AXXESS Mobility Protect

Nationality

Non-Malaysian

Malaysian

Notes:

Premium	RM 35.88
8% Service Tax	RM 2.87
Total Premium	RM 38.75

1. You will be charged annually for continuous coverage

2. The premium is inclusive of 25% commission/RM 8.97 to Perks Premier Sdn Bhd

3. The product is underwritten and provided by AIG Malaysia Insurance Berhad. Terms and conditions apply.

I confirm that I have an active Touch n Go card. I further understand and agree that I will be charged annually for my premium for subsequent renewal of my policy until cancelled and I must register this card in order to make a claim.

I confirm that I am a resident of Malaysia and within the eligible age of 18 years to 75 years. I further confirm that I have fully read the Product Disclosure Sheet and Terms & Conditions , and acknowledge that I understand and accept the same, and the policy is suitable to my insurance needs.

Notes:

Premium	RM 2.99
8% Service Tax	RM 0.24
Total Premium	RM 3.23

1. You will be charged monthly for continuous coverage

2. The premium is inclusive of 25% commission/RM 0.75 to Perks Premier Sdn Bhd

3. The product is underwritten and provided by AIG Malaysia Insurance Berhad. Terms and conditions apply.

I confirm that I have an active Touch n Go card. I further understand and agree that I will be charged monthly for my premium for subsequent renewal of my policy until cancelled and I must register this card in order to make a claim.

Mobility Protect by AXXESS

Registration

Choose Your Preferred Coverage Period

Notes:

Notes:

Contact

Email

Address

Mobility Protect by AXXESS

Registration

Choose Your Preferred Coverage Period

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