Date : 24/02/2024 Confidential

Claim ID : 8493533 PIC : FAZEELAH BEGUM BINTI MOHAMAD SALIH

Hospital : Pantai Hospital Kuala Lumpur Fax No :

Etiqa Family Takaful Berhad

ATTN:ADMISSION DEPT
Group
Dear Sir/Madam,

OUTPATIENT SPECIALIST GUARANTEE LETTER

Patient Name : YOGESWARY AP GUNARATHANAM
Patient NRIC No. : 890402075484
Employee Name : YOGESWARY AP GUNARATHANAM
Certificate Number: TOPW000075
Company Name : 1MILLENNIUM INTERNATIONAL SDN BHD
Treatment Date : 15/02/2024
Diagnosis : Ovarian dysfunction
Referral Diagnosis : ‐
Attending Doctor : VIJAY ANANDA PARAMASVARAN
Remarks : TOP UP AMOUNT APPROVED RM1102.10 (TOTAL EXCESS :RM 362.5 TESTOSTERON LEVEL (RM114.50) THYROID PROFILE (RM94) VITAMIN D (RM154)

This is to confirm that we guarantee the medical expenses in connection with the outpatient treatment of the above‐mentioned patient,
up to a limit of RM 500.00

If the above limit is insufficient, pls send us the bill for a top up GL subject to available balance limit.

Important Terms:‐
1. Items not related to treatment of the above diagnosis are NOT covered.
2. Vitamins/ Supplements are NOT covered.
3. Vaccination & Immunization are NOT covered.

Please send in the following for bill payment to our address stated below;
1. Outpatient Guarantee Letter
2. Original bill

Thank you.

Yours faithfully,

Nur Shahirah Ng
Head, Medical and Staff Claims
Etiqa Family Takaful Berhad

To be completed by Attending Doctor (MUST be completed for payment)

Diagnosis :