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Product Type

Personal Details

Full Name

Date of Birth

Gender

Mobile Number

Email Address

Address

Tax Identification No. (TIN)

Occupation

Beneficiary

Medical history for the last 3 years

Bicycle Details

Brand/Make

Model

Chassis No. / Serial No.

Sum Insured

Term of Insurance (Start)

Term of Insurance (End)

Usage

Other Details

Upload Supporting Documents

Documents Reference

Photo of the Assured with the Bike
Photo of the frame with the Serial No.
Loss Record for the past three (3) years

Note: Warranted that the bike should only be used by the owner/assured as the authorized user within the Philippines jurisdiction only.

Beneficiary

(1) Name of Beneficiary

Date of Birth

Relationship

(2) Name of Beneficiary

Date of Birth

Relationship

(3) Name of Beneficiary

Date of Birth

Relationship

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