COLLECTION, USE AND DISCLOSURE OF PERSONAL DATA

We generally do not collect your personal data unless (a) it is provided to us voluntarily by you directly or via a third party who has been duly authorised by you to disclose your personal data to us (your “authorised representative”) after (i) you (or your authorised representative) have been notified of the purposes for which the data is collected, and (ii) you (or your authorised representative) have provided written consent to the collection and usage of your personal data for those purposes, or (b) collection and use of personal data without consent is permitted or required by the PDPA or other laws. We shall seek your consent before collecting any additional personal data and before using your personal data for a purpose which has not been notified to you (except where permitted or authorised by law).


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COMPANY CONTACT

Attached a copy of your current policy's benefit schedule. We will use the existing benefits as a starting point to improve the proposed program.

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Phone

EXISTING POLICY

Dependents Coverage*

When is the current policy's expiration date?

Current Insurer*

Which insurance company currently provides the employee benefits?

Number of Employees*

TYPE OF BENEFITS

Which benefits are included?

Which benefits are included?

Which benefits are included?

EMPLOYEE DETAIL 1

Minimum 02 members to starts a policy

Employee 1*
Employee 1 Gender*
Employee 1 Occupation*
  • Indoor Admin - Accounts, Admin,
  • Indoor Manual - Storeman, general worker in workshop, tea lady,
  • Outdoor Admin - Sales,
  • Outdoor Manual - Deliveryman, Driver, technician,
Employee 1 Classification*

EMPLOYEE DETAIL 2

Employee 2*
Employee 2 Gender*
Employee 2 Occupation*
  • Indoor Admin - Accounts, Admin,
  • Indoor Manual - Storeman, general worker in workshop, tea lady,
  • Outdoor Admin - Sales,
  • Outdoor Manual - Deliveryman, Driver, technician,
Employee 2 Classification*

EMPLOYEE DETAIL 3

Employee 3
Employee 3 Gender
Employee 3 Occupation
  • Indoor Admin - Accounts, Admin,
  • Indoor Manual - Storeman, general worker in workshop, tea lady,
  • Outdoor Admin - Sales,
  • Outdoor Manual - Deliveryman, Driver, technician,
Employee 3 Classification

EMPLOYEE DETAIL 4

Employee 4
Employee 4 Gender
Employee 4 Occupation
  • Indoor Admin - Accounts, Admin,
  • Indoor Manual - Storeman, general worker in workshop, tea lady,
  • Outdoor Admin - Sales,
  • Outdoor Manual - Deliveryman, Driver, technician,
Employee 4 Classification

EMPLOYEE DETAIL 5

Employee 5
Employee 5 Gender
Employee 5 Occupation
  • Indoor Admin - Accounts, Admin,
  • Indoor Manual - Storeman, general worker in workshop, tea lady,
  • Outdoor Admin - Sales,
  • Outdoor Manual - Deliveryman, Driver, technician,
Employee 5 Classification

EMPLOYEE DETAIL 6

Employee 6
Employee 6 Gender
Employee 6 Occupation
  • Indoor Admin - Accounts, Admin,
  • Indoor Manual - Storeman, general worker in workshop, tea lady,
  • Outdoor Admin - Sales,
  • Outdoor Manual - Deliveryman, Driver, technician,
Employee 6 Classification

EMPLOYEE DETAIL 7

Employee 7
Employee 7 Gender
Employee 7 Occupation
  • Indoor Admin - Accounts, Admin,
  • Indoor Manual - Storeman, general worker in workshop, tea lady,
  • Outdoor Admin - Sales,
  • Outdoor Manual - Deliveryman, Driver, technician,
Employee 7 Classification

EMPLOYEE DETAIL 8

Employee 8
Employee 8 Gender
Employee 8 Occupation
  • Indoor Admin - Accounts, Admin,
  • Indoor Manual - Storeman, general worker in workshop, tea lady,
  • Outdoor Admin - Sales,
  • Outdoor Manual - Deliveryman, Driver, technician,
Employee 8 Classification

EMPLOYEE DETAIL 9

Employee 9
Employee 9 Gender
Employee 9 Occupation
  • Indoor Admin - Accounts, Admin,
  • Indoor Manual - Storeman, general worker in workshop, tea lady,
  • Outdoor Admin - Sales,
  • Outdoor Manual - Deliveryman, Driver, technician,
Employee 9 Classification

EMPLOYEE DETAIL 10

Employee 10
Employee 10 Gender
Employee 10 Occupation
  • Indoor Admin - Accounts, Admin,
  • Indoor Manual - Storeman, general worker in workshop, tea lady,
  • Outdoor Admin - Sales,
  • Outdoor Manual - Deliveryman, Driver, technician,
Employee 10 Classification

CUSTOMISED PLAN

BENEFITS CLASSIFICATION

Director Benefits Included*

DIRECTOR AGE GROUP

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

How many directors are in this age bracket?

DIRECTOR BENEFITS

Choose the benefits that are required for directors.

Dir_GTL*

Do you want to include Group Term Life? For Directors?

DIRECTOR - GTL BENEFIT

Number of directors to be covered for GTL

Sum Assured value for each director

(Eg: 500,000 for each director)

If sum assured is based on salary, input as "NA"

(Eg: 12, 24, 30, 36, 48) months per director

Total monthly salaries for all directors combined

(Eg: $31,000 per month for three directors)

Dir_GPA*

Do you want to include Group PA? - For Directors?

