No paper forms. No appointments just to fill in your details. Our secure online wizard takes you through every field — step by step, in English or Chinese.
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Guided Step-by-Step
10 clearly labeled steps. Each section explained. No insurance jargon — just clear fields and hints.
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Secure & Private
Your data stays in your browser. Nothing is stored on a server until you choose to submit. PDF generated client-side.
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Instant PDF
Click Download at the Review step. A formatted application PDF is generated instantly and ready to WhatsApp to Derrick.
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WhatsApp Submission
After downloading your PDF, send it straight to +60 16-542 6195. Derrick processes it — same day.
Platform Features
Everything built around your experience
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Smart IC Processing
Enter your MyKad number and your date of birth, age, and gender are auto-filled from the IC. Passport applicants use dropdown pickers.
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Real-Time Validation
Every field is validated before you advance. Clear error messages in English and Chinese. No surprises at the end.
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Full Review Screen
Step 10 shows every field you entered, grouped by category. Click Edit on any section to jump back and correct — without losing other data.
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PDF Generation
Generate a branded, formatted application document in one click. Your application ID, date, and all data included. Print or share.
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Bilingual Throughout
Switch between English and Chinese at any point. Every label, hint, error message, and step name is available in both languages.
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Mobile Friendly
Designed to work on any device. Fill in from your phone, download the PDF, and WhatsApp it without switching devices.
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Save Progress
Coming Soon
Start your application, save your progress, and return later to finish. Your data stays safe between sessions.
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Application Dashboard
Coming Soon
Track your application status, view policy documents, and manage renewals — all in one place with your JomPlan account.
The Journey
From first click to policy issued
A clear picture of exactly what happens, and when.
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1
Fill the Form
10 guided steps · ~12 min
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2
Review & Download
Check all details · Generate PDF
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3
WhatsApp Derrick
Send PDF · Bring IC when we meet
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4
Derrick Processes
Submitted · Same day
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5
Policy Issued
Welcome pack by email · Covered
Secure · Guided · Bilingual
Apply for Insurance Online
Complete all sections. At Step 10 you can download your PDF and WhatsApp it to Derrick at +60 16-542 6195.
Step 1 of 10Applicant Information
Personal Details (Applicant Details)
Required.
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Enter a valid NRIC (e.g. 850418-14-5401).Example: 850418 - 14 - 5401
Please select a complete date of birth.
Required.
Enter a valid mobile number.
Enter a valid email.
Gender *
Smoking Status *
Please select marital status.
Please select number of children.
Is the Applicant also the Life Insured? *
Residential Address
Required.
Required.
Enter 5-digit postcode.
Please select a state.
Life Insured Details
Complete this section only if the Life Insured is a different person from the applicant.
Required.
Enter a valid NRIC.
Required.
Please select.
Required.
Gender *
Smoking Status *
Employment Information
Required.
Office Address
Optional — fill in if applicable.
Nominee Information
Required.
Please select.
Required.
Required.
Banking Information
Whose account will be used for premium payment?
Please select a bank.
Enter a valid account number.
Required.
Physical Information
Applicant
Enter height 50–250 cm.
Enter weight 10–300 kg.
Life Insured
Identity Card Verification
📁 Please bring your physical NRIC when we meet up so it can be verified in person — no photo needs to be sent separately. The IC number you've entered earlier in this form is all that's needed to process your application.
Please bring:
• Applicant IC — front and back • Life Insured IC — front and back (if different from applicant)
Health Information
Current Health Status *
Select Conditions
Consent & Declaration
Declaration
“I confirm that all information provided in this application is true, complete, and accurate to the best of my knowledge.”
Privacy Consent
“I consent to the collection, use, processing, and disclosure of my personal information for the purpose of preparing and processing my insurance application.”
Please enter your full name to acknowledge.
You must tick this box to continue.
Please review your information. Click Edit on any section to make changes.
Application Submitted!
Application IDProcessing…
Your application has been received. Derrick will personally review your details and contact you via WhatsApp or phone within one business day.
📋 Your PDF has been emailed to you
A copy of your completed application (with Application ID) has been sent to your email address. Please remember to bring your physical NRIC when you meet Derrick, so it can be verified in person.
Click "Download PDF" at Step 10. A formatted application document is generated on your device instantly.
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2
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Keep Your IC Ready
No photos needed — the IC number you typed in the form is enough. Just keep your physical NRIC (and Life Insured's, if different) on hand to bring when we meet.
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3
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WhatsApp Derrick
Send the PDF to +60 16-542 6195 and bring your physical NRIC when we meet. Derrick will confirm receipt, usually within the hour.
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4
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Policy Issued
Derrick submits your application. Once approved, your welcome pack and policy documents arrive by email.
Your data is stored only in your browser's memory for the duration of your session. Nothing is sent to any server. The PDF is generated entirely on your device. When you close the tab, the data is cleared.
Yes. The health step (Step 8) allows you to declare pre-existing conditions. Derrick will review your application and advise on the best available options, including guaranteed acceptance plans that don't require a medical check-up.
You'll need: (1) Your MyKad or passport, (2) your bank account details, (3) your nominee's name and IC number, (4) a rough idea of your monthly income. For employees, your company name and address. That's it — no medical reports needed at this stage.
The application takes around 12–15 minutes to complete. Save Progress is coming soon — for now, it's best to set aside 15 minutes. If you need a break, WhatsApp Derrick and he can assist you directly.
Derrick receives your PDF via WhatsApp. He reviews the information and processes the application — typically the same business day. Just remember to bring your physical NRIC when you meet, for verification. You'll receive a confirmation and next steps from Derrick directly.
Yes, fully. The application is mobile-optimised. You can fill in the form, download the PDF, and send it via WhatsApp — all from your phone without switching devices.
Ready to Start?
Your insurance application is 15 minutes away.
Or prefer a face-to-face walkthrough? Book a free consultation and Derrick will guide you through every step.