CHUBB CLINIC STAFF'S GROUP PA

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Number of Employees*
Please enter a number from 3 to 15.
Number of Employees*
Please enter a number greater than or equal to 16.
- Class 1 - Professional and mercantile classes and those engaged in clerical or administrative duties (not superintending or engaging in manual labour)
- Class 2 - Superintending but not engaging in manual labour, Commercial Travellers, Shop Proprietors and Shop Assistants (not using tools or machinery, loading or unloading vehicles)
- Class 3 - Occupation involving occasional or regular manual work not particularly hazardous in nature but involving the use of tools or machinery (not using woodworking machinery)

Clinic Company Name
Nature of Business
Total Employees
Period Insurance
PIC Name*
First
Phone*
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Payment Method
All Premium Amount included SST 6%. We are now support online payment gateway through SecurePay for better experience. RM1.50 will be charge for every transaction.
Total Price Plan
Price: RM 0.00
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Plan Type	Accidental Death and Disablement	Accidental Medical Expenses
Plan 500	RM 500,000	RM 10,000
Plan 250	RM 250,000	RM 5,000
Plan 100	RM 100,000	RM 3,000
Plan 50	RM 50,000	RM 1,000
Additional Free Benefits
Accidental Hospital Income (Maximum 60 Days)		50 per day
Alternative Medical Expenses		500
Death due to Dengue		10% Sum Insured up to maximum of 50,000
Dengue Recuperation		1,000
Additional Indemnity for Public Conveyance		Double Indemnity of Accidental Death Sum Insured
Burns (2nd and 3rd degree)		5,000
Fractured Bones		5,000
Recruitment Costs		5,000
Visitor’s Benefit		5,000
Funeral Expenses/Repatriation of Remains		5,000
Coma Benefit		1,000
Mobility/Home Renovation Expense		1,000
Get Well Benefit		500
Snatch Theft/Robbery		250
Ambulance Cost		500
Dependent Child Supplement		5,000 per child/10,000 per family
Trauma Counselling Compensation		Trauma Counselling Compensation
Credit Card Indemnity		1,000
Corporate Events Cover for Family – AD		25,000
Corporate Events Cover for Family – Medical		1,000

Payment Method