Employee Benefits Quote Business Details Contact Person Name Contact Number Email Company Name Office Address Description of Business Period of Coverage From Period of Coverage Ends Presently Insured? Please chooseYesNo Existing Insurer Total Number of Employees No. of Employees to be Insured? Insurance Coverage Benefits | Life Insurance Group Term Life (GTL) Group Personal Accident (GPA) Group Critical Illness (GCI) Group Disability Income (GDI) Benefits | Medical Group Hospital & Surgical (GHS) Group Major Medical (GMM) Benefits | Others Group Outpatient (GCO) Group Specialist (GSO) Dental Maternity Are there any members currently in hospital or requires frequent admission (e.g. hospital admission