Travel Claims Medical Follow-up Form

Claim details

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Declaration, authorisation and data privacy consent

1. I authorise any person or organisation who has relevant information on this claim, including but not limited to any medical practitioner, health care provider, insurance company and investigative agencies, to release and exchange such information (including personal health information) requested by DirectAsia Insurance and/or its claims service providers.
2. I authorise DirectAsia Insurance and its claims service providers to collect, use, disclose and to exchange with the persons or organisations any information (including personal health information).
3. I am authorised to disclose information (including personal health information) about the Claimant if this claim is made on behalf of them, and understand that I am liable for the disclosure of information required to relevant parties for processing the claim
4. I further give my consent for DirectAsia Insurance to use the personal data given in this claim form or otherwise obtained and disclose such data to DirectAsia Insurance authorised staff, associated individuals and/or companies or any independent third parties (within or outside Singapore) who will provide claims administrative, advice and/or information or claims services in relation to my claim. I understand and give consent for DirectAsia Insurance to use my personal data for audit, business analysis, reinsurance purposes and for the purposes set out in DirectAsia Insurance Terms and Conditions which can be found at https://www.directasia.com/terms-conditions.
5. By submitting this claim, I confirmed that the information given is true and correct to the best of my knowledge and belief.
6. I accept that I have no further claim against DirectAsia once they have made payment on this claim and payment on this claim shall constitute a full and final settlement of all claims which I may have against DirectAsia.
7. I fully understand that any false or fraudulent statement or any attempt to suppress or conceal any material facts shall render the policy void and the Insurer may refuse to pay my claim.