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Covers up to RM80,000
3-minute sign-up, cancel anytime!
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I hereby consent to opt-in for the free coverage and agree to be contacted if necessary for verification or servicing purposes. |
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By clicking the “Activate” button below, you hereby express your consent to share your Personal Data, agree to receive marketing, promotional and cross sell offers, accept the Privacy Policy and read the Product Disclosure Sheet (PDS). |
FATCA (US Foreign Account Tax Compliance Act) Declaration
Are you a US Tax obligated person? Click here to read more about FATCA Declaration.
Common Reporting Standard (CRS) Declaration
Are you currently a Tax resident outside Malaysia? Click here to read more about Common Reporting Standard Declaration. (Note: Only applicable to a policy which is subject to the OECD Common Reporting Standard)*
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No, I am currently solely a Tax Resident in Malaysia |
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Yes, I am currently a Tax Resident of the following countries: (Please fill the Foreign Tax Residency Self-certification Form) |
Member And/Or Life(S) To Be Assured Declaration
The term “Company” shall refer to Great Eastern Life Assurance (Malaysia) Berhad.
The terms “we/us/our” shall refer to the Life(s) to be Assured, if any.
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I/We have read and agree to the Beneficial Owner, FACTA, and CRS Declaration for Member and Life(s) to be Assured |
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I/We have read and fully understand the terms, product benefits, exclusions, premiums, fees and charges as set out in the Product Brochure, Product Disclosure Sheet, Terms and Conditions, and Important Notice. |
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I/We understand that this information will be used as the basis and an integral part of the policy to be issued, and any false information may result in the nullification of coverage and rejection of any claims by the Insurer. |
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I/We would like to receive updates and information about the Company, products, services, promotions, charitable causes or other marketing information from relevant third parties of the Company. |
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I/We understand and agree that the Company may ask for supporting documents for the purposes of identification and to verify my relationship with the Life(s) Assured. I understand and agree that the Company may not process my application if I fail to provide the requested supporting documents within the time specified by the Company. |
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I acknowledge and agree that my application may be subject to further underwriting review. The insurer reserves the right to defer, postpone or decline my application based on the information provided, and I will be notified accordingly if further action or documentation is required.* |
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By clicking the "Next" button below, you hereby express your consent to share your Personal Data, agree to receive marketing, promotional and cross sell offers, accept the Privacy Policy and read the Product Disclosure Sheet (PDS) by the Business Partner.* |
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I/We hereby declare and confirm that the specimen signature and image of NRIC provided with this application is my/our signature and NRIC. I/We understand and agree that the specimen signature and NRIC provided with this application shall be used by the Company as basis for the approval of all transactions requiring my/our assent and/or signature, and for any other servicing or identity verification purposes. |
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I/We hereby confirm that the information, statements and answers in this application form together with any other documents submitted in connection with this application form and all statements made and answers given to the Company are complete and accurate (“the Information”). I/We understand that the Information given by me/us is relevant to the Company in deciding whether to accept my/our application or not, and the rates and terms to be applied. The Company may terminate or void the application (if issued), deny or reduce my/our claim, or change or vary the terms of coverage, if there is any non-disclosure, misrepresentation, misstatement, inaccuracy or omission. |
Beneficial Owner Declaration
Are you the beneficial owner who ultimately owns and/or has effective control over this proposed insurance?
If the answer is “NO”, please complete the Questionnaire On Beneficial Owner and submit it along with a Statutory Declaration signed by the beneficial owner. Please contact the Authorised Representative for a copy each of the Questionnaire On Beneficial Owner and the Statutory Declaration.
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Please proceed to activate and confirm the declaration. |
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