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Worry Free Accident Insurance

Payment

, and I do not fall under the excluded occupations, and fully understand and agree to the exceptions, terms and conditions listed in 

I agree to the use of my personal data by Prudential for direct marketing purposes in accordance with the 

Personal Information Collection Statement

I acknowledge and agree that Prudential General Insurance Hong Kong Limited to notify my Financial Consultant (as I specified if any) or a Financial Consultant will be assigned to follow up my policy and provide policy servicing.

I understand that if the below box is not ticked, it represents that I agree to receive marketing message and materials in the future.

I do not wish to receive any marketing communications from Prudential General Insurance Hong Kong Limited.

If you have any enquiries for the application, please contact Customer Service by emailing to  

This information does not contain the full terms and conditions of this plan and is for reference only. Before the purchase, please refer to the 

 for exceptions and detailed terms and conditions respectively. 

This product is offered and underwritten by Prudential General Insurance Hong Kong Limited (Part of Prudential plc (United Kingdom)) (“Prudential”). Prudential is an authorized insurer registered with Insurance Authority.

This document is intended to be distributed in Hong Kong only. Prudential does not offer or sell any insurance product in any jurisdictions outside Hong Kong in which such offering or sale of the insurance product is illegal under the laws of such jurisdictions.

firstName

surName

gender

dateOfBirth

phoneNumber

email

inceptionDate

referralCode

Personal details

Terms and conditions

Summary and Premium

Confirmation

* Levy collected by the Insurance Authority (if any) has been imposed on this policy at the application rate and would be remitted in accordance with the prescribed arrangements. For further information, please visit <a href='https://www.prudential.com.hk/levy' target='_blank' class='pru-link text-pru-red'>www.prudential.com.hk/levy</a> or <a href='https://www.ia.org.hk/en/levy' target='_blank' class='pru-link text-pru-red'>www.ia.org.hk/en/levy</a>. If you do not pay the overdue levy timely, the Insurance Authority ("IA") may, according to the law, impose on the policyholder a penalty and may recover the outstanding levy as a civil debt due to the IA.

You can access your policy details through the “PRUServices” feature of Pulse app. Please download “Pulse” and use your mobile number

Please review your Certificate of Insurance and Policy Provision at PRUServices in Pulse App.

Your policy is issued. An email notification will be sent to you shortly.

You can access your policy details by linking your policy through the “PRUServices” feature of Pulse app.

Please enter your personal details and upload a photo of your identity card/passport

