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Name of Company
Company Address
Postal Code
Country
Contact Person
Designation
Tel (Direct Line)
Fax
Mobile
Email
Total No. of Employees
No. of Management Staff
No. of Executives & Junior Managers
No. of Other Ranks
Nature of Business
Do you have an exisitng Group Insurance Plan?
Current Insurer
From (dd/mm/yyyy)
To (dd/mm/yyyy)
Group Basic Medical
Group Term Life
Group Personal Accident
Group Major Medical
Group Living Care
Group Outpatient
Current Annual Premiums
Group Basic Medical
Group Term Life
Group Personal Accident
Group Major Medical
Group Living Care
Group Outpatient
Group Employee Beneift Quotation (Singapore)
Company Details:
Current Group Insurance Details:
If yes please provide further details below...
Period of insurance:
Current Group Benefits (can tick as many as possible):
If your company is re-looking to restructuring the current group benefits, please indicate below at what would you like to consider so that we could plan in accordance to your company's needs. (please tick as many or as little as you like)