Device Claim Insurance

Registration

Device Claim Form

  • Policy Information:-

  • Name of school / organisation:
  • Claimant's Information:-

  • Accident & Loss Details:-

  • :
  • Description of Accident:
  • Attachment(s) if any:
    Drop files here or
  • Bank Account Details:-

    Please provide your bank details for us to accelerate your claims payment process by direct transfer to your bank account

  • Name (as per bank account):
  • Account no.:
  • Declaration and Customer's Data Privacy Consent

    I/We confirm that I am/We are the claimant and/or the Policyholder and I/We declare that all the particulars given above are to the best of my/our knowledge true and correct.

    In connection with my/our and/or the claimant’s claims, I/We give consent for Rizk Insurance Solutions Agency Pte Ltd (“RIS”) and their respective representatives or agents to collect, use, store, transfer and/or disclose the information (including that provided by sources other than myself) concerning me/us and/or the claimant, to or with all such persons (including any member of the RIS or any third party service provider, and whether within or outside of Singapore and the Policyholder when claiming under a Group Policy) for the purpose of enabling RIS and their respective representatives or agents to provide me/us and/or the claimant (where applicable) with services required of an insurance provider, including the evaluating, processing, administering and/or managing my/our and/or the claimant’s claims or the Policyholder Group Policy(ies) with RIS (as the case may be).

    By checking this box, I, the claimant, agree to the above.