DIRECTOR - GPA BENEFIT

Sum Assured value for each director

(Eg: 500,000 for each director)

If sum assured is based on salary, input as "NA"

(Eg: 12, 24, 30, 36, 48) months per director

Total monthly salaries for all directors combined

(Eg: $31,000 per month for three directors)

Dir_GCI*

Do you want to include Group Critical illness Benefits? - For Directors?

DIRECTOR - GROUP CRITICAL ILLNESS BENEFIT

Sum Assured value for each director

(Eg: 100,000 for each director)

DIRECTOR - GROUP HOSPITAL BENEFIT

Dir_GHS*

Do you want to include Group Hospital & Surgical Benefits? - For Directors?

Dir_GHS R&B*

Type of Room & Board Benefits (Both Private and Government Restructured Hospitals)

DIRECTOR - GROUP OUTPATIENT BENEFIT

Dir_Outpatient*

Do you want to include Group Outpatient Benefits? - For Directors?

Manager Benefits Included*

MANAGER AGE GROUP

MANAGER BENEFITS

Choose the benefits that are required for managers

MANAGER - GTL BENEFIT

Mgr_GTL*

Do you want to include Group Term Life? For Managers?

Sum Assured value for each manager

(Eg: 300,000 for each manager)

If sum assured is based on salary, input as "NA"

(Eg: 12, 24, 30, 36, 48) months per manager

Total monthly salaries for all managers combined

(Eg: $25,000 per month for three managers)

MANAGER - GPA BENEFIT

Mgr_GPA*

Do you want to include Group PA? - For Managers?

Sum Assured value for each manager

(Eg: 300,000 for each manager)

If sum assured is based on salary, input as "NA"

(Eg: 12, 24, 30, 36, 48) months per manager

Total monthly salaries for all managers combined

(Eg: $25,000 per month for three managers)

MANAGER - GROUP CRITICAL ILLNESS BENEFIT

Mgr_GCI*

Do you want to include Group Critical illness Benefits? - For Managers?

Sum Assured value for each manager

(Eg: 50,000 for each manager)

MANAGER - GROUP HOSPITAL BENEFIT

Mgr_GHS*

Do you want to include Group Hospital & Surgical Benefits? - For Managers?

Mgr_GHS R&B*

MANAGER - GROUP OUTPATIENT BENEFIT

Mgr_Outpatient*

Do you want to include Group Outpatient Benefits? - For Managers?

Mgr_GP*
Mgr_Specialist*
Mgr_Dental*
Executive Benefits Included*

EXECUTIVE AGE GROUP

EXECUTIVE BENEFITS

Choose the benefits that are required for executives

EXECUTIVE - GTL BENEFIT

Exec_GTL*

Do you want to include Group Term Life? For Executives?

Sum Assured value for each executive

(Eg: 200,000 for each executive)

If sum assured is based on salary, input as "NA"

(Eg: 12, 24, 30, 36, 48) months per executive

Total monthly salaries for all executives combined

(Eg: 60,000 per month for fifteen executives)

EXECUTIVE - GPA BENEFIT

Exec_GPA*

Do you want to include Group PA? - For Executives?

Sum Assured value for each executive

(Eg: 200,000 for each executive)

If sum assured is based on salary, input as "NA"

(Eg: 12, 24, 30, 36, 48) months per executive


Total monthly salaries for all executives combined

(Eg: 60,000 per month for fifteen executives)

EXECUTIVE - GROUP CRITICAL ILLNESS BENEFIT

Exec_GCI*

Do you want to include Group Critical illness Benefits? - For Executives?

Sum Assured value for each executive

(Eg: 30,000 for each executive)

EXECUTIVE - GROUP HOSPITAL BENEFIT

Exec_GHS*

Do you want to include Group Hospital & Surgical Benefits? - For Executives?

Exec_GHS R&B*

EXECUTIVE - GROUP OUTPATIENT BENEFIT

Exec_Outpatient*

Do you want to include Group Outpatient Benefits? - For Executives?

Exec_GP*
Exec_Specialist*
Exec_Dental*
Non Executive Benefits Included*

NON EXECUTIVE AGE GROUP

NON EXECUTIVE BENEFITS

Choose the benefits that are required for non executives

NON EXECUTIVE - GTL BENEFIT

Non Exec_GTL*

Do you want to include Group Term Life? For Non Executives?

Sum Assured value for each non executive

(Eg: 100,000 for each executive)

If sum assured is based on salary, input as "NA"

(Eg: 12, 24, 30, 36, 48) months per non executive

Total monthly salaries for all non executives combined

(Eg: 100,000 per month for twenty five non executives)

NON EXECUTIVE - GPA BENEFIT

Non Exec_GPA*

Do you want to include Group PA? - For Non Executives?

Sum Assured value for each non executive

(Eg: 50,000 for each executive)

If sum assured is based on salary, input as "NA"

(Eg: 12, 24, 30, 36, 48) months per non executive

Total monthly salaries for all non executives combined

(Eg: 100,000 per month for twenty five non executives)

NON EXECUTIVE - GROUP CRITICAL ILLNESS BENEFIT

Non Exec_GCI*

Do you want to include Group Critical illness Benefits? - For Non Executives?

Sum Assured value for each non executive

(Eg: 25,000 for each non executive)

NON EXECUTIVE - GROUP HOSPITAL BENEFIT

Non Exec_GHS*

Do you want to include Group Hospital & Surgical Benefits? - For Non Executives?

Non Exec_GHS R&B*

NON EXECUTIVE - GROUP OUTPATIENT BENEFIT

Non Exec_Outpatient*

Do you want to include Group Outpatient Benefits? - For Non Executives?

Non Exec_GP*
Non Exec_Specialist*
Non Exec_Dental*

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