By submitting this claim form online, you:

declare that the particulars stated above are true, accurate and complete and understand that if you have in this or in any further declaration in respect of this claim, made any false or fraudulent statement or suppress conceal or falsely state any material fact whatsoever my claim may be refused and referred to the relevant /appropriate authorities .
authorise any person or organisation who has relevant information on this claim, including any medical practitioner, health care provider, insurance company and investigative agencies, to release and exchange such information (including personal health information) requested by ERGO Insurance and/or its claims service providers.
authorise ERGO Insurance and its claims service providers to collect, use, disclose and/or process your personal data set out in this form and any other information provided by you or possessed by ERGO Insurance for the purpose of enabling ERGO to provide you with services required of an insurance provider, such as evaluating, processing, administering, and/or managing of your relationship and policies with ERGO Insurance. This includes among other things policy servicing, processing, investigating, handling, administering and/or settling your claim with ERGO or other insurers.
understand that ERGO Insurance may/will disclose and transfer your personal data to third parties, including but not limited to its affiliates, representatives, agents and third party service providers, lawyers/law firms, whether located within or outside Singapore, for one or more of the above purposes, and the said third parties may/will subsequently collect, use, disclose and/or process your personal data for or more of the above purposes;
accept that the personal data protection clauses herein are not exhaustive and you have read, understood and accept the terms of ERGO’s Personal Data Protection Policy at https://www.ergo.com.sg/pdpa/;
confirm that you are authorised to disclose information (including personal health information) about the insured person if this claim is made on behalf of them./li>
confirm that you or the insured person is not claiming from any other insurance policy or on your or insured person's employment benefits provided by your or insured person’s employer.
agree and accept that ERGO Insurance reserves the rights to contact the institution directly for validation of any submitted medical document’s authenticity and can request for the original bill/certified true copies whenever necessary within 1 year from the date of receipt of such medical document.

Please note that this procedure is only intended as a guide. Each claim submitted to ERGO will be reviewed based on its own merits in accordance with the concerned policy terms and conditions. We reserve our right to request for additional documents and/or information on a case-by-case basis.

Please keep all original documents and invoices for 12 months from the date of online submission for verification purpose

Kindly note that it may take longer to process a claim if we require additional information or documents from you. For any claims enquiry, amendment of details or submission of supporting or original documents, please email our friendly claims officers at onlineclaims@ergo.com.sg with your policy number