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APPLY NOW (INDEMNITY)
APPLY EMBEDDED PRODUCT
RESOURCES

ABOUT
APPLY NOW (INDEMNITY)
APPLY EMBEDDED PRODUCT
RESOURCES

FAST TRACK FORM

Step 1 of 3 - Choose Category

33%

Type of Application(Required)

Newly Apply

Renewal Case ( previously applied with Medindemnity )

Choose Professional Healthcare Services

There are 10 main healthcare services fields. Please select one of the category and proceed with the "Next" button below after you have selected and confirm the yearly premium.

Healthcare Services

BENEFIT AT A GLANCE

Please choose your prefer date to start cover

From(Required)

DD slash MM slash YYYY

To(Required)

Optional Benefits

Aggravated Damages

Yes - subject to additional 2% Premium

Aggravated damages are what the court will order doctors to pay on top of the claims such as emotional stress caused by negligence

Auto Reinstatement

Yes - subject to additional 2% Premium

When the existing coverage limit is exhausted during claims then policy will automatically reinstated full coverage amount which can be utilized for subsequent claims

Defense Costs (Limit in addition) Extension

Yes - subject to additional 5% Premium

Defense Cost Extension will only being triggered provided the policy Limit of Liability is exhausted. Total Limit In Addition for Defense costs / Legal Representation Expenses will be same proportion up to the Limit of Liability or Remaining Limit of Liability bears to the total Loss.

Person in Charge Endorsements

Yes - subject to additional 35% Premium

YOUR TOTAL PREMIUM - includes SST 8%, stamp, transaction fee and optional extension (if any)

Promo Code

Consent (Please ✔️ here)(Required)

IMPORTANT NOTICE TO THE APPLICANTS

Your duty of disclosure

You have the duty to disclose to Chubb Insurance Malaysia Berhad any matter that:(a) You know to be relevant to our decision on whether to accept the risks or not and the rates and terms to be applied; or (b) a reasonable person in circumstances could be expected to know to be relevant.
You have the duty to disclose those matters to Us before you renew, extend , vary or reinstate a contract of general insurance,

Non-Disclosure

If you fail to comply with duty of disclosure, We May have the option of avoiding the contract of insurance from its beginning. If you non-disclosure is fraudulent, We may also have the right to keep the premium that you have paid.

Change of Risks or circumstances

You should advice US as soon as practicable of any change to your normal business as disclosed in this application.

Subrogation

Where you have agreed with another person or company, who would otherwise be liable to compensate you for any loss or damage which is covered by the policy , that you will not seek to recover such loss or damage from that person , Chubb will not covet you to the extent permitted by law , for such loss or damage.

The policy is underwritten by Chubb Insurance Malaysia Berhad, Registration Number: 197001000564 (“Chubb”). Chubb is licensed under the Financial Services Act 2013 and regulated by Bank Negara Malaysia. This policy is distributed by Tan Secretarial Services, a registered agent of Chubb, on the platform owned and operated by MedIndemnity.

The benefit(s) payable under eligible certificate/policy/product is(are) protected by PIDM up to limits. Please refer to PIDM’s TIPS Brochure or contact Chubb Insurance Malaysia Berhad or PIDM.

The benefit(s) payable under eligible certificate/policy/product is(are) protected by PIDM up to limits. Please refer to PIDM's TIPS brochure or contact Chubb Insurance Malaysia Berhad or PIDM (visit: www.pidm.gov.my).
Please refer to the Policy Wording for the full details of benefits, exclusions, terms and conditions,. Click here for Policy Wordingand Product Disclosure Sheet.

Underwritten by Chubb Logo

Distributed by Tan Secretarial Services.

Are you Foreign Doctor ?(Required)

Yes

Gender

Country(Required)

Name(Required)

First

IC Number(Required)

Passport Number(Required)

Phone(Required)

Email(Required)

Date of Birth(Required)

DD slash MM slash YYYY

Any changes of your practice address?(Required)

Yes

Primary Practice Address ( Clinic / Hospital )(Required)

Address Line 1 Address Line 2 City State Poscode

Please state : Licensing body

Please state : Registration number

Claim History - Have any claims been made against you ; aware of any circumstances & allegations being made against you ; have you been the subject of disciplinary action by professional body ; have you had criminal charges brought against you ?(Required)

Yes

Please provide full details and status of each claim.

