APPLICATION FOR COVID-19 VACCINATION SIDE EFFECTS COVER

● If you are already entitled to any of our COVID-19 Add-ons, kindly fill in your details here to enjoy the benefit of our COVID vaccination side effects cover.
● IMPORTANT NOTICE: PLEASE KEY IN ALL YOUR CORRECT PARTICULARS IN ORDER FOR US TO PROCESS YOUR APPLICATION

* ALL FIELDS REQUIRED

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By submitting this application, you confirm that you have read and agreed to accept the Terms and Conditions herein and you shall be bound by them. Please refer to our website for notice on Personal Data Protection Act 2020: https://www.pacificinsurance.com.my/pdpa/ *

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