To get a quotation, you may supply your information with the following form. If you have the renewal notice and claim record, you may also fax to us for a better rate.
TYPE
：
FAQ
Provide you with Hospital Cover and optional Out-patient Cover. You may also have a quotation on Income Protection Plan and Life Insurance Plan with the following data given to us.
Quotation Application Form
A.
Contact Information
Name
：
Mr
Ms
Email
：
Phone No.
：
Mobile No.
：
Fax No.
：
B.
Particular of insured data
Plan type
：
Hospital Cover
Hospital and Outpatient Cover
Starting Date
：
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
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25
26
27
28
29
30
31
d
1
2
3
4
5
6
7
8
9
10
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12
m
2002
2003
2004
2005
2006
2007
2008
2009
2010
y
Name of Applicant
：
Mr
Ms
Date of Birth
：
d
m
y
Sex
：
Male
Female
I.D. No. ：
Occupation
：
Name of Applicant
：
Mr
Ms
Date of Birth
：
d
m
y
Sex
：
Male
Female
I.D. No. ：
Occupation
：
Relation with First Applicant：
Name of Applicant
：
Mr
Ms
Date of Birth
：
d
m
y
Sex
：
Male
Female
I.D. No. ：
Occupation
：
Relationship with First Applicant：
Name of Applicant
：
Mr
Ms
Date of Birth
：
d
m
y
Sex
：
Male
Female
I.D. No. ：
Occupation
：
Relationship with First Applicant：
You may use the following to give us further information such as the address or claim record of past three years, etc
：
What is the scope of cover of a Medical Insuranc
e?
Please state the limitations of an ordinary Medical Insuranc
e?