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 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.
- Kindly refer the attachment file under Declaration

- I have read and agreed to the Declaration & Authorisation and Product Disclosure Sheet.

- I hereby declare and agree for Chubb to deal with your personal data on this application to hold, use and disclose for the purpose of processing this application and providing subsequent services for this and/or other insurance products and services, direct marketing, and data matching as the Insurer may consider necessary in accordance with Chubb's Personal Data Protection Notice.

What is Add On ?

[1] CLINIC PROTECT

May add on coverage to fire proof your clinic’s medical equipment,apparatus and machinery ;burglary or theft ,public liability , money in transit , fidelity guarantee ,plate glass and employer liability.

Do you want to purchase Clinic Protect together with Medical Indemnity policy?

Yes

Select Package

Package A - FIRE coverage RM 200,000 and Burglary coverage RM 30,000 [Additional premium RM 344.90 per annum ]

Package B - FIRE coverage RM 200,000 and Public Liability sum insured RM 1,750,000 [Additional premium RM 345.20 per annum ]

Package C - FIRE coverage RM 200,000 and Money insurance coverage RM 20,000 [Additional premium RM 320.93 per annum]

Package D - FIRE coverage RM 200,000 and Plate Glass coverage RM 35,000 [ Additional premium RM 345.80 per annum]

Package E - FIRE coverage RM 200,000 and Fiduciary Guarantee sum insured RM 20,000 [ Additional premium RM 515.30 per annum ]

Package F - FIRE coverage RM 200,000 and Employer Liability sum insured RM 1,000,000 [ Additional premium RM 320.93 per annum ]

Fire - Cover loss or damage to your clinic premises and it’s clinic contents or dental equipment as result of fire or lightning and domestic explosion
Burglary - Coverage of loss or damage on valuable clinic items stored at your clinic premises due to forcible entry and armed robbery

Fire - Cover loss or damage to your clinic premises and it’s clinic contents or dental equipment as result of fire or lightning and domestic explosion
Public Liability - cover legal liability to pay compensation for third party/ patients or clinic visitors for bodily injury or accidental damage caused by doctors or clinic staffs etc

Fire - Cover loss or damage to your clinic premises and it’s clinic contents or dental equipment as result of fire or lightning and domestic explosion
Money - Cover money at clinic which resulting from break into ,actual and attempted theft / burglary of the premises.
(a) money in transit outside premises ( from premises to bank and vice versa )
(b) money in premises and kept in locked drawer , cabinet , cash register, petty cash box after business hours.

Fire - Cover loss or damage to your clinic premises and it’s clinic contents or dental equipment as result of fire or lightning and domestic explosion
Plate Glass - Cover Damages and breakage of plate glass & window frame as a result of accident or misfortune

Fire - Cover loss or damage to your clinic premises and it’s clinic contents or dental equipment as result of fire or lightning and domestic explosion
Fidelity Guarantee - Cover any Dishonesty of Employees –embezzlement or misappropriation of money or goods by own employees or clinic staffs

Fire - Cover loss or damage to your clinic premises and it’s clinic contents or dental equipment as result of fire or lightning and domestic explosion
Employer Liability - Cover Liability to employee for death/injury/ illness due to the negligence of the employer failure in providing safe working environment or condition

Clinic Name

Business Registration Number (SSM/ KKM No.)

PIC Name

Contact Number

Location of Risks

Address Line 1 Address Line 2 City State Poscode

Quick Guide

Product Disclosure Sheet

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)

This field is hidden when viewing the form

Total Addon

YOUR FINAL TOTAL PREMIUM IS:

Price: RM 0.00

includes SST 8%, stamp , transaction fee and optional extension (if any)

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

Choose Payment Method(Required)

Pay Now (Online Banking)

Pay Now (Credit Card)

Pay Now (eWallet)
Please choose correct payment method to proceed.

GET YOUR MEDICAL MALPRACTICE INSURANCE WITH US

We promise to give our best services to you

OurGOOGLE TESTIMONIAL

Don't take our word for it. Check what some of doctors have to say

Mr Tan is very efficient and very helpful. So easy to deal with. I received my indemnity insurance policy just one day after payment made 👍🏻 very trusted and reliable.