<div><div style='display:flex; flex-direction:row; margin-left:0.625rem;padding-bottom: 0.25rem;'><div style='margin-right:0.625rem'>1)</div><div><span style='text-align:justify'>I hereby declare and confirm that I fulfill the following health conditions:</span></div></div><div style='display:flex; flex-direction:row; margin-left:2rem;  '><div style='margin-right:0.625rem'>i.</div><div><span style='text-align:justify'>Never suffer from any illness, mental disease, physical impairment, defects or deformities and/ or any condition affecting mobility, sight, speech and/ or hearing</span></div></div><div style='display:flex; flex-direction:row; margin-left:2rem;  '> <div style='margin-right:0.375rem'>ii.</div><div><span style='text-align:justify'>Have not received any surgical and medical treatment or encountered any accidents during the past 6 months which have prevented myself from following my occupations, business or pursuits for a period of longer than 7 days</span></div></div> <div style='display:flex; flex-direction:row; margin-left:2rem;  '> <div style='margin-right:0.1875rem'>iii.</div><div><span style='text-align:justify'>Have not ever been declined of life or accident insurance, or been refused to renew your insurance, or had any special conditions imposed, or at a lowered sum insured</span></div></div><div style='display:flex; flex-direction:row; margin-left:2rem;  '></div>
<div style='display:flex; flex-direction:row; margin-left:0.625rem; padding-bottom: 0.25rem;'><div style='margin-right:0.625rem'>2)</div> <div><span style='text-align:justify'>I hereby declare and confirm that I do not engage in or carrying out any of the following types of work or occupation:</span></div></div> <div style='display:flex; flex-direction:row; margin-left:2rem;  '> <div style='margin-right:0.625rem'>i.</div><div><span style='text-align:justify'>Working in Hazardous Environments or with Hazardous Objects, include but not limited to Bodyguard, Construction site worker or manual worker in a construction site, Lift (installation/ maintenance), Manufacturing, producing or working with ammunitions, explosives, flammable or fireworks, Professional diver, Working at building façade, Working at height of 30 feet or higher from ground or floor level or Working in underground</span> </div></div><div style='display:flex; flex-direction:row; margin-left:2rem;'><div style='margin-right:0.375rem'>ii.</div><div><span style='text-align:justify'>Working in Gambling Establishments such as Casino and Mahjong centre (except counter staff and clerical staff of Hong Kong Jockey Club)</span></div></div><div style='display:flex; flex-direction:row; margin-left:2rem;'> <div style='margin-right:0.1875rem'>iii.</div><div><span style='text-align:justify'>Other types of work or occupation include Aircrew, Armed collector, Debit collector (other than directly employed by bank), Driver of public light bus or heavy vehicle, Hawker – non-fixed store, Jockey, Massagist, Professional sportsman, Reporter, Ship crew, Stevedore, Working in entertainment business (e.g. actor/ actress/singer/ stuntman/ film production, etc.), Working in nightclub, disco, karaoke club or bar</span></div></div> <div style='display:flex; flex-direction:row; margin-left:0.625rem;padding-bottom: 0.25rem;'><div style='margin-right:0.625rem'>3)</div><div ><span style='text-align:justify'>I hereby declare and confirm that all statements and particulars given by me in this application are, to the best of my knowledge and belief, true and complete. I understand and agree that this application shall form the basis of the proposed insurance policy ('Policy').</span></div></div>
<div style='display:flex; flex-direction:row; margin-left:0.625rem;padding-bottom: 0.25rem;'> <div style='margin-right:0.625rem'>4)</div><div ><span style='text-align:justify'>I hereby declare and confirm that I am a resident of Hong Kong SAR.</span></div></div>
<div style='display:flex; flex-direction:row; margin-left:0.625rem;padding-bottom: 0.25rem;'> <div style='margin-right:0.625rem'>5)</div><div ><span style='text-align:justify'>I understand and agree that the Policy shall not be in force unless and until: (ii) Prudential General Insurance Hong Kong Limited (the 'Company') has issued the Policy; and (ii) the premium of the Policy has been paid.</span></div> </div>
<div style='display:flex; flex-direction:row; margin-left:0.625rem;padding-bottom: 0.25rem;'> <div style='margin-right:0.625rem'>6)</div><div ><span style='text-align:justify'>I understand and agree that in all circumstances, coverage details and coverage period cannot be changed, no refund of premium is allowed once the Policy has been issued.</span></div></div>
<div style='display:flex; flex-direction:row; margin-left:0.625rem;padding-bottom: 0.25rem;'> <div style='margin-right:0.625rem'>7)</div> <div ><span style='text-align:justify'>I authorize the Company to collect from my designated credit card account all premium and levy in respect of the Policy unless alternative means of payment instruction has been given to and accepted by the Company.</span></div></div>
<div style='display:flex; flex-direction:row; margin-left:0.625rem;padding-bottom: 0.25rem;'> <div style='margin-right:0.625rem'>8)</div><div ><span style='text-align:justify'>I understand and agree that the descriptions of any benefits and exclusions here may not be complete; and should refer to the Policy for details of all the terms and conditions of the Policy.</span></div></div>
<div style='display:flex; flex-direction:row; margin-left:0.625rem;padding-bottom: 0.25rem;'><div style='margin-right:0.625rem'>9)</div><div ><span style='text-align:justify'>I understand and agree that by submitting this application, I shall be bound by the Company’s 'Disclaimer and Intellectual Property Rights Statement' and 'Privacy Policy'.</span></div></div>
<div style='display:flex; flex-direction:row;'> <div style='margin-right:0.625rem'>10)</div><div ><span style='text-align:justify'>I understand that this application is directed only at persons in Hong Kong and must only be acted upon by persons in Hong Kong, the information on this application shall not be construed as an offer to sell or solicitation to buy or provision of any insurance product outside Hong Kong. Prudential General Insurance Hong Kong Limited does not offer or sell any insurance product in any jurisdictions outside Hong Kong in which such offering or sale of the insurance product is illegal under the laws of such jurisdictions.</span></div> </div>
<div style='display:flex; flex-direction:row;'><div style='margin-right:0.625rem'>11)</div><div ><span style='text-align:justify'>I understand and agree that the mobile phone number provided in this application will be saved under policy record and used as identity authentication relating to this plan, for which the system will issue Identity Verification Code through SMS message to this mobile phone number.</span></div></div></div>

