MSIG Insurance Application

You must check the information you have provided is complete and accurate. You should also disclose all relevant information which may influence the Company in the acceptance of this insurance, decide the terms and the premium you will pay

*** Insert your Name or Passport No. to the payment reference when making online banking transfer.

Name as in Passport *

Passport No. *

Gender *

Birth Date *

Nationality *

Passport Image

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Size limit: 10MB per file

Contact Email *

Please fill in Email Address You actively using to get future updates.

Contact Phone *

Insurance coverage date starts from *

Select Plans *

Plan E200 - Annual Premium RM 470

Plan E250 - Annual Premium RM 540

Plan E300 - Annual Premium RM 620

*** We only support Interbank Giro (online bank transfer) as a payment method. Insert your Name or Passport No. to the payment reference when making online banking transfer to the following bank account.

Company: MSIG Insurance (Malaysia) Berhad

Bank Name: Standard Chartered Bank

Bank Account No: 7700702178

Bank Account Type: Current Account

Payment Receipt Reference Number *

You are able to obtain the receipt reference number from receipt after you have made online bank transfer.

0/20

Payment Receipt *

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Size limit: 50MB per file

Signature

Upon Signature, you are agreed to the Privacy Notice, and consent to share the data to specific third party.

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Remark: Once you have completed the payment process and submitted the form, you will receive the cover note within 1 - 2 working days via email. If you do not receive the cover note, kindly contact us at https://thefars.com/#contact-us

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