Travel :
Application form
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*
new user application
your user name* :
password** :
confirm password :
Password hint :
*User name : ( 6 – 50 numbers, English characters )
**Password : ( 6-12 numbers and English characters )
*
Insured information
Insured ( age over 18, Hong Kong resident and buy the insurance in Hong Kong )
Title
Surname :
First Name :
HKID No. :
()
Date of Birth :
Gender :
Contact phone no. :
Email :
Residential Address
Correspondence address

Press here, I confirm to apply for the above insurance having read and accepted the declaration and all the terms and conditions of use of this website.