Anisah Abdul Latiff
09/07/2022
Very fast and efficient process for insurance application. Thank you 😊

Nurhidayah Mohd Hafiz
09/11/2022
Mr Tan, Its been a great experience with your services . You have the natural ability to understand and feel what your customers are experiencing, and you are able to... read more

Linda Aziz
09/10/2022
Good efficient service.

Denise Ravindran
09/03/2022
Excellent service! Very responsive towards my follow up email and provided the policy as promised. Thanks again

adzlia adnan
09/09/2022
Fast and efficient service. Never thought it was this easy.

Syatrah Abd Halim
09/03/2022
I had a good experience as Eeriec was efficient when handling my policy

Arunth Thilagalingam
09/10/2022
Mr. Tan of Tan Secretarial Services is a very responsive and reliable insurance agent and he carried out our whole discussion right through to providing me with my professional indemnity... read more

premela thavanesan
09/03/2022
It's the only one I found that has 500k coverage. Also cheaper than other companies.

Wong Qi Ying
09/03/2022
The staff is very accommodating & providing a very fast Thanks a lot for the quick response for my inquiries.

Jel Silva
09/06/2022
Got assisted by Me Errieec. Staff very helpful

Pert Studio
09/08/2022
Excellent service by Mr Errieec, detailed explanation given and very fast processing. Recommended.

Sharlyne Kee
09/06/2022
We were very satisfied with Mr Tan’s service, the policy was received on the same day and my husband able to renew his apc on time. He even recommended Mr... read more

Hajar Mohd Nor
09/03/2022
Responsive and reliable agent who is professional to provide the service.

Sok Yan Foo
09/03/2022
A very easy and convenient way of getting a PA cover for my domestic helper.

Alvin Yeo
09/04/2022
Mr Errieec Tan is a real good agent. He kept reminding and was vry patient with me.. He was also very responsive at any time and i got my indemnity... read more

Sanjena 1305
09/03/2022
Swift & easy. Agent are friendly and very helpful with answering my questions and concerns

Atiq Nasir
09/06/2022
Fast and easy... Hassle free. Thumb up

Kenneth choo
09/07/2022
Very professional in terms of communication and responsive to our needs... Thanks again for your help n understanding mr tan. Highly recommended!

pragash balakrishnan
09/03/2022
Excellent service by Mr. Tan, a very professional and detailed person. I need my insurance urgently for an official application and he had managed to get it done for me.... read more Highly recommended.

Rachel Goh
09/06/2022
My first time purchase maid insurance with them. Very attentive and prompt service! Highly recommend😊

lydia wong
09/11/2022
Very responsive and helpful. I encountered a slight issue initially but Eric gave his best advice and assistance. My issue was solved less than 24 hours. Highly recommended

Alice Tan
09/07/2022
VERY FAST RESPONSE AND GOOD VALUE WITH THE POLICY.....5 STARS

Fizzy Salleh
09/03/2022
Had a great pleasure dealing with aMr. Errieec

lalithkumar subramaniam
09/05/2022
Easy. Responsive. All online.

Puteri Zatil Aqmar
09/03/2022
Good service and professional

Janice Hew
09/03/2022
Very responsive agent with excellent services. Recommended for those want fast track to apply indemnity insurance 👍👍

Noor Zaidy Noor Salleh
09/03/2022
Erieec is professional in handling my queries and even give me credit period to settle the premium payment. They are so kind and i recommended to those whom have financial... read more

Dr Aizam Muhammad
09/03/2022
Provided speedy service for the maid's insurance that I needed to purchase. Delivered online within the same day of application. 5 stars!

Ee Lin Soh
09/10/2022
Very fast process and the service is good. Tq

Rajasekaran Arumugam
09/03/2022

About us

We are the first of its kind one stop online shop in Malaysia specially catered for Medical Practitioner in Malaysia Since 2018.

ALL FORMS

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Contact Us

We are ready to assist you.

Office Address: LEVEL 33 Ilham Tower No 8 , Jalan Binjai, 50450 Kuala Lumpur, Malaysia.

Phone: +603 21175278
Support Line : 018-3872349

Email: [email protected]

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