Travel Insurance Nomination Form | Berjaya Sompo Insurance
Travel Insurance Nomination Form
Details of Insured
Insured Person's Full Name
NRIC / Passport No.
Your travel insurance policy number can be found inside the policy document, sent by our system to your email inbox upon successful purchase of our travel insurance plan. Example as below:
Policy No. (QBxxxxxx)
Email Address
1 Nominee
Nomination
Note:
You may nominate up to 4 beneficiary nominees.
Details of Nominee(s)
Nominee 1
Full Name of Nonimee
NRIC / Passport No.
Date Of Birth
Mobile No. (010xxxxxxx)
Email Address
Please Select
Relationship
%
Share (Percent)
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