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

 

Please complete all required fields!

China Taiping i-Secure

The Life Insured will be(*)

My Child

Myself

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Basic Sum Assured

$50,000$60,000$70,000$80,000$90,000$100,000$110,000$120,000$130,000$140,000$150,000$160,000$170,000$180,000$190,000$200,000$225,000$250,000$275,000$300,000$325,000$350,000$375,000$400,000Invalid Input

Please note that the sum of the total Early CI and Advanced CI sum assured cannot exceed the Basic Sum Assured selected.

Early CI Sum Assured(*)

$25,000$30,000$35,000$40,000$45,000$50,000$55,000$60,000$65,000$70,000$75,000$80,000$85,000$90,000$95,000$100,000$125,000$150,000$175,000$200,000$225,000$250,000$275,000$300,000Invalid Input

Advanced CI Sum Assured(*)

$25,000$30,000$35,000$40,000$45,000$50,000$55,000$60,000$65,000$70,000$75,000$80,000$85,000$90,000$95,000$100,000$125,000$150,000$175,000$200,000$225,000$250,000$275,000$300,000Invalid Input

Guaranteed Benefit Factor

2x3x4xInvalid Input

Initial Premium Payment by:(*)

Interbank Transfer

Cheque

Cashier's Order

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About Your Child

Name of Child(*)

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NRIC, FIN or Birth Cert No. of Child

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Gender of Child

MaleFemaleInvalid Input

Date of Birth of Child

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Resident Status of Child

SingaporeanSingaporean PRWork PassDependant/Long Term/Student PassInvalid Input

Nationality of Child

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Country of Birth of Child

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About You

Name as in NRIC(*)

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NRIC/FIN Number

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Gender

MaleFemaleInvalid Input

Date of Birth

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Resident Status

SingaporeanSingaporean PRWork PassDependant/Long Term/Student PassInvalid Input

Nationality

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Country of Birth

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Are you / life insured currently residing in Singapore?

YesNoInvalid Input

If you / life insured are currently not residing in Singapore, have you / life insured resided outside of Singapore continuously for 5 years or more preceding the date of this application?

YesNoInvalid Input

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 / life insured been residing in Singapore for a total of 183 days or more in the last 12 months preceding the date of this application?

YesNoInvalid Input

If No, please provide a copy of passport including pages with immigration stamps or similar travel documents.

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Do you / life insured 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?

YesNoInvalid Input

If No, please provide a copy of passport including pages with immigration stamps or similar travel documents.

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Employment Status(*)

Full time

Part time

Self-employed

Not employed/Retiree/Homemaker

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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.

 

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Marital Status(*)

SingleMarriedWidowedDivorcedInvalid Input

Are you a smoker?(*)

Yes

No

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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 for you / life insured?

YesNoInvalid Input

If Yes, please provide details below stating the Insurer, Type of Policy and Reasons.

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Have you / life insured ever made any claims or are you intending to make any claims on any policy with any insurer?

YesNoInvalid Input

If Yes, please provide details below stating the Insurer, Nature of Claim, Year of Claim and Reasons.

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Do you / life insured 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?

YesNoInvalid Input

If Yes, please provide details below.

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Does your / life insured's 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?

YesNoInvalid Input

If Yes, please provide details below.

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Have you / life insured travelled or do you / life insured travel or live away from current residence city location in any year? (For over 90 days)

YesNoInvalid Input

If Yes, please provide details: Countries, Purpose (business/pleasure), Duration of Stay, Frequency per Year

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Do you / life insured anticipate the pattern of frequency of travel will change substantially over the next 12 months? (for travel over 90 days)

YesNoInvalid Input

 

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Source of Funds

Source of Funds to Pay Premiums(*)

Employment

Savings

Investment

Inheritance

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How did you accumulate your wealth?(*)

Employment

Investment

Inheritance

Sale of Asset

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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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Please state your child's current height (metres)(*)

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Please state your child's current weight (kilograms)(*)

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Do you / life insured have a regular doctor or has consulted any doctor in the last 24 months? (*)

YesNoInvalid Input

Number of doctor(s) consulted

12More than 2Invalid Input

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 / life insured currently experiencing symptoms or are you now receiving or considering receiving medical advice/treatment from a doctor?(*)

YesNoInvalid Input

In the past 5 years, have you / life insured 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?(*)

YesNoInvalid Input

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

 

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Have you / life insured 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?(*)

YesNoInvalid Input

b. Diabetes, thyroid disorders or any other endocrine disorders?(*)

YesNoInvalid Input

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?(*)

YesNoInvalid Input

d. Asthma, persistent cough (longer than 4 weeks), coughing with blood, pneumonia, bronchitis, tuberculosis, breathing complaints/discomfort or any other lung diseases?(*)

YesNoInvalid Input

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?(*)

YesNoInvalid Input

f. Gastritis, stomach or duodenal ulcer, blood in stools, fi stula, piles or any other stomach or bowel disorders?(*)

