Group Hospitalisation & Surgical (GHS)

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Group Hospitalisation & Surgical (GHS) - Opt Out Form

Sila isikan butiran anda di bawah untuk menarik diri daripada polisi perlindungan 'Group Hospitalisation & Surgical (GHS) - MyMedKad by GrabInsure'.

Nota Penting:

Sekiranya anda ingin mendaftar semula ke dalam polisi sekali lagi, tempoh menunggu 30 hari akan dikenakan semula.

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Please fill in your details below to opt-out from the 'Group Hospitalisation & Surgical (GHS) - MyMedKad by GrabInsure' coverage policy.

Important notes:

Should you want to re-enrol into the policy again, the 30-day waiting period will apply again.

Nama Penuh | Full Name *

Mengikut Kad Pengenalan | According to IC

Jantina | Gender *

Lelaki | Male

Perempuan | Female

Nombor Kad Pengenalan | IC Number *

Tanpa '-' | Without '-'

Contoh format | Format sample: 900101101234

Alamat Emel | Email Address *

Yang didaftar dengan Grab | Registered with Grab

Sebab untuk Menarik Diri | Reason for Opt Out *

Sila kongsi dengan kami mengapa anda tidak lagi mahu dilindungi di bawah polisi insurans percuma ini.

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Please share with us why you no longer want to be covered under this free insurance policy.

Polisi ini tidak berguna kepada saya | The policy is not useful to me

Saya mahu daftar untuk polisi insurans lain | I want to opt in for other insurance policies

Other:

Dengan meneruskan, anda membenarkan maklumat peribadi anda untuk dikumpul, diproses dan dipindahkan oleh GrabCar Sdn Bhd dan/atau MyTeksi Sdn Bhd, MCIS Insurance Berhad dan ejen sah mereka atau pembekal perkhidmatan pihak ketiga untuk tujuan pendaftaran, pengurusan dan pentadbiran penyertaan anda dalam insurans Group Hospitalisation & Surgical (GHS) - MyMedKad oleh GrabInsure sebagai ahli yang diinsuranskan.

Grab dan MCIS Insurance Berhad akan memproses maklumat peribadi anda mengikut Notis Privasi Grab dan Notis Privasi MCIS Life, yang kedua-duanya anda akui bahawa anda telah membaca dan memahami sebelum meneruskan.

Anda juga mengakui bahawa anda tidak memberikan sebarang maklumat peribadi pihak ketiga kepada Grab dan MCIS Life tanpa mendapat persetujuan semua pihak yang terlibat.

By proceeding, you authorise your personal information to be collected, processed and transferred by GrabCar Sdn Bhd and/or MyTeksi Sdn Bhd, MCIS Insurance Berhad and their authorised agents or third-party service providers for the purpose of enrolment, management and administration of your participation in the Group Hospitalisation & Surgical (GHS) - MyMedKad by GrabInsure insurance as an insured member.

Grab and MCIS Insurance Berhad will process your personal information in accordance with the Grab Privacy Notice and the MCIS Life Privacy Notice, both of which you acknowledge that you have read and understood prior to proceeding.

You also acknowledge that you have not provided any third party personal information to Grab and MCIS Life without obtaining the consent of all parties involved.

Ya, saya setuju | Yes, I consent

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