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Advanced Hospitalisation Income Benefit Rider

Complete and submit your details below to attach this rider to your Group Multiple Benefits Insurance Scheme (GMBIS) plan!

Name (as per NRIC) *

NRIC No. *

Advanced Hospitalisation Income Rider Top-Up Amount (RM) *

Scheme Number *

Kindly refer to your servicing intermediary on the scheme number.

I consent to include this Advanced Hospitalisation Income Benefit Rider to my existing GMBIS plan and confirm that the information I have provided is complete and correct.

I consent to allow the Company to charge the additional premium as stated above using the same payment method as per my existing GMBIS plan.

Note: If the existing payment method is via auto-deduction from your bank account, please submit a new Direct Debit Authorization (DDA) form.

I consent to receive marketing communications from Great Eastern Life Assurance (Malaysia) Berhad and would like someone to contact me

The information which you have provided in this form may be used by Great Eastern Life Assurance (Malaysia) Berhad (the Company), its agents, and the related companies of the Company to keep you updated with important announcements, information and news about the Company, its products, services, promotions and offers from time to time. You may withdraw your consent to any of the above communications by calling Customer Service Careline at 1300-1300 88 or by writing to us at wecare-my@greateasternlife.com.

Important Notes:

1. *Guaranteed acceptance with no medical underwriting is available during Special Promotion period only. Kindly refer to your servicing intermediary on the availability of the promotion.

2. Customers with an existing hospitalisation benefit in their Group Multiple Benefits Insurance Scheme (GMBIS) plan are allowed to purchase this rider up to 0.1% of their basic sum assured, while those without an existing hospitalisation benefit in their GMBIS plan are allowed to purchase this rider up to 0.2% of their basic sum assured

3. Disclaimer: The information provided in this page is not an insurance contract. The descriptions of cover are a brief summary for quick and easy reference. Please refer to the Product Brochure, Product Disclosure Sheet, Policy Contract and FAQ for more information on the insurance plan. The Advanced Hospitalisation Income Benefit Rider is underwritten by Great Eastern Life Assurance (Malaysia) Berhad.

Terms and conditions apply.

This information is correct as at 17 April 2023.

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