27/09/2021

STANDARD LETTER OF QUERY

DC Rep : 6719560 KUALA LUMPUR SHAMALA A/P SELVAM

Imm : 5790185 KUALA LUMPUR KANGAIYAMMA A/P ARUMUGAM
GSM/ FA : 5790185 KUALA LUMPUR KANGAIYAMMA A/P ARUMUGAM

Dear Sir/Madam

Proposal No :KUL/69352/21 Policy No : 1048216404

Name of Proposer/Grantee :MR GANESAN A/L NILAMEGAN
Name of Life to be Assured : MISS MAYUREE A/P GANESAN (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).
PLS ASSIST THE PROPOSER TO OBTAIN THE M.A.R. DIRECTLY FROM THE DR BY HAVING THE
CLINICAL ABSTRACT APPLICATION DULY COMPLETED (Question to Agent/ FAR).
M.A.R ON BORN PREMATURITY WITH BIRTH WEIGHT 1.75KG. DOCTOR TO COMMENT ON THE
UP-TO-DATE FOLLOW UP FINDING AND DETAILS, ANY ABNORMALITY /COMPLICATION DURING
FOLLOW UP WITH EXACT DIAGNOSIS, ANY HISTORY OF ADMISSION, ANY TREATMENT GIVEN, ANY
COMPLICATION, GROWTH AND DEVELOPMENTAL MILESTONE, PROGNOSIS AND CURRENT
CONDITION AND COPY OF ALL INVESTIGATION REPORTS FOR MAYUREE A/P GANESAN (Question to
Clinic).

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

OTHER QUERY
PLEASE FURNISH US COMPLETE AND UP-TO-DATE CHILD HEALTH BOOK WITH ALL DETAILS OF
FOLLOW UP RECORD UNTIL CURRENT DATE FOR REVIEW. (Question to Life Assured 1).
PLEASE FURNISH US COPY OF DISCHARGE SUMMARY AND ALL INVESTIGATION REPORT DONE FOR
ADMISSION DUE TO VIRAL FEVER AS DECLARED IN PROPOSAL FORM FOR REVIEW. (Question to Life
Assured 1).

We reserve the right to call for additional underwriting requirements if the above are not complied within 14 days

Page 1 of 4
Proposal No :KUL/69352/21 Policy No :1048216404

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
 27/09/2021

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

LEE PEK YOKE ( TEL. NO.: 603-42598111 )

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

Page 2 of 4
Proposal No :KUL/69352/21 Policy No :1048216404

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
 27/09/2021

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

PROPOSAL NO. :KUL/69352/21 POLICY NO. : 1048216404
LIFE TO BE ASSURED : MISS MAYUREE A/P GANESAN

*********************************************************************************************************************
* 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. Please reconfirm on your height(cm) and weight(kg).

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.

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 4
Proposal No :KUL/69352/21 Policy No :1048216404

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
 27/09/2021

ATTENDING DOCTOR

Dear Doctor

Medical Attendant's Report

On The Life Of : MAYUREE A/P GANESAN
Identity Card No : 200920-08-0354
Life Assured's Party Id type : NEW MALAYSIAN IC
Our Proposal No : KUL/69352/21 Policy No : 1048216404
_______________________________________________________________________________________

The abovenamed has applied for life insurance with our company and it was stated in his/her proposal that
he/she was under your care for treatment of

BORN PREMATURITY WITH BIRTH WEIGHT 1.75KG. DOCTOR TO COMMENT ON THE UP-TO-DATE
FOLLOW UP FINDING AND DETAILS, ANY ABNORMALITY /COMPLICATION DURING FOLLOW UP WITH
EXACT DIAGNOSIS, ANY HISTORY OF ADMISSION, ANY TREATMENT GIVEN, ANY COMPLICATION,
GROWTH AND DEVELOPMENTAL MILESTONE, PROGNOSIS AND CURRENT CONDITION AND COPY OF
ALL INVESTIGATION REPORTS

We shall be pleased if you would furnish us the necessary medical report giving full details of the
illness/operation etc., so that we are able to assess the risk more accurately. Enclosed is a letter of
authorisation from the abovenamed.

We look forward to receiving the required medical report soonest.

Yours faithfully

LEE PEK YOKE ( TEL. NO.: 603-42598111 )

VICE PRESIDENT & HEAD
KUALA LUMPUR BRANCH

This is a computer generated letter which requires no signature.

Page 4 of 4
Proposal No :KUL/69352/21 Policy No :1048216404

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