ebconnect.singlife.com
Open in
urlscan Pro
23.36.163.237
Public Scan
URL:
https://ebconnect.singlife.com/eb/ehd/?caseId=732E18C475C731AF9A9861D4B5B9EAEC&requestId=2CA26854D4CBA32AF3C9EAF66A352AA3291335...
Submission: On December 12 via manual from US — Scanned from NL
Submission: On December 12 via manual from US — Scanned from NL
Form analysis
1 forms found in the DOM<form _ngcontent-c3="" class="ng-tns-c3-0 ng-untouched ng-pristine ng-invalid" action="" novalidate="">
<div _ngcontent-c3="" class="flex mw-75">
<div _ngcontent-c3="" class="m-form-row"><label _ngcontent-c3="" class="a-label" for="caseId"><b _ngcontent-c3="" class="ng-tns-c3-0">Case Number:</b></label>
<div _ngcontent-c3="" class="m-form-row__content"><!----><input _ngcontent-c3="" class="a-textbox ng-untouched ng-pristine ng-invalid" name="caseId" placeholder="Enter your Case Number" required="" type="text"></div>
</div>
<div _ngcontent-c3="" class="m-form-row"><label _ngcontent-c3="" class="a-label" for="dob"><b _ngcontent-c3="" class="ng-tns-c3-0">Insured Person Date of Birth:</b></label>
<div _ngcontent-c3="" class="m-form-row__content"><!----><input _ngcontent-c3="" class="a-date ng-untouched ng-pristine ng-invalid" name="dob" placeholder="dd/mm/yyyy" required="" type="date"></div>
</div>
</div>
<div _ngcontent-c3="" class="btn-container"><button _ngcontent-c3="" class="a-button a-button--primary mb-40" type="button">Proceed</button><span _ngcontent-c3="" class="m-show-more-button ng-trigger ng-trigger-toggleHelpText"
style="height: auto; opacity: 1;">
<div _ngcontent-c3="" class="m-show-more-expand a-button a-button--tertiary a-button__icon" aria-controls="#helpText" aria-describedby="helpText" aria-expanded="false" href="#helpText"><span _ngcontent-c3="" class="a-button__inner">Can't find
Case Number?</span></div>
</span></div>
<div _ngcontent-c3="" class="helpText ng-trigger ng-trigger-toggleHelpText" style="height: 0px; opacity: 0; overflow: hidden;">
<div _ngcontent-c3="" class="img-container"><img _ngcontent-c3="" class="ng-tns-c3-0" alt="" src="assets/img/case-number-sample.png"></div><span _ngcontent-c3="" class="m-show-more-button">
<div _ngcontent-c3="" class="m-show-more-contract a-button a-button--tertiary a-button__icon" aria-describedby="helpText" aria-expanded="true" href="#"><span _ngcontent-c3="" class="a-button__inner">Close</span></div>
</span>
</div>
<div _ngcontent-c3="" class="m-form-row m-0"><!----></div>
</form>
Text Content
This site uses cookies to provide you with a better user experience. By continuing, you accept our cookie policy. Accept and close * Skip to content Electronic Health Declaration WELCOME -------------------------------------------------------------------------------- ELECTRONIC HEALTH DECLARATION TO CONTINUE, PLEASE ENTER YOUR CASE NUMBER AND DATE OF BIRTH FOR VERIFICATION. Case Number: Insured Person Date of Birth: Proceed Can't find Case Number? Close * Terms of Use * Privacy Policy * Cookie Policy * Personal Data Protection * Security Practices * NFPMPA0317 11/2015 * © 2018 Singlife with Aviva Please wait Session Expired. Please click on the link in your email to restart the health declaration process. FOR BEST VIEWING EXPERIENCE, PLEASE USE GOOGLE CHROME TO ACCESS THIS WEBSITE.