ePolicy

Merimen ePolicy (ColdFusion Server)

Travel Insurance Application details :

Type of Trip*

Single Trip

Departing From*

Coverage Start Date*

Coverage End Date* (Maximum number of days allowed per travel is 90 days.)

Time of Departure* (As indicated in the ticket)

Flight Number*

Purpose of Travel*

Fields with asterisks (*) are mandatory.

To know more about our Travel Insurance product's benefits and exclusions, click here.

Click here for the Policy Form.

Gold

₱

Non-Schengen

Accidental Death and Disablement
1,000,000
Medical and Additional Expense
1,000,000

Diamond

₱

Non-Schengen

Accidental Death and Disablement
1,000,000
Medical and Additional Expense
1,000,000

Platinum

₱

Non-Schengen

Popular

Accidental Death and Disablement
1,000,000
Medical and Additional Expense
1,000,000

To know more about our Travel Insurance product's benefits and exclusions, click here.

Promo code

Complete client information and proof of valid identification are required under the Anti-Money Laundering Act (Republic Act No 10365, as amended) and the Insurance Commission Know-Your-Customer guidelines (Circular Letter No 2018-48) before an insurance company may issue a policy.

Insured's Surname*

Insured's Given Name*

Insured's Middle Name

Date of Birth* (This on-line system covers individuals from 1 year old to 75 years old only. If you are not between this age range, please email [email protected].)

Civil Status*

Birthplace - Country*

Birthplace - Province*

Birthplace - City*

Gender*

Male Female

Nationality*

Present Address

Address Type*

House or Unit No., Building Name*

Street*

Village, Area

City, Province

Zipcode*

The Permanent Address is the same as the Present Address.

Permanent Address

Address Type*

House or Unit No., Building Name*

Street*

Village, Area

City, Province

Zipcode*

Contact Number*

Mobile Number*

Email Address*

Beneficiary*

Name of Beneficiary*

Relationship with Beneficiary*

Please tick

If the Insured is different from the Payor

Fields with asterisks (*) are mandatory.

Surname*

Given Name*

Middle Name

TIN*

Date of Birth*

Birthplace - Country*

Birthplace - Province*

Birthplace - City*

Nationality*

The Payor’s Address, Contact Number and Mobile Number are the same as those of the Insured's.

Present Address

Address Type*

House or Unit No., Building Name*

Street*

Village, Area

City, Province

Zipcode*

The Permanent Address is the same as the Present Address.

Permanent Address

Address Type*

House or Unit No., Building Name*

Street*

Village, Area

City, Province

Zipcode*

Contact No.

Mobile Number*

Email Address*

Employment Market Sector of the Payor*

Please tick

If you are a BPI Client

Additional Insured's Details

Employment Type*

Sources of Funds*

Name of Employer*

Nature of Work / Self-Employment / Business

Fields with asterisks (*) are mandatory.

Types of ID*

ID Number*

Date of Expiry*

Upload ID - Insured*

Browse

Upload Vaccination Card - Insured

Browse

Additional Payor's Details

Types of ID*

ID Number*

Date of Expiry*

Upload ID - Payor*

Browse

Fields with asterisks (*) are mandatory.

File formats accepted are .gif, .jpeg, .png, .jpg, .tif, .tiff, .jpe, .doc, .docx, .pdf

I confirm that I have read and understood the Terms, Conditions, Warranties and Clauses stated above. All coverages are subject to the conditions and exclusions stated above. I further acknowledge that I will be unconditionally bound by the terms and conditions stated above when the insurance coverage takes effect.

I declare that I have verified and complied with all the necessary / specific travel rules and requirements of destinations / countries.

I declare that I am fit to travel.

For Payors, I declare that the Insured is fit to travel.

I declare that the above information is true and complete, and I have not withheld any information material to this Application. I agree that this Application shall be incorporated in the insurance contract between me and BPI/MS Insurance Corporation.

I hereby authorize BPI/MS to inquire about and investigate all the declared information from whatever sources BPI/MS may consider appropriate and use any contact details to communicate to me for whatever purpose (such as customer satisfaction surveys, etc.).

I agree that this Application, if approved, shall form part of and shall be the sole basis in issuing the Personal Accident Insurance Policy. Any material fact disclosed or misrepresented at the time this Application is accomplished, shall exempt the insurer from any liability caused or brought about by such undisclosed or misrepresented material fact.

Agree*

You may send marketing materials about your products and services through email.

Yes

Fields with asterisks (*) are mandatory.

The insurance policy will be issued only after the premium is paid.

If you wish to have your travel insurance policy cancelled, we can approve the request if the reason is valid and acceptable. Supporting documents need to be provided. Please send us an email two working days before the effectivity date of the insurance coverage. Otherwise, the insurance policy cannot be cancelled anymore. Please send an email to [email protected].

It is understood that upon the issuance of the policy, no payment for Documentary Stamp Tax will be refunded as a result of the cancellation or endorsement of the policy or a reduction in the premium due for whatever reason.

Agree*

Do you want a hard copy of your insurance policy to be sent to your present address?

Yes

You will be directed to the payment gateway for the payment of the premium.

Fields with asterisks (*) are mandatory.

Quotation Summary

Travel Details

Period of Coverage : to

Plan Selection

Package :

Total Premium :

Sub Total :
Documentary Stamps : 0.00
Premium Tax (0.00%) : 0.00
Local Government Tax (0.00%) : 0.00

Insured's Details

Payor's Details

Upload ID Document - Insured

Disclaimer

Payment

We're Sorry

We're sorry for the inconvenience but your policy failed to be issued. Please contact out helpline via email for assistance.

Quotation No.:

Total Payable:

We value your feedback. For other inquiries, requests and comments, please send an email to [email protected].

Thank you

Thank you for choosing BPI/MS. An email will be sent to you to continue your purchase. If you do not receive it within 3 days, please send an email to [email protected].

Quotation No.:

Premium:

Travel Insurance Application details :

Gold

Diamond

Platinum

We're sorry for the inconvenience but your policy failed to be issued. Please contact out helpline via email for assistance.

We value your feedback. For other inquiries, requests and comments, please send an email to [email protected].

Thank you for choosing BPI/MS. An email will be sent to you to continue your purchase. If you do not receive it within 3 days, please send an email to [email protected].

Unable to Save & Proceed

Payment Processing

Page Loading

Notification

Unable to Save & Proceed