Property & Casualty (Non-WICA Including Marine) Claims

STEP 1 – POLICY & CLAIM DETAILS

IMPORTANT NOTES

1.	Please ensure all information provide is accurate and complete to the best of your knowledge.
2.	Submission of this form does not constitute an admission of liability by the insurer.
3.	Any false or misleading information may result in rejection of the claim and/or policy being voided.
4.	Claims should be reported as soon as possible in accordance with policy terms.

Policy Number

Particulars Of Policyholder /
Insured Person

Name

Contact Number

Email 2

Email 3

STEP 1 – POLICY & CLAIM DETAILS

Nature Of Claim(Please Tick The Relevant Boxes)

If others

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STEP 1 – POLICY & CLAIM DETAILS

DETAILS OF LOSS / OCCURRENCE

Date

Time

Place of Loss / Occurrence

Describe how the incident / loss took place

Please describe Nature of Damage / Injury

For road traffic accident claim, please confirm whether the accident involve any third party?

Yes

If yes, please state

(i) Vehicle No. of third party

(ii) Motor Insurer of third party

Were there any witnesses to the incident?

Yes

If yes, please state

Name

Contact Number

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STEP 1 – POLICY & CLAIM DETAILS

DETAILS OF PROPERTY LOST OR DAMAGED

Description of Property Lost or Damaged

Year of Purchase

Original Purchase Price ($)

Amount Claimed ($)

DETAILS OF PERSON (S) INJURED

Name

Contact Number

Nature of Injuries

Occupation / Nature of Work

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STEP 1 – POLICY & CLAIM DETAILS

ANY OTHER INSURANCE

Have you or claimed or do you intend to claim from any other insurer for this incident / injury / loss?

Yes

If yes, please state

Name of insurer(s)

Details of law firm engaged (if any)

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STEP 2 – UPLOAD DOCUMENTS

UPLOAD DOCUMENTS

Please provide the following documents (if applicable): a) Original purchase bills / invoices of property lost / damaged, if available.
b) Written report(s) lodged with the Police in respect of theft claim.
c) Colour photos showing the damaged property / CCTV footage showing circumstances of the incident.
d) Assessment report from repairer on the cause and extent of the damaged.
e) Tenancy and / or Contract Agreement

EQ Insurance will accept electronic copies of final medical bills / tax invoices / receipts. However, we reserve all rights to request for the original documents within 12 months from the date of submission. In the event that the original final medical bills / tax invoices / receipts are not available during our review, EQ Insurance reserves the right to recover any claims that have been paid by EQ Insurance to the Policyholder / Insured Person.

Total Size : 0 MB
(Please note: Total file size should be less than 20MB)

INVOICES

Delete

OTHERS

Delete

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STEP 3 – PAYMENT

NOTE EQ INSURANCE COMPANY LIMITED shall not be liable for any losses incurred by you as a result of providing inaccurate PayNow registered details or bank account details.
(Letter of Authorisation is required if payee for PayNow Linked Account or Bank Transfer is not the insured)

Payment Method

PayNow

Bank Transfer

Cheque payee name:

(Note: An administrative fee based on the issuing bank's prevailing charges will be imposed for every lost/re-issued cheque)

Note: please state NA if not applicable for NRIC/FIN or mobile no. or UEN

PayNow registered name

PayNow registered NRIC/FIN or mobile number

PayNow registered UEN (for corporate account)

Bank name

Bank account holder's name

Bank account number

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STEP 4 – REVIEW

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STEP 5 – DECLARATION & AUTHORISATION

DECLARATION, AUTHORISATION AND DATA PRIVACY CONSENT BY INSURED

By submitting this claim, I/we declare, authorise, and consent to the following:

1.Accuracy of Information
All statements, answers, and documents provided are complete, accurate, true, and not misleading to the best of my/our knowledge and belief. I/We will promptly inform EQ Insurance Company Limited ("EQI") of any changes affecting this claim.

2.Consequences of Fraud or Misrepresentation
Any false, fraudulent, or misleading statement, or concealment of material facts, may result in rejection of this claim, forfeiture of policy rights, voidance of the policy, recovery of paid amounts and costs, and reporting to the Singapore Police Force, GIA Fraud Register, and other relevant authorities.

3.Authorisation (Third-Party / Corporate Policies)
In cases where I/we are not the policyholder, or in the scenario of a corporate policy, I/we confirm that I/we have been duly authorised by the insured member(s) (hereafter referred to as the ‘Insured’) to provide relevant information pertaining to the claims. I/we acknowledge full responsibility for ensuring the accuracy and validity of this submission. Furthermore, I/we agree to indemnify EQI against any losses or claims arising from this submission.

4.Medical & Records Authorisation
I/We authorise EQI and its representatives to obtain and disclose any relevant information from hospitals, doctors, employers, individuals, organisations, or authorities relating to illnesses, injuries, medical history, consultations, treatments, diagnostic tests, hospital admissions (past, present, or pending/recommended), and employment/wage records. This authorisation remains valid throughout the claim, appeal, and recovery process. A photocopy, scanned, or electronic copy of this authorisation is as valid as the original.

5.Personal Data Protection (PDPA)
I/We consent to EQI's collection, use, disclosure, processing, and retention of personal data for claim, policy, fraud prevention, recovery, and regulatory purposes. Data may be shared with EQI's authorised representatives, intermediaries, service providers, reinsurers, legal/regulatory bodies, industry databases, and dispute resolution forums, in line with EQI's Personal Data Protection Statement available at www.eqinsurance.com.sg.

6.Anti-Fraud, AML & Sanctions
I/We declare this claim is not connected to any sanctioned party or unlawful activity and consent to sanctions, AML, and fraud screening checks in line with MAS requirements.

7.Other Insurance & Subrogation
I/We have disclosed all other insurance policies covering the same loss/event and agree to fully cooperate with EQI in any recovery or subrogation action, without prejudicing EQI's rights.

8.Authenticity of Documents
All documents submitted are genuine, unaltered, and true copies.

9.Electronic Submission
I/We agree that submission via the online tick-box constitutes a legally binding signature under the Electronic Transactions Act 2010 of Singapore.

I/We have read, understood, and agree to the above declarations, authorisations, and consents.

Date

Verification Code

Please enter Verification Code as shown below

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THIS SECTION MUST BE COMPLETED

All Risk	Fire
Burglary / Theft	Machinery all Risk
Engineering / EAR / CAR	Plate Glass
Fidelity Guarantee	Public Liability
Others