Tokio Marine - Credit Card Form

* Required fields

Policyholder's Name *

I hereby authorize Tokio Marine Insurance Singapore Ltd. to debit my Credit Card account with the below stated premium account.

Payment Mode *

VISA / MasterCard

Instalment is only valid for Premium $500 and above.

Bank

Credit Card Number *

Expiry *

Premium Amount *

Cardholder Name *

Contact Number (Mobile) *

Contact Number (Home) *

Terms & Conditions

Credit Card payment is only acceptable for policies issued in personal name/sole proprietor.
We will only accept credit cards in the name of the Insured/Policyholder or their spouse.
Should the payment transaction fails, you will be notified to pay the premium in cash or by cheque immediately. Otherwise, your insurance coverage may be affected.
In the event that you voluntarily terminate the IPP transaction, an administrative fee will be charged by the credit card company.

Cardholder Signature *

* Required fields