CHUBB's Home PLUS FORM

Step 1 of 3 - Contact Information

Name(Required)
First
Residence / Home Address
Address Line 1 Address Line 2 City State Poscode
Phone(Required)
Email(Required)

Declaration (Please ✔️ here)(Required)
Declaration
- I have read and understood the importance notices contained in this application.
- I agree that this proposal together with any other information will form the basis of any contract of insurance.
- I acknowledge that if this application is accepted, the contract of insurance will be subject to terms and conditions as set out in the policy wording as issued or as otherwise specifically varied in writing by Chubb or STMB
- I declare after inquiry that the statement, particulars and information contained in this application and in any document accompanying this application are true and correct in every detail and that no other material facts have been misstated, suppress or omitted .
- I undertake to inform Chubb or STMB of any material alteration to those facts before completion of the contract of insurance.
- I understand the Chubb or STMB needs to deal with our personal data to administer our Policy and offer us insurance products and services . To achieve these purpose ,I allow Chubb or STMB to collect, use and disclose our personal data to selected third parties in or outside Malaysia, in accordance with Personal Data Protection Notice
Payment Method
All Premium Amount included SST 8%. We are now support online payment gateway through Billplz for better experience.
Premium shown here is based on your early date selection and addon purchase(if any)
YOUR FINAL TOTAL ADDON IS:
RM 0.00
Dear customer,
🔵 Press “Submit” button and proceed with Online Payment FPX or Credit Card Payment
🟢 Press “Get Quotation” button will receive an email with indicative quotation for review
🔴 If agreeable then Press “Sign Up” button to redirect you to payment page for online banking or credit card
Choose Payment Method(Required)

Pay Now (Online Banking)

Pay Now (Credit Card)

Pay Now (eWallet)
Please choose correct payment method to proceed.
Dear customer,
Dear customer
🔴Press “Submit” button and proceed with online payment FPX or credit card or Touch n Go , Boast , GrabPay and Shopee Pay
🟢Press “ Get Quotation “ button will receive an email with indicative quotation for your review .
🔵If Agreeable then press “Sign up “ button to redirect you to payment page for online banking FPX or credit card or Touch n Go , Boast , GrabPay and Shopee Pay
Name
This field is for validation purposes and should be left unchanged.