GPA Application

You must check the information you have provided is complete and accurate. You should also disclose all relevant information which may influence the Company in the acceptance of this insurance, decide the terms and the premium you will pay

*** Insert your Name or Passport No. to the payment reference when making online banking transfer.

NUTP Member No. *

Name as in IC *

IC No. *

Religion *

Marriage Status *

Contact Email *

Please fill in Email Address You actively using to get future updates.

Contact Phone *

Occupation *

Exact Duty *

Employer Name *

Nature of Business *

Work Address *

Office No. *

Include Spouse?

Include Children?

Select Payment Method *

Signature

Upon Signature, you are agreed to the Privacy Notice, and consent to share the data to specific third party.

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Remark: Once you have completed the payment process and submitted the form, you will receive the cover note within 1 - 2 working days via email. If you do not receive the cover note, kindly contact us at https://thefars.com/#contact-us

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