Downloads

36 Critical Illness + Life + Saving

These forms are applicable for the schemes as below:-

  • Livin’ Pay GS2072
  • Livin’ Pay Plus GS115 / GS3545 / H2072
  • Dana Restu Plus GS140A
  • Dana Restu GS140
  • Barakah H2415
APPOINTMENT OR CHANGE OF NOMINEES

APPOINTMENT OR CHANGE OF NOMINEES FORM


CLAIM
Critical Illness

Brain, Nerve, Muscle Related Conditions
CONFIDENTIAL MEDICAL CERTIFICATE – DOCTOR
DIRECT CREDIT FACILITY FORM
LETTER OF AUTHORISATION OR CONSENT – Non-Death
LIVING ASSURANCE CLAIM FORM – CLAIMANT’S STATEMENT
CHECKLIST

Cancer
CONFIDENTIAL MEDICAL CERTIFICATE – DOCTOR
DIRECT CREDIT FACILITY FORM
LETTER OF AUTHORISATION OR CONSENT – Non-Death
LIVING ASSURANCE CLAIM FORM – CLAIMANT’S STATEMENT
CHECKLIST

Heart Related Conditions
CONFIDENTIAL MEDICAL CERTIFICATE – DOCTOR
DIRECT CREDIT FACILITY FORM
LETTER OF AUTHORISATION OR CONSENT – Non-Death
LIVING ASSURANCE CLAIM FORM – CLAIMANT’S STATEMENT
CHECKLIST

Other Illnesses
CONFIDENTIAL MEDICAL CERTIFICATE – DOCTOR
DIRECT CREDIT FACILITY FORM
LETTER OF AUTHORISATION OR CONSENT – Non-Death
LIVING ASSURANCE CLAIM FORM – CLAIMANT’S STATEMENT
CHECKLIST

Death

Death due to Accident
ACCIDENTAL DEATH BENEFITS CLAIM
DEATH CLAIM FORM – CLAIMANT’S STATEMENT
LETTER OF AUTHORISATION OR CONSENT – for Death
DIRECT CREDIT FACILITY FORM
CHECKLIST

Death due to Illness
DEATH CLAIM FORM – CLAIMANT’S STATEMENT
DEATH CLAIM FORM – DOCTOR’S STATEMENT
LETTER OF AUTHORISATION OR CONSENT – for Death
DIRECT CREDIT FACILITY FORM
CHECKLIST

Death Outside Malaysia or Singapore
DEATH CLAIM FORM – CLAIMANT’S STATEMENT
DEATH CLAIM FORM – DOCTOR’S STATEMENT
LETTER OF AUTHORISATION OR CONSENT – for Death
DIRECT CREDIT FACILITY FORM
CHECKLIST

Hospitalisation Benefit

DIRECT CREDIT FACILITY FORM
GROUP HOSPITALISATION BENEFIT (HB) CLAIM FORM- CLAIMANT’S

Partial and Permanent Disability

ACCIDENT CLAIM FORM ATTENDING PHYSICIAN’S STATEMENT – DOCTOR
ACCIDENT CLAIM FORM – CLAIMANT’S STATEMENT
DIRECT CREDIT FACILITY FORM
LETTER OF AUTHORISATION OR CONSENT – Non-Death
CHECKLIST

Total and Permanent Disability

Total and Permanent Disability due to Accident
TOTAL PERMANENT DISABILITY CLAIM – DOCTOR’S STATEMENT
TOTAL AND PERMANENT DISABILITY BENEFITS CLAIM FORM – CLAIMANT’S STATEMENT
LETTER OF AUTHORISATION OR CONSENT – Non-Death
DIRECT CREDIT FACILITY FORM
CHECKLIST

Total and Permanent Disability due to Illness
TOTAL PERMANENT DISABILITY CLAIM – DOCTOR’S STATEMENT
TOTAL AND PERMANENT DISABILITY BENEFITS CLAIM FORM – CLAIMANT’S STATEMENT
LETTER OF AUTHORISATION OR CONSENT – Non-Death
DIRECT CREDIT FACILITY FORM
CHECKLIST


CLAIM CHECKLIST

PARTIAL & PERMANENT DISABILITY CHECKLIST

TPD Claim Checklist

TOTAL AND PERMANENT DISABILITY DUE TO ILLNESS CHECKLIST
TOTAL AND PERMANENT DISABILITY DUE TO ACCIDENT CHECKLIST

Hospital Benefit Checklist

HOSPITAL BENEFIT (NITE STAY ONLY)
HOSPITAL BENEFIT (MED REIMB + NITE STAY)
HOSPITAL BENEFIT (IF USE PERSONAL MED CARD)
HOSPITAL BENEFIT (10% + RM200 + NITE STAY)

Death Claim Checklist

DEATH OUTSIDE MALAYSIA OR SINGAPORE CHECKLIST
DEATH DUE TO ILLNESS CHECKLIST
DEATH DUE TO ACCIDENT CHECKLIST

Critical Illness Checklist

CRITICAL ILLNESS DUE TO OTHER ILLNESS CHECKLIST
CRITICAL ILLNESS DUE TO HEART RELATED CONDITIONS CHECKLIST
CRITICAL ILLNESS DUE TO CANCER CHECKLIST
CI DUE TO BRAIN, NERVE & MUSCLE RELATED CONDITIONS CHECKLIST


HEALTH WARRANTY

HEALTH WARRANTY FORM


PARTIAL SURRENDER, FULL SURRENDER, EARLY MATURITY, REFUND

APPLICATION FOR SURRENDER OR PARTIAL SURRENDER, REFUND OF EXCESS PREMIUM, EARLY MATURITY
DIRECT CREDIT FACILITY FORM


MISC

REQUEST FOR PERSON CHANGES (GMBS)

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