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Forms

For your basic ElderShield policy

Form Purpose Download
Health Declaration Form
To declare any Pre-existing Disabilities before your ElderShield Policy commences.

(Please read Can I join ElderShield if I have Pre-existing Disability? for the definition of "Pre-existing Disability".)

Download here

Application Form
To apply for ElderShield if you
(i) are not in the auto-coverage group,
(ii) have previously opted-out, or
(iii)
your current ElderShield policy is already in-force but you would like to switch to Aviva (you will need to terminate your existing policy with your insurer).

(Issuance is subject to medical assessment.)

Download here

Change of Insurer Form
To switch from your current insurer to Aviva
Download here


For your basic ElderShield policy and/or MyCare policy

Form Purpose Download
Change of Premium Payment Method Form

To change payment method and/or payer.

Download here

Reinstatement Form
To reinstate existing ElderShield policies that have lapsed for not more than than 180 days.

Download here

Claim Form
To apply for claims under the ElderShield scheme.

(Please read How to make a claim.)


Download here

You may send the completed forms to our New Business Department at 4 Shenton Way SGX Centre 2 #01-01 Singapore 068807 or fax to 6827 7475, unless otherwise stated.

* To print the Forms from this website, you will need to have Adobe Acrobat Reader installed on your computer.

 

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