1) This document is an iPad insurance registration form for River Valley High School's 1-to-1 Learning Program for the year 2012. 2) It requires basic student and parent/guardian contact information as well as the iPad serial number to process the insurance through RIZKCARE ASSURANCE and Liberty Insurance. 3) The insurance provides 2 years of coverage for the iPad with a S$200 excess, and any claims will be handled directly between the parent/guardian and Liberty Insurance.

1. Year 2012, 1-to-1 Learning Program
RIZKCARE ASSURANCE(IPAD)
IPAD INSURANCE REGISTRATION FORM
Please take note:
** For submission, kindly bring along this form during collection of iPad. **
Payment of $171.20(WIFI) / $192.60(3G)* to be made upon collection and payable to “NCS
Pte Ltd”
* Cancel where necessary
For insurance enquiries, please contact Mr. Endy Ong at 96568375
or email to al.ong@rizksolutions.com or enquiries@rizksolutions.com
Website: http:// www.rizksolutions.net or www.libertyinsurance.com.sg
IMPORTANT NOTES: The information is necessary to process the insurance for the Apple iPad
Name of the School River Valley High School (Secondary)
Name of
1) NRIC No.:
Student:
CLASS :
2) Relationship:
Name of
Parent /
Guardian
Email address:
Home Contact:
Residential
Address
Mobile Contact:
3) Description: SKU/Part# Description Serial Number
4) Claim In the event of Claim, payment to be made to: Parent / Guardian
(please tick to select one) Student
Name of Parent / Guardian
(Please provide if Name differs from above)
___________________________ _________________________
Parent / Guardian Signature &
Parent / Guardian & NRIC Reference
NRIC
Date:
Policy Coverage: 2 Years Policy Excess: S$200
5)
Information
Notes:
It is important that all insurance claims / activities shall be made between the insured (Parent / Guardian
on behalf of student) and the insurer (Liberty Insurance).
For Officials Use: Liberty
6) Policy Number Start Date
(From Liberty) End Date