AXA Rewards Register & Win Campaign (November 2021)

Thank you for your interest in participating in AXA Rewards Register & Win Campaign. Please fill up this form to complete the campaign requirement. Should you be selected as one of the winners, we will contact you via email to inform on how to claim the prize.

By clicking the submit the form, you hereby agree to and accept the following terms and conditions of this campaign.

1. Insured's Full Name (as per NRIC) *This question is required.

2. Insured's NRIC *This question is required.

3. Insured's Contact Number

4. Email Registered for AXA Rewards Membership *This question is required. Please ensure the email address is correct. We will not be responsible for any errors in your email.

5. Are you an AXA Employee or AXA Partner (Agent)? *This question is required.