AXA Insurance Form

Please download the following pdf file(s) for more information on the type of travel insurances available. Kindly fill up the form below to request for purchase of your chosen travel insurance. If you have more than 3 person to be insured, please submit first form and fill up a second form with the same information for ‘Details (Insured Person #1)’ section.

Proposal Form


  1. STATEMENT PURSUANT TO SECTION 149(4) OF THE INSURANCE ACT 1996, MALAYSIA: You are to disclose in this proposal from, fully and faithfully all the
    facts which you know or ought to know, otherwise the policy issued hereunder may be void.
  2. The personal data submitted by and collected from you may be used by us and/or any company within the AXA Group of companies and/or any of its
    associated companies, within or outside Malaysia, for administration or direct marketing purposes and in this connection, we may transfer or disclose that
    information to any of those other companies. We will cease to use the Personal Data for direct marketing purposes if you request us to do so. For further
    details, please refer to our “Data Privacy Notice” stipulated on our website.
  3. Family Plan includes you, your spouse and all your children accompanying you.
  4. Cash/Cheque/Credit card payment must accompany this application.
  5. Proof of Purchase/Bills/Documentary Evidence is required for all claims.
  6. Any extension of the cover is not allowed during the trip or after you have departed for your destination.
  7. Maximum age of the applicant is below 80 years old.


All questions must be fully answered – ticks and dashes will not suffice. Please write in block letters and tick (/) as appropriate.



Insured Person #1

Marital Status:

Choice of Benefit:

Choice of Plan:

Premium (RM)


Insured Person #2

Marital Status:

Choice of Benefit:

Choice of Plan:

Premium (RM)


Insured Person #3

Marital Status:

Choice of Benefit:

Choice of Plan:

Total Premium (RM)


Details (Insured Person #1)




A journey shall include return to Malaysia during the Period of Insurance except for ‘One-way’ travel.

One-way Travel: Yes No 
Type of Travel: Business Leisure/Social 
Period of Travel: From To
Length of Trip: (both days included)
Area of Travel: 1 2 3 


I/We hereby nominate the following as my/our nominee(s). (Please nominate according to the numbering order on Part A)
In accordance to Section 166 of the Insurance Act 1996, Malaysia, nominee(s) should be spouse, child or parent(s) if there is no spouse or child at the time of making this nomination. A nominee of Muslim policy owner upon receipt of policy money shall distribute the policy money in accordance with the Syariah law.


I am/We are in good health, free from physical impairment of deformity and I am/we are not travelling for the purpose of obtaining medical treatment or travelling against the advice of any medical practitioner. I/We understand no refund of premium is granted once travel certificate is issued.




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  •    Phone: +60377282033

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About Us

Triways Travel Network (M) Sdn Bhd was founded in the year 1981 with over 35 years of experience in the travel and tourism industry. We are committed to our motto, ‘Triways Presents The World’, and we specialize in ticketing, inbound, outbound, UMRAH, MICE, travel insurance and other travel related services. We are licensed by the government under MOTAC and is a member of MATTA and Lufthansa City Center. Triways Travel Network (M) Sdn Bhd is an expert in providing a one-of-a-kind experience for our clients to their desired destination. Our tailor-made packages have successfully won the hearts of our valued customers over the years. Travel with Triways and experience an unforgettable vacation of your dreams!

Contact Us


List of Awards

  • Diamond Award for Outstanding Sales Achievement (2005-2013)
  • Abacus Ruby Award – Top Booking Performance (2003)
  • Abacus Pearl Award – Top Booking Performance (2004)
  • Amadeus – Best Performance (2006/2007)
  • Amadeus – Top Achiever Award (2009/2010)
  • Top Agent Award from Korean Airlines (2013)
  • Top Agent Award from Air Astana (2014)