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✦ Licensed Insurance · Digital Application

Apply for insurance
the right way.

Guided. Secure. Paperless. Complete your insurance application online in under 15 minutes — with a PDF you can download and WhatsApp instantly.

Start My Application → How It Works
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Free to complete
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SSL encrypted
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No commitment until signed
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Bilingual EN / 中文
Application Steps
1
Applicant Info
Name, IC, contact
2
Employment
Occupation & company
3
Nominee
Who receives the benefit
4
Health & Banking
Medical & payment details
5
Review & Download PDF
Verify all details, then send
Built for Modern Clients

Why apply online with Derrick?

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.
🖨️
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 Derrick Advisory 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 + IC photos
⚙️
4
Derrick Processes
Submitted · Same day
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5
Policy Issued
Welcome pack by email · Covered
Secure · Guided · Bilingual

Online Insurance Application

Complete all sections. At Step 10 you can download your PDF and WhatsApp it to Derrick at +60 16-542 6195.

Step 1 of 10 Applicant Information
Personal Details
Required.
Enter a valid NRIC (e.g. 850418-14-5401). Example: 850418 - 14 - 5401
Required.
Enter a valid mobile number.
Enter a valid email.
Gender *
Smoking Status *
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.
Nominee IC Number
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.
Identity Card Submission
How would you like to submit your IC? *
Required documents:
• 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.

After You Submit

What happens after you download your PDF?

1
📥
Download the PDF
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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Take Your IC Photos
Take clear photos of your NRIC front and back (and Life Insured's IC if different). Good lighting, no glare.
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3
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WhatsApp Derrick
Send the PDF + IC photos to +60 16-542 6195. 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.
💬 WhatsApp Derrick Now Book Consultation Instead
Common Questions

Frequently Asked Questions

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 and IC photos via WhatsApp. He reviews the information, processes the application — typically the same business day. 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.

Start Application Now → Book Free Consultation