Foreign Worker Insurance

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POLICY

Proposal Date *

Policy Inception Date *

Policy Expiry Date *

PROPOSER

Business Name *

CPF No. *

Business Nature *

Address *

Postal Code *

CONTACT

Name of Person-In-Charge *

Home Phone No.

Home Fax No.

Work Phone No.

Work Fax No.

Mobile No. *

Email Address *

FOREIGN WORKERS

WORKER 1

Name *

Work Permit / S Pass No. *

Date of Birth *

Nationality *

Gender *

WORKER 2

Name

Work Permit / S Pass No.

Date of Birth

Nationality

Gender *

WORKER 3

Name

Work Permit / S Pass No.

Date of Birth

Nationality

Gender *

WORKER 4

Name

Work Permit / S Pass No.

Date of Birth

Nationality

Gender *

WORKER 5

Name

Work Permit / S Pass No.

Date of Birth

Nationality

Gender *