PRODUCT ENQUIRY FORM
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  Thank you for your interest in Great Eastern's range of life insurance plans.  
  If you wish to find out more about a particular plan, kindly contact us at the Marketing Hotline  
  at 1300 1300 38 or email us at marketing@lifeisgreat.com.my or complete the form below:  
     
 
     

Designation*
:  
Full Name*
:  
Date of birth* (DD/MM/YYYY)
:  

NRIC (Old)
:  
NRIC (New)*
:  --
Contact Number*
:  -
Contact Number (Home)
:  -
Contact Number (Office)
:  -
Email*
:  
Address
:  
     
Postcode
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Town / City*
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State*
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Product Enquiry*
:
Life Protection Investment-Linked / Savings
Critical Illness Coverage Medical & Health
Retirement Education
Product Name (if any)
:  
Preferred Language
:  
Do you have any life insurance coverage with Great Eastern?*
:  
Comments (max. 300 characters)
:  
     
Field marked * are compulsory.

 

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