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  • Head Office: Menara Great Eastern 303 Jalan Ampang 50450 Kuala Lumpur

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    This standard letter from Great Eastern Life Assurance requests additional medical requirements and questionnaires be completed for an insurance application. It notes that all medical requirements must be obtained at the applicant's expense. It also reserves the right to require further underwriting if the requested materials are not received within 14 days and that a health warranty may be required if more than 30 days pass from the application date. A supplementary questionnaire for the life to be assured asks several questions related to travel history and potential COVID-19 exposure or symptoms.

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    This standard letter from Great Eastern Life Assurance requests additional medical requirements and questionnaires be completed for an insurance application. It notes that all medical requirements must be obtained at the applicant's expense. It also reserves the right to require further underwriting if the requested materials are not received within 14 days and that a health warranty may be required if more than 30 days pass from the application date. A supplementary questionnaire for the life to be assured asks several questions related to travel history and potential COVID-19 exposure or symptoms.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    21 views3 pages

    Head Office: Menara Great Eastern 303 Jalan Ampang 50450 Kuala Lumpur

    Uploaded by

    soumya
    This standard letter from Great Eastern Life Assurance requests additional medical requirements and questionnaires be completed for an insurance application. It notes that all medical requirements must be obtained at the applicant's expense. It also reserves the right to require further underwriting if the requested materials are not received within 14 days and that a health warranty may be required if more than 30 days pass from the application date. A supplementary questionnaire for the life to be assured asks several questions related to travel history and potential COVID-19 exposure or symptoms.

    Copyright:

    © All Rights Reserved
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    of 3

    19/03/2020

    STANDARD LETTER OF QUERY

    DC Rep : 6212163 KUALA LUMPUR CHAN KIM SEONG


    Imm : 5858294 KUALA LUMPUR LIM YEN HEONG
    GSM/ FA : 5858294 KUALA LUMPUR LIM YEN HEONG

    Dear Sir/Madam

    Proposal No :KLO/14883/20 Policy No : 1034526616


    Name of Proposer/Grantee :MR SOUMYA RANJAN MISHRA
    Name of Life to be Assured : MADAM PRANATEE MISHRA (Life Assured 1)

    To enable us to process the above proposal, we would appreciate it if you could kindly arrange to complete the
    additional requirements as indicated below :

    MEDICAL REQUIREMENT
    ALL MEDICAL REQUIREMENTS ARE TO BE OBTAINED AT PROPOSER'S OWN EXPENSE (Question to
    Life Assured 1).

    QUESTIONNAIRES
    QUESTIONNAIRE FOR LIFE-TO-BE-ASSURED'S / PROPOSER'S COMPLETION (Question to Life Assured
    1).

    We reserve the right to call for additional underwriting requirements if the above are not complied within 14 days
    from the date of this letter.

    In all cases, a Health Warranty Tendering First Premium will be required if more than 30 days have elapsed
    since the date of proposal or medical examination, whichever is later.

    If you have any questions, please do not hesitate to contact us.

    Yours faithfully

    NG LI YAN ( TEL. NO.: 603-4259 8111 )


    VICE PRESIDENT & HEAD
    NEW BUSINESS
    This is a computer generated letter which requires no signature.

    Page 1 of 3
    Proposal No :KLO/14883/20 Policy No :1034526616

    Great Eastern Life Assurance (Malaysia) Berhad (93745-A)

    Head Office : Menara Great Eastern 303 Jalan Ampang 50450 Kuala Lumpur
    Tel (603)42598888 Fax (603)42598000 Careline 1300130088 Email wecare-my@greateasternlife.com Website www.greateasternlife.com
    19/03/2020

    SUPPLEMENTARY QUESTIONNAIRE TO BE COMPLETED BY LIFE TO BE ASSURED/PROPOSER


    PROPOSAL NO. :KLO/14883/20 POLICY NO. : 1034526616
    LIFE TO BE ASSURED : MADAM PRANATEE MISHRA

    *********************************************************************************************************************
    * IMPORTANT NOTICE: You are to disclose in this form, fully and faithfully, all the facts which you *
    * know or ought to know, otherwise the policy if issued hereunder may be *
    * invalidated. If you are in any doubt about whether certain facts are material, *
    * these facts should be disclosed. *
    *********************************************************************************************************************
    Please complete the following :

    1. Are you now in Malaysia?#

    2. Have you been travelling to, residing, working and/or studying in mainland China, Italy, Iran, South Korea, Spain,
    Germany, France for the past 1 month? If Yes, have you returned to Malaysia for more than 14 days?

    3. Are you currently being quarantined in relation to the COVID-19?#

    4. Are you currently suffering from any symptoms of the COVID-19?#

    5. Do you have intention to travel to mainland China, Italy, Iran, South Korea, Spain, Germany, France in the next 3
    months?##

    I certify that there has been no change in the condition of my health and that I have received no medical
    attention, consultation or examination whatsoever, since the date of completion of the said application for life
    assurance.

    I declare that the above answer(s) is/are true and complete to the best of my knowledge. I understand that the
    above statement shall form the basis of my proposed contract of assurance.

    Page 2 of 3
    Proposal No :KLO/14883/20 Policy No :1034526616

    Great Eastern Life Assurance (Malaysia) Berhad (93745-A)

    Head Office : Menara Great Eastern 303 Jalan Ampang 50450 Kuala Lumpur
    Tel (603)42598888 Fax (603)42598000 Careline 1300130088 Email wecare-my@greateasternlife.com Website www.greateasternlife.com
    19/03/2020

    Signature of Life to be Assured Signature of Proposer


    (if other than the Life to be Assured)
    Date: Date:

    Signature of Witness Signature of Witness


    Name: Name:

    NRIC No.: NRIC No.:

    Page 3 of 3
    Proposal No :KLO/14883/20 Policy No :1034526616

    Great Eastern Life Assurance (Malaysia) Berhad (93745-A)

    Head Office : Menara Great Eastern 303 Jalan Ampang 50450 Kuala Lumpur
    Tel (603)42598888 Fax (603)42598000 Careline 1300130088 Email wecare-my@greateasternlife.com Website www.greateasternlife.com

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