MESPOUSECHILD
MY DETAILS
Please enter your own information first, as we will use it to validate any future claims.
i
Please ensure the accuracy of your contact information, as we will use it to validate any future claims.
First Name
Last Name
Gender
DOB
Identity no.
Mobile Number
Email Address
MY ADDRESS
Address
How many dependents do you have? (Optional)
 
What types of insurance plans do you currently own? (Optional)
 
DECLARATION AND AUTHORIZATION

Please read and confirm you agree with the following.

By proceeding, I confirm the following:

  1. I declare that the information I provide in this registration is complete, true and correct to the best of my knowledge. 
  2. I agree to the Terms and Conditions of this registration.
  3. I have read and accepted the Personal Information Collection Statement of Cigna.
Please agree the declarations to continue.
Submit
SPOUSE'S DETAILS
First Name
Last Name
Gender
DOB
Identity type
Identity no.
What is your height?
cm
How much do you weigh?
kg
Smoking Habit
 YES
 NO
Next
CHILD  'S DETAILS
First Name
Last Name
Gender
DOB
Identity type
Identity no.
What is your height?
cm
How much do you weigh?
kg
Smoking Habit
 NO
Next