GCash Insurance Family Coverage | Enrolling your Dependents

GCash Insurance Family Coverage | Enrolling your Dependents
Thank you for availing of GCash Insurance Family Cover!

The Family coverage you purchased allows your immediate, eligible family members to also enjoy insurance coverage. Please fill out this form with the details of your dependents as soon as possible to make any future claims easier to process.

To facilitate this, you will need your Policy Reference Number which can be found in the insurance activation message sent to you by GCash Insure via SMS.

We will be collecting the following:
- Your full name, policy reference number, and GCash number. These will be used to verify your application/request.
- Your email address - You will receive the confirmation through email once your request has been processed.
- The full name, date of birth, and relationship to you as the primary insured of your two (2) dependents.
You may view the full GCash Insurance product specification, terms, and conditions here.

For questions and inquiries, you may email gcashinsure-support@microensure.com

We will ensure that your information is handled with full confidentiality and privacy, and will only be used for the purposes of policy activation and management.

You may view MicroEnsure's Data Privacy Policy here.
Principal Insured's Details

Please provide your personal information and GCash Insure policy details here. This will be used to verify your application/request.
Full Name*

First NameMiddle NameLast Name
GCash Registered Mobile Number*
Marital Status*
Email*
example@example.com
Policy Reference Number*
Can be found in the activation message

Dependents' Details

Please take note of who you can name as your dependents for this family cover.

Married users may nominate the following dependents:
- Legal spouse who is not older than 64 years of age.
- Children who are 3 - 21 years old.

Single users may nominate the following dependents:
- Parents who are not older than 64 years of age.
- Siblings who are 3 - 21 years old.
Dependent 1*

First NameLast Name
Date of Birth*

MonthDayYear
Relationship to You (Primary Insured)*
Dependent 2*

First NameLast Name
Date of Birth*

MonthDayYear
Relationship to You (Primary Insured)*

Beneficiary Details

Your insurance benefits are intended to go to your Beneficiary should the insured event occur. If you were not able to designate your Beneficiary yet, please accomplish this form to ensure the smooth processing of any future claim.

Any death benefits payable from your Life and Accident coverage shall be paid to the Beneficiary you designated. Under the Insurance Code of the Philippines, the Beneficiary should generally have an insurable interest in the life of the Insured. Under the same Code “a person has an insurable interest in something/ someone when loss or damage to it would cause that person to suffer a financial loss or certain other kinds of losses.”

The following may thus be declared as beneficiaries:

1. Parents,

2. Siblings,

3. Legal spouse, or

4. Children, whether legitimate or illegitimate.
Beneficiary*

First NameLast Name
Date of Birth*

MonthDayYear
Relationship to You (Primary Insured)*
Please verify that you are human*
Should be Empty: