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SureCover Application Form
Name ( as per IC) :
NRIC No. (New) :
Email :
Contact No. :
Address Line 1
Address Line 2
Postcode
City
State
Perlis
Kedah
Penang
Perak
Selangor
N. Sembilan
Malacca
Johor
Pahang
Kelantan
Terengganu
Sabah
Sawarak
Kuala Lumpur
W.P. Labuan
Citizen Status
Malaysian
Permanent Resident
Race
Malay
Chinese
Indian
Others
Religion
Choose a value
Islam
Buddhism
Christian
Hindu
Others
Gender
Male
Female
Married Status
Single
Married
Divorced
Widowed
Place of Birth
Weight / Height :
Spouse Name :
Spouse NRIC No.
Bank Account No.
Bank Name :
Ambank
Bank Islam
Maybank
Public Bank
Rhab Bank
CIMB Bank
Affin Bank
Hong Leong Bank
BSN
Alliance Bank
Bank Muamalat
HSBC
Citibank
UOB Bank
OCBC Bank
Bank Rakyat
Card Payment :
Debit Card
Credit Card
Card Number
Name on the card
Expiry Date
Employment status
Self Employed
Employee
Retire
Worker
Occupation
Company Name :
Company Address Line 1 :
Company Address Line 2
C.Postcode
C.City
C.State
Perlis
Kedah
Penang
Perak
Selangor
N. Sembilan
Malacca
Johor
Pahang
Kelantan
Terengganu
Sabah
Sawarak
Kuala Lumpur
W.P. Labuan
Nominee Name :
Nominee NRIC No. :
Relationship
Required *
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Home
About Us
FAQs
SAG Group
VICare Services
Quotation Enquiry
Better Insurance Plan
Best Comprehensive
Zurich SureCover
Zurich Application Form
Car & Motor Insurance
Download
Contact Us
Log In
Signup