Activate your Personal Accident Insurance today!
Please enter your Personal Accident Insurance PIN
Personal Information
Insured Name
Complete Address
Mobile No.
+63
Email Address
Date of Birth
Gender
Male
Female
Nationality
- Select -
Filipino
Afghan
Albanian
Algerian
Argentine
Argentinian
Australian
Austrian
Bangladeshi
Belgian
Bolivian
Botswanan
Brazilian
Bulgarian
Cambodian
Cameroonian
Canadian
Chilean
Chinese
Colombian
Costa Rican
Croat
Cuban
Czech
Dane
Dominican
Ecuadorian
Egyptian
Salvadoran
Englishman
Englishwoman
Estonian
Ethiopian
Fijian
Finn
Frenchman
Frenchwoman
German
Ghanaian
Greek
Guatemalan
Haitian
Honduran
Hungarian
Icelander
Indian
Indonesian
Iranian
Iraqi
Irishman
Irishwoman
Israeli
Italian
Jamaican
Japanese
Jordanian
Kenyan
Kuwaiti
Laotain
Latvian
Lebanese
Libyan
Lithuanian
Malagasy
Malaysian
Malian
Maltese
Mexican
Mongolian
Moroccan
Mozambican
Nambian
Nepalese
Dutchman
Dutchwoman
New Zealander
Nicaraguan
Nigerian
Norwegian
Pakistani
Panamanian
Paraguayan
Peruvian
Pole
Portuguese
Romanian
Russian
Saudi (Arabian)
Scot
Senegalese
Serbian
Singaporean
Slovak
South African
Korean
Spaniard
Sri Lankan
Sudanese
Swede
Swiss
Syrian
Taiwanese
Tajikistani
Thai
Tongan
Tunisian
Turk
Ukranian
Emirati
Brit
American
Uruguayan
Venezuelan
Vietnamese
Welshman
Welshwoman
Zambian
Zimbabwean
Type of Government ID
- Select -
SSS
TIN
Passport
Driver's License
National ID (Philippine Statistic Authority)
Government ID Number
Source of Fund
Upload Copy of Government ID, if available
Nature of Work
Name of Employer / Business Name (for self-employed)
Beneficiary Information
Complete Name
Contact Number
Relationship with the insured
- Select -
Legal Spouse
Child
Surviving Parent
Sibling
I understand and agree that by filling out my personal information above, I authorize MAA, including its affiliates, subsidiaries, third parties contracted by MAA, to use said personal information to evaluate and assess my request.
Submit