eTiQa Insurance & Takaful

Download Forms:

	Absolute Assignment Form

	Consent of Reassignment Form

	Declaration on Reinstatement of Golden Horizon Form

	Health Declaration Form

	Nomination Form

	Request for Change Form

	Statutory Declaration Form

Change of Address/Contact Details:

Duly completed Form/supplementary Document Required:
•	Request for Change Form or
•	You may email us at info@etiqa.com.my or
•	Call us via 1300 13 8888

New Nomination:

Duly completed Form/supplementary Document Required:
•	Nomination Form
•	Copy of Identity Card/Birth Certificate of nominee

Change in Nomination:

Duly completed Form/supplementary Document Required:
•	Nomination Form
•	Copy of Identity Card/Birth Certificate of new nominee

Duplicate Certificate (loss of original Certificate):

Duly completed Form/supplementary Document Required:
•	Request for Change Form or letter from Contract holder advising on current correspondence address and telephone no.
•	Statutory Declaration form signed in the presence of the Commissioner for Oaths (‘Pesuruhjaya Sumpah’)
•	Stamp duty RM10/- and
•	RM30/- administration fee

Change in Mode:

Duly completed Form/supplementary Document Required:

•

Request for Change Form

•	to be submitted about a month before the appropriate effective date, i.e. the next due date and one of the due dates must coincide with the anniversary of the commencement date of the certificate

•

Notification of Payment

For payment method via Biro Perkhidmatan Angkasa (BPA) that involves any changes to contribution the following is required:

•

Request for Change Form

•

Copy of Payslip

•

Copy of Identity Card

•

‘Borang Kelayakan 60%’

For all other payment methods that involves any changes to contribution:

•

Request For Change Form indicating change in contribution limit

•

For Standing Instruction, Contract Holder would need to advise the banker on any changes in contribution limit

Increase in Rider Sum Assured:

Duly completed Form/supplementary Document Required:

•

Request for Change Form

•

Health Declaration Form

•	to be submitted about a month before the certificate anniversary day

•

Notification of Payment

For payment method via Biro Perkhidmatan Angkasa (BPA) that involves any changes to contribution, the following is required:

•

Request for Change Form

•

Copy of Payslip

•

Copy of Identity Card

•

‘Borang Kelayakan 60%’

For all other payment methods that involves any changes to contribution:

•

Request For Change Form indicating change in contribution limit

•

For Standing Instruction, Contract Holder would need to advise the banker on any changes in contribution limit

Decrease in Basic Sum Assured:

Duly completed Form/supplementary Document Required:

•

Request for Change Form

•	to be submitted about a month before the next contribution due

For payment method via Biro Perkhidmatan Angkasa (BPA) that involves any changes to contribution the following is required:

•

Request for Change Form

•

Copy of Payslip

•

Copy of Identity Card

•

‘Borang Kelayakan 60%’

For all other payment methods that involves any changes to contribution:

•

Request For Change Form indicating change in contribution limit

•

For Standing Instruction, Contract Holder would need to advise the banker on any changes in contribution limit

Decrease in Rider Sum Assured:

Duly completed Form/supplementary Document Required:

•

Request for Change Form

•	to be submitted about a month before the next contribution due

For payment method via Biro Perkhidmatan Angkasa (BPA) that involves any changes to contribution the following is required:

•

Request for Change Form

•

Copy of Payslip

•

Copy of Identity Card

•

‘Borang Kelayakan 60%’

For all other payment methods that involves any changes to contribution:

•

Request For Change Form indicating change in contribution limit

•

For Standing Instruction, Contract Holder would need to advise the banker on any changes in contribution limit

Inclusion of Rider/s:

Duly completed Form/supplementary Document Required:

•

Request for Change Form

•

Health Declaration Form

•	to be submitted about a month before the certificate anniversary day

•

Notification of Payment

For payment method via Biro Perkhidmatan Angkasa (BPA) that involves any changes to contribution the following is required:

•

Request for Change Form

•

Copy of Payslip

•

Copy of Identity Card

•

‘Borang Kelayakan 60%’

For all other payment methods that involves any changes to contribution:

•

Request For Change Form indicating change in contribution limit

•

For Standing Instruction, Contract Holder would need to advise the banker on any changes in contribution limit

Deletion of Rider/s:

Duly completed Form/supplementary Document Required:

•

Request for Change Form

•	to be submitted about a month before the next contribution due

For payment method via Biro Perkhidmatan Angkasa (BPA) that involves any changes to contribution the following is required:

•

Request for Change Form

•

Copy of Payslip

•

Copy of Identity Card

•

‘Borang Kelayakan 60%’

For all other payment methods that involves any changes to contribution:

•

Request For Change Form indicating change in contribution limit

•

For Standing Instruction, Contract Holder would need to advise the banker on any changes in contribution limit

Partial Withdrawal:

Submit the completed Partial Withdrawal Forms as follow:
•	Duly completed Partial Withdrawal Form
•	Signed by Policy Owner
•	Certified True Copy of the Policy Owner identification Card
•	The Withdrawal will only be allowed on after the contract is in force for 3 years
•	A processing fee of RM15.00 will be charged for every withdrawal
•	Minimum sum should not be below RM100.00
•	Maximum amount withdraw should not exceed 80% of the Participant Account
•	Withdrawal can only be made one a year

Sarjana Intellectual Award:

Form to be completed
•	Intellectual Award Application Form duly completed and signed by Policy Owner and witnessed
•	Certified True Copy Exam Result’s Slip
•	Certified True Copy of the Policy Owner identification Card
•	Certified True Copy of the Life Assured identification Card

Others:
•	Only participants of Sarjana Plan is eligible to claim the Intellectual Award
•	The issue date of the plan should be prior to the Exam date and the certificate should be inforced until current date

Exam results eligible for Sarjana Intellectual Award as follow:
•	UPSR (5As) - RM500.00
•	PMR (8As) - RM750.00
•	SPM (8As) - RM1,000.00
•	STPM (5As)- RM1,000.00

Reinstatement:

Reinstatement is allowed within three years from the effective date of lapse. Documents required for all products:
•	Health Declaration form duly completed and signed by the participant, contract owner and witness
•	Full remittance of all outstanding contributions including reinstatement fee if any
•	Medical report if applicable (The expense is to be borne by policy owner.)

NOTE: The above are standard guidelines and when the need arises, the Company would request for further information/documents in accordance to company guidelines. Each request for change is subject to the terms and conditions of the respective policy. For any further assistance on above please get in touch with your agent or call our customer service at 1300 13 8888 or write in to info@etiqa.com.my.