[INSURANCE] Personal Accident Insurance Sign-up Form

  • Personal Accident Insurance | Sign-up Form

    Magandang Araw, Bossing! Salamat sa iyong interes na kumuha ng Personal Accident Insurance. Para masimulan ang iyong pag-sign-up, fill-upan ang form na ito.

  • Data Privacy Consent

    In accordance with Data Privacy Act of 2012, its "Implementing Rules and Regulations" and our Company Data Privacy Policies, you hereby authorize Lala Automotive Philippines Inc. and our participating insurance providers to know, collect, and process your personal information through this sign-up form.

    Thank you! If you AGREE, please click NEXT. 

  • Personal and Vehicle Information

    Please input the necessary information
  • Format: (0000) 000-0000.
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  • Beneficiary

  • Consent and Confirmation

    This is to confirm that the information provided are true and accurate. I hereby authorize Lala Automotive Philippines, Inc. to use my personal information for this program. I understand that any incorrect information I provided will lead to automatic rejection of my application. Click SUBMIT to confirm.
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