*Levy collected by the Insurance Authority (if any) has been imposed on this policy at the application rate and would be remitted in accordance with the prescribed arrangements. For further information, please visit 

1)I hereby declare and confirm that I fulfill the following health conditions: i.Never suffer from any illness, mental disease, physical impairment, defects or deformities and/ or any condition affecting mobility, sight, speech and/ or hearing
 ii.Have not received any surgical and medical treatment or encountered any accidents during the past 6 months which have prevented myself from following my occupations, business or pursuits for a period of longer than 7 days
 iii.Have not ever been declined of life or accident insurance, or been refused to renew your insurance, or had any special conditions imposed, or at a lowered sum insured 2)I hereby declare and confirm that I do not engage in or carrying out any of the following types of work or occupation: 
i.Working in Hazardous Environments or with Hazardous Objects, include but not limited to Bodyguard, Construction site worker or manual worker in a construction site, Lift (installation/ maintenance), Manufacturing, producing or working with ammunitions, explosives, flammable or fireworks, Professional diver, Working at building façade, Working at height of 30 feet or higher from ground or floor level or Working in underground
ii.Working in Gambling Establishments such as Casino and Mahjong centre (except counter staff and clerical staff of Hong Kong Jockey Club)
iii.Other types of work or occupation include Aircrew, Armed collector, Debit collector (other than directly employed by bank), Driver of public light bus or heavy vehicle, Hawker – non-fixed store, Jockey, Massagist, Professional sportsman, Reporter, Ship crew, Stevedore, Working in entertainment business (e.g. actor/ actress/singer/ stuntman/ film production, etc.), Working in nightclub, disco, karaoke club or bar
3)I hereby declare and confirm that all statements and particulars given by me in this application are, to the best of my knowledge and belief, true and complete. I understand and agree that this application shall form the basis of the proposed insurance policy ('Policy').
4)I hereby declare and confirm that I am a resident of Hong Kong SAR.
5)I understand and agree that the Policy shall not be in force unless and until: (ii) Prudential General Insurance Hong Kong Limited (the 'Company') has issued the Policy; and (ii) the premium of the Policy has been paid.
6)I understand and agree that in all circumstances, coverage details and coverage period cannot be changed, no refund of premium is allowed once the Policy has been issued.
7)I authorize the Company to collect from my designated credit card account all premium and levy in respect of the Policy unless alternative means of payment instruction has been given to and accepted by the Company.
8)I understand and agree that the descriptions of any benefits and exclusions here may not be complete; and  should refer to the Policy for details of all the terms and conditions of the Policy.
9)I understand and agree that by submitting this application, I shall be bound by the Company’s 'Disclaimer and Intellectual Property Rights Statement' and 'Privacy Policy'.
10)I understand that this application is directed only at persons in Hong Kong and must only be acted upon by persons in Hong Kong, the information on this application shall not be construed as an offer to sell or solicitation to buy or provision of any insurance product outside Hong Kong. Prudential General Insurance Hong Kong Limited does not offer or sell any insurance product in any jurisdictions outside Hong Kong in which such offering or sale of the insurance product is illegal under the laws of such jurisdictions.
11)I understand and agree that the mobile phone number provided in this application will be saved under policy record and used as identity authentication relating to this plan, for which the system will issue Identity Verification Code through SMS message to this mobile phone number.

I am currently residing in Hong Kong at the time of this insurance application.

 If you do not pay the overdue levy timely, the Insurance Authority (“IA”) may, according to the law, impose on the policyholder a penalty and may recover the outstanding levy as a civil debt due to the IA.

, and fully understand the exceptions, terms and conditions listed in 

Accidental Death and Permanent Disablement: Maximum sum insured HK$100,000/ Policy

<div>Accidental Death and Permanent Disablement: Max. sum insured HKD100,000/ Policy. Public Holidays Protection Upgrade. <p>Premium <span style='font-weight:bold'>HKD {{plansPage.selectedPackage.premium}}</span> inclusive of taxes</p></div>

Accidental Death and Permanent Disablement: Maximum sum insured HK$200,000/ Policy

<div>Accidental Death and Permanent Disablement: Max. sum insured HKD200,000/ Policy. Accidental Hospital Cash: Daily benefit limit HKD200. Public Holidays Protection Upgrade. <p>Premium <span style='font-weight:bold'>HKD {{plansPage.selectedPackage.premium}}</span> inclusive of taxes</p></div>

Accidental Death and Permanent Disablement: Maximum sum insured HK$300,000/ Policy

<div>Accidental Death and Permanent Disablement: Max. sum insured HKD300,000/ Policy. Accidental Hospital Cash: Daily benefit limit HKD300. Public Holidays Protection Upgrade. <p>Premium <span style='font-weight:bold'>HKD {{plansPage.selectedPackage.premium}}</span> inclusive of taxes</p></div>

Accidental Death and Permanent Disablement: Maximum sum insured HK$400,000/ Policy

<div>Accidental Death and Permanent Disablement: Max. sum insured HKD400,000/ Policy. Accidental Hospital Cash: Daily benefit limit HKD400. Public Holidays Protection Upgrade. <p>Premium <span style='font-weight:bold'>HKD {{plansPage.selectedPackage.premium}}</span> inclusive of taxes</p></div>

Accidental Death and Permanent Disablement: Maximum sum insured HK$500,000/ Policy

<div>Accidental Death and Permanent Disablement: Max. sum insured HKD500,000/ Policy. Accidental Hospital Cash: Daily benefit limit HKD500. Public Holidays Protection Upgrade. <p>Premium <span style='font-weight:bold'>HKD {{plansPage.selectedPackage.premium}}</span> inclusive of taxes</p></div>

Travel coverages

Sum insured of Accidental Death and Permanent Disablement up to HK$500,000

Sum insured

Flexible plan coverage – coverage period could be choosing from daily, weekly to monthly protection

Flexible coverages

Worldwide personal accident protection|worldIcon-hk?namespace=HK||Offers Accidental Death and Permanent Disablement Benefits up to HK$500,000|patient-hk?namespace=HK||Double up Accidental Death and Permanent Disablement benefit if accident occurs on a Hong Kong Public Holiday|holiday-calender-hk?namespace=HK||Flexibly covers daily, weekly or monthly coverage period|calender-hk?namespace=HK||Exceptions and excluded occupations apply, please refer to the sections headed 'Exceptions' and 'General Exceptions' under the <a target='_blank' href='https://api.pulse.prudentialcorporation-asia.com/api/v1_0_0/cms/Worry_Free_Accident_Insurance_Policy_Provision_1121_specimen?namespace=HK'><span style='color:#ED1B2E;text-decoration: underline'>Policy Provision</span></a> and excluded occupations in the <a target='_blank' href='https://www.prudential.com.hk/EN/.galleries/pdf/brochure/worry-free-accident-insurance-product-brochure.pdf'><span style='color:#ED1B2E;text-decoration: underline'>Product Brochure</span></a> respectively before purchase.

This product is offered and underwritten by Prudential General Insurance Hong Kong Limited (a member of Prudential plc group) (“Prudential”). Prudential is an authorized insurer registered with Insurance Authority.

This product is intended to be distributed in Hong Kong only. Prudential General Insurance Hong Kong Limited does not offer or sell any insurance product in any jurisdictions outside Hong Kong in which such offering or sale of the insurance product is illegal under the laws of such jurisdictions.

<span class='text-h3-bold'>Eligibility</span> of Application

<p>1. Hold a HKID Card</p><p>2. Aged between 18 and 70 (both age inclusive)</p><p>3. Reside in Hong Kong and is in Hong Kong when applying for this plan</p><p>4. Purchase the plan for yourself as insured person</p><p>5. Only one policy can be purchased during coverage period</p><p>6. Settle premium by a VISA/MasterCard that belongs to the applicant</p>

Please click “<a class='pru-link'><span class='text-pru-red'>View More Plans</span></a>” for more plan and policy term selection. Please refer to the Product Brochure for detailed product features, the Policy Provisions for detailed terms and conditions.

Please click “Show More” for eligibility of application, detailed product features and terms and conditions.