This section reserved exclusively to existing Policy Holder of AXA Insurance SmartTraveller that have opted for the Activation Program.
After completion of the form please click the submit below or fax to 6221 5900. You will receive an email message or call if via fax to confirm upon receipt of your application form.

Our Customer Service Officer will arrange and contact you within 24-hour to confirm on the SmartTraveller Activation.

You may also contact our hotline at 1800 880 4741 to speak directly with the Customer Service Officer for more assistance.

Name :		NRIC :
Address :
DOB :	DD 12345678910111213141516171819202122232425262728293031 MM 123456789101112 YYYY 196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010	Sex :	M F
Tel :	home office mobile
Email :
Occupation :	Industry :
FAMILY MEMBERS PARTICULARS (if coverage is required)
Name Sex NRIC DOB M F M F M F M F
Choice of Plan : Individual   Family Choice of Benefit : VIP   Classic Zone of Travel : Zone A   Zone B   Zone C Payment Details : By Credit Card Only
Period of Insurance :	DD 12345678910111213141516171819202122232425262728293031 MM 123456789101112 YYYY 1960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011 to     DD 12345678910111213141516171819202122232425262728293031 MM 123456789101112 YYYY 1960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011

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If you would like to download the form, click here.