of Event Leading to the cancellation

Date of Event

Date of Event Leading to the curtailment

Date of Event Leading to the postponement

Date of Event leading the replacement of traveler

Please enter valid Date of Event

Name of Sick/Deceased/Injured Person

Please enter valid Name of sick/deceased/injured

Name of Sick/Deceased/Injured Person

Please enter valid Name of sick/deceased/injured

Administrative Charges/Fees

Please enter valid Administrative Charges/Fees

If caused by illness, has the insured person suffered from this before? If so please give details

Please enter valid Description

Travel Expenses Paid in Advance

Please enter valid Travel Expenses Paid

Refund Amount

Please enter valid amount and make sure Refund is less than Expenses

Please state why there was no refund

Please enter valid Reason

{{x.CoverageDetailName}}

DONE EDIT

Name of the Other Party

Please enter valid Name of the Other Party

Address of the Other Party

Please enter valid Address of the Other Party

Date of Occurrence

Please enter valid Date of Occurrence

(Optional) Were you the cause of the damage and/or injury to the party? If so, please give circumstances of the incident.

Please enter valid Description

(Optional) Did you pay the other party for his damage and/or injury?

Yes
No

{{x.CoverageDetailName}}

DONE EDIT

Date of Accident

Please enter valid Date of Accident

Location of Accident

Please enter valid Location of Accident

Circumstance of Accident

Please enter valid Circumstance of Accident

{{x.CoverageDetailName}}

DONE EDIT

Date Achieved

Please enter valid Date Achieved

Time Achieved (HH:mm)

Please enter valid Time Achieved Future time of achieved is not allowed.

Name of Organized Event

Please enter valid Name of Organized Event

Club Name

Please enter valid Club Name

Club Address

Please enter valid Club Address

Receipt Date

Please enter valid Receipt Date

{{x.CoverageDetailName}}

DONE EDIT

Type of Claim

Give full particular of circumstances giving rise to the loss or damage

Please enter valid description

Date of Loss/Damage

Please enter valid Date of Loss/Damage

Time of Loss/Damage (HH:mm)

Please enter valid Time of Loss/Damage Future time of Loss/Damage is not allowed.

Add Loss/Damaged Item

Brand

Please enter valid Brand

Model

Please enter valid Model

Date of Purchase

Please enter valid Date of Purchase

Purchase Price

Please enter valid Purchase Price

Net Amount Claimed

Total Net Amount Claimed limit S${{ Loss[x.DetailID].MaxAmount | number}}. Please enter valid Net Amount Claimed

Loss / Damaged Item List

 Add
Brand Model Date of Purchase Purchase Price Net Amount Claimed Remove
{{ lossItem.brandDesc}} {{ lossItem.modelDesc}} {{ lossItem.datePurchase | date:'dd/MM/yyyy'}} S${{ lossItem.valueBeforeLoss | number}} S${{ lossItem.netAmountClaimed | number}}

{{x.CoverageDetailName}}

DONE EDIT

Give full particular of circumstances giving rise to the claim

Please enter valid description

Date of Injury/Illness

Please enter valid Date of Injury/Illness

Add Unused Green Fee

Club Name

Please enter valid Club Name

Club Address

Please enter valid Club Address

Green Fee paid in advance

Please enter valid Green Fee paid in advance

Refund Amount

Please enter valid amount and make sure Refund is less than Expenses

Net Amount Claimed

Total Net Amount Claimed limit S${{ Loss[x.DetailID].MaxAmount | number}}. Please enter valid Net Amount Claimed

Loss / Damaged Item List

 Add
Club Name Club Address Green Fee paid in advance Refund Amount Net Amount Claimed Remove
{{ lossItem.clubName}} {{ lossItem.clubAddress}} S${{ lossItem.depositAmount | number}} S${{ lossItem.refundAmount | number}} S${{ lossItem.netAmountClaimed | number}}

{{x.CoverageDetailName}}

DONE EDIT

Reason for trip cancellation

Please enter valid Reason for trip cancellation

Date of Event leading to cancellation

Please enter valid Date of Event leading to cancellation

Name of Sick/Deceased/Injured Person

Please enter valid Name of Sick/Deceased/Injured Person

Relationship to Insured

If caused by illness, has the insured person suffered from this before? If so, please give details

Please enter valid Description

Add Lost Frequent Flyer Points

Frequent Flyer Points being claimed

Flight Origin

Please enter valid Flight Origin

Flight Destination

Please enter valid Flight Destination

Name of Hotel

Please enter valid Name of Hotel

Type of room booked

Please enter valid Type of room booked

Loss / Damaged Item List

 Add
Frequent Flyer Points being claimed Flight Origin Flight Destination Name of Hotel Type of room booked Remove
{{ lossItem.modelDesc }} {{ lossItem.flightOrigin }} {{ lossItem.flightDestination }} {{ lossItem.hotelName }} {{ lossItem.roomType }}

Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Loss[x.DetailID].MaxAmount | number}}. Please enter valid amount.

Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Loss[x.DetailID].MaxAmount | number}}. Please enter valid amount.

Loss of Personal Money Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Loss[x.DetailID].Subcoverages[0].MaxAmount | number}}. Please enter valid amount.

Loss of Travel Documents Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Loss[x.DetailID].Subcoverages[1].MaxAmount | number}}. Please enter valid amount.

Total Claim Amount (SGD)

Claim amount is greater than the maximum benefit allocated. You can only claim up to S${{ Loss[x.DetailID].MaxAmount | number}}. Please enter valid loss of personal money or travel document claim amount.

Claim documents uploaded

{{y.description}}

Edit Upload

Declaration, Authorization & Customer's Data Privacy Consent

[Declaration] I/We declare that the information given in this form is true and correct to the best of my knowledge and belief. I/We understand that all information and supporting documents may be subject to review by Etiqa and Etiqa shall reserves all rights to recover any and all amounts if for any reason any claim is found to be fraudulent. Etiqa shall also reserve the right to pursue any actions at law or in equity that it deems appropriate in dealing with such fraudulent activity.

[Authorization] I/We hereby consent to and authorize the medical practitioner involved in the claimant’s care to discuss and disclose treatment details and discharge arrangements with and to Etiqa Insurance Pte Ltd. I/We agree that a copy of this consent shall have the validity of the original.

[Customer’s Data Privacy Consent] I/We further declared that the information written in this claim form or held by Etiqa Insurance Pte Ltd whether contained in my/our insurance application or otherwise obtained may be used and disclosed to your authorised staff, associated individuals and/or companies or any independent third parties (within or outsideSingapore) who will provide claims administrative, advice and/or information or claims services in relation to my/our claim. I/We understand my/our data that may also be used for audit, business analysis and reinsurance purposes.

I/We agree to abide by the terms & conditions.
$ {{claimTravel.TotalClaimAmount | number:2}}
Total Claim Amount