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TUBERCULOSIS FACTS
Sunday,Monday,Tuesday,Wednesday,Thursday,Friday,Saturday
January,February,March,April,May,June,July,August,September,October,November,December
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Begin Application
Please fill out your information and upload your documents here:
First Name
Last Name
Your Email
Contact Number
Complete Address
Date of Birth
Place of Birth
Gender
Male
Female
Transgender
Non-binary/Non-conforming
Prefer not to say
Civil Status
Single
Married
Separated/Annulled
Widowed
Nationality
Tax Identification Number
Other ID Number (SSS/GSIS)
Source of Fund
Employer/Business Name
Employer/Business Address
Nature of Business/Work
Are presently or formerly a Government Official?
Yes
No
If presently or formerly a Government Official, please specify (write NA if not applicable):
Do you have a close personal or family relationship with any Government Official?
Yes
No
Authorized Representative and Contact Number
Name of Beneficiary
Relationship to the Insured
Brand of Bicycle
Accessories
Reflectors
GPS
LED Lights
Biker's Helmet
Biker's Protective Gear
Other Accessories (write NA if Not Applicable)
Biker Class
Class A Biker - one who goes to/from place of work, e.g factory, shop, store, office and for pleasure
Class B Biker - one who does all types of commercial undertaking by biking, e.g deliveries of goods and services.
Year acquired
Market Value or Purchase Price if new
Data Privacy Consent of Trinity:
https://trinity-insures.com/pages/data-privacy-consent-form
I agree
DECLARATIONS: (1) I hereby apply that I am in good health and free from physical impairment or deformity, (2) I hereby warrant that all statements in this applicant are true and complete to the best of my knowledge and belief, (3) I also understand and agreed that no coverage will be in effect until the Company approves this application, the policy issued on the premium is paid full, (4) I understand that under Republic Act 9160 (Anti-Money Laundering Act) as amended by Republic Act 9194 and pertinent regulations, all insurance companies are required to satisfactory establish the identities of all its customers. Hence, Trinity reserve the right not to accept and process any application for insurance if the customer fails to provide sufficient evidence to establish his identity, (5) I understand that any change in the above details should be made in writing and submitted to Trinity prior to Policy commencement date. Otherwise, the Policy is not enforced, (6) I hereby apply for Insurance as set out in the above application form and declare, to the best of my knowledge and belief, that the foregoing statements and particulars are true and complete. I hereby agree to notify Trinity of any material change in the information as stated above, and (7) I hereby certify that I voluntarily and expressly consent to the collection, processing, sharing, storing of my personal and/or sensitive information by Trinity for the purpose/s necessary in processing my insurance policy and in any related transactions and/or in any other purposes as stated in the Data Privacy Statement of Trinity or in https://trinity-insures.com/pages/data-privacy-consent-form. I hereby certify that I carefully understood the terms above before giving my consent.
I agree
Required Document
Official Receipt of Bicycle's Purchase Price
Owner’s Copy of Valid ID (with address) with 3 specimen signatures
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Begin Application
Please fill out your information and upload your documents here:
First Name
Last Name
Your Email
Contact Number
Complete Address
Age of Owner
Date of Birth
Place of Birth
Gender
Male
Female
Transgender
Non-binary/Non-conforming
Prefer not to say
Civil Status
Single
Married
Separated/Annulled
Widowed
Nationality
Tax Identification Number
Other ID (SSS/GSIS)
Source of Funds
Employer/Business Name
Employer/Business Address
Nature of Business/Work
Are presently or formerly a Government Official?
Yes
No
If presently or formerly a Government Official, please specify (write NA if not applicable):
Do you have a close personal or family relationship with any Government Official?
Yes
No
Authorized Representative and Contact Number
Name of Beneficiary
Relationship to the Insured
Name of Pet
Kind of Pet
Cat
Dog
Breed
Age of Pet (in years and months)
Pet's Gender
Male
Female
Color
Date of Birth
Place of Birth
Pet's Distinguishing Characteristics
Passport Number
With Microchip
Yes
No
Microchip No.
Veterinarian/Clinic
Pre-existing Conditions
Package
Package A with Microchip
Package A no Microchip
Package B with Microchip
Package B no Microchip
Package C with Microchip
Package C no Microchip
Package D with Microchip
Package D no Microchip
Package E with Microchip
Package E no Microchip
Package F with Microchip
Package F no Microchip
Data Privacy Consent of Trinity:
https://trinity-insures.com/pages/data-privacy-consent-form
I agree
DECLARATIONS: (1) I hereby confirm that me and my pet(s) are permanent resident of the Philippines. (2) I hereby confirm that my pet is not a subject of police complaint. (3) I hereby confirm that me and my pet(s) are in good health and free from any impairment or deformity, otherwise stated in this application, (4)I hereby apply for Insurance as set out in the above application form and declare, to the best of my knowledge and belief, that the foregoing statements and particulars are true and complete. I hereby agree to notify Trinity of any material change in the information as stated above, and (5) I hereby certify that I voluntarily and expressly consent to the collection, processing, sharing, storing of my personal and/or sensitive information by Trinity for the purpose/s necessary in processing my insurance policy and in any related transactions and/or in any other purposes as stated in the Data Privacy Statement of Trinity or in https://trinity-insures.com/pages/data-privacy-consent-form. I hereby certify that I carefully understood the terms above before giving my consent.
I agree
Required Documents
Health/Medical and Vaccination Records of Pet
Two-sides Picture and Distinguishing Features of Pet
Owner's Copy of Valid ID with 3 specimen signatures
Optional Documents
Copy of PCCI Registration
Copy of Pet Passport
Official Receipt of Pet's Purchase Price
Copy of proof of registration for RFID/Microchip
0%
ATTACH DOCUMENTS. Please zip files into one folder.
Apply Now
Begin Application
Please fill out your information and upload your documents here:
First Name
Last Name
Your Email
Contact Number
Complete Address
Gender
Male
Female
Transgender
Non-binary/Non-conforming
Prefer not to say
Date of Birth
Place of Birth
Civil Status
Single
Married
Separated/Annulled
Widowed
Nationality
Tax Identification Number
Other ID Number (SSS/GSIS)
Source of Fund
Employer/Business Name
Employer/Business Address
Nature of Business/Work
Are presently or formerly a Government Official?
Yes
No
If presently or formerly a Government Official, please specify (write NA if not applicable):
Do you have a close personal or family relationship with any Government Official?
Yes
No
Authorized Representative and Contact Number
Name of Beneficiary
Relationship to the Insured
Year
Vehicle Make/Brand
Model
Series/Variant
Market Value of Big Bike or Purchase Price if new
Data Privacy Consent of Trinity:
https://trinity-insures.com/pages/data-privacy-consent-form
I agree
DECLARATIONS: (1) I hereby apply for Insurance as set out in the above application form and declare, to the best of my knowledge and belief, that the foregoing statements and particulars are true and complete. I hereby agree to notify Trinity of any material change in the information as stated above, and (2) I hereby certify that I voluntarily and expressly consent to the collection, processing, sharing, storing of my personal and/or sensitive information by Trinity for the purpose/s necessary in processing my insurance policy and in any related transactions and/or in any other purposes as stated in the Data Privacy Statement of Trinity or in https://trinity-insures.com/pages/data-privacy-consent-form. I hereby certify that I carefully understood the terms above before giving my consent.
I agree
Required Document
OR/CR of Big Bike
Owner’s Copy of Valid ID (with address) with 3 specimen signatures
Photos of the vehicle (front, rear, and sides) prior to cover
0%
ATTACH DOCUMENTS. Please zip files into one folder.
Apply Now