YesNoInvalid Input

g. Jaundice, Hepatitis B or Hepatitis C carrier or any form of hepatitis, liver disorder or gall bladder disorder?(*)

YesNoInvalid Input

h. Blood, protein or sugar in urine, kidney stones, infection or any other disorders of the kidney, bladder or genital organs?(*)

YesNoInvalid Input

i. Slipped discs, gout, arthritis, osteoporosis, chronic back pain or deformity or disorders of the muscles, spine, limbs or joints or severe injury?(*)

YesNoInvalid Input

j. Cancers, tumours, cysts, polyps, fi broids, enlarged lymph nodes, unusual skin lesion, or growths of any kind?(*)

YesNoInvalid Input

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?(*)

YesNoInvalid Input

l. Systemic lupus erythematosus, rheumatic fever, rheumatic arthritis, Kawasaki’s disease, vasculitis, scleroderma, or any other disorders of the immune system?(*)

YesNoInvalid Input

m. Any other illness, disorder, operation, physical disability or accident not mentioned above?(*)

YesNoInvalid Input

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

 

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Have you / life insured 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?(*)

YesNoInvalid Input

Please provide details:

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Have any of your / life insured's 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?(*)

YesNoInvalid Input

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 / life insured drink beer, wine or other alcohol?(*)

YesNoInvalid Input

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 / life insured ever smoked or used tobacco/nicotine products including cigarettes, cigars, cigarillos, pipe, chewing tobacco, nicotine patches, gum or shisha? (*)

YesNoInvalid Input

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 / life insured ever taken addictive drugs or substances, or been treated or counselled for alcoholism or the use of addictive drug or substances?(*)

YesNoInvalid Input

Please provide details:

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Additional Questions for Females Only

(Skipped for males)

a. Have you / life insured suffered from or are aware of any breast lumps or any other disorders of your breasts?(*)

YesNoInvalid Input

b. Have you / life insured suffered from irregular or painful or unusually heavy menstruation, fibroids, cysts or any other disorders of the female organs?(*)

YesNoInvalid Input

c. Have you / life insured ever had any abnormal pap smear test or been told by any doctor to have a repeat pap smear within the next 6 months?(*)

YesNoInvalid Input

d. Have you / life insured been advised to have a mammogram, biopsy, operation of the breasts, ultrasound pelvis, colposcopy or any other gynecological investigations?(*)

YesNoInvalid Input

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.? (*)

YesNoInvalid Input

Diagnosis date(*)

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please provide diagnosis details(*)

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f. Are you / life insured now pregnant?(*)

YesNoInvalid Input

How many weeks?(*)

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Is the life insured below 18 years old?(*)

YesNoInvalid Input

a. Does either of the child’s parents have equivalent cover as proposed in this application?(*)

YesNoInvalid Input

Please provide reason below(*)

Ineligible due to medical reasons

Pending application with other insurers

Others

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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)? (*)

YesNoInvalid Input

Please provide reason below(*)

Ineligible due to medical reasons

Propose Insured is the only child

Others

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Please provide details(*)

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Is the juvenile below 2 years old?(*)

YesNoInvalid Input

a. Is the child a premature baby (i.e. less than 37 weeks of gestation)?(*)

YesNoInvalid Input

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?(*)

YesNoInvalid Input

c. Any special care needed after birth?(*)

YesNoInvalid Input

d. Has the child been advised, or been told to go for further follow up, or further evaluation, or monitoring after each routine assessment?(*)

YesNoInvalid Input

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?(*)

YesNoInvalid Input

 

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Existing Insurance

Do you / life insured have any existing policy(ies) or applications pending with any insurance company?(*)

YesNoInvalid Input

If Yes, please provide details of your total insurance coverage (including concurrent applications and applications pending approval from other company(ies)) and indicate the currency.(*)

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Please include details on:
1. Name of the Company
2. Sum Assured for Life / TPD / Critical Illness / Others
3. Annual Premium
4. Year Issued

 

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Document Upload

Upload Picture of Your NRIC - Front (First ID)(*)

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Upload Picture of Your NRIC - Back (First ID)(*)

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Upload Driver's Licence or Passport (Second ID)(*)

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Upload Picture of Your Child's ID Documents (Front)(*)

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Upload Picture of Your Child ID Documents (Back)(*)

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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 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

Declarations(*)

I Agree to all declarations aboveInvalid Input

 

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Where did you hear about us?

Where did you hear about us?

InsureDIY Email

Google Ads

Facebook Ads

Referral

Articles/online search

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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

 

Whole of Life Critical Illness Cover

Early to Advanced Stage Critical Illness

Surrender Value available

Get InsureDIY
Promotions

Online
Application
through
InsureDIY

Why Apply i-Secure?

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

 Lifelong critical illness cover

 Early stage to late stage critical illnesses cover

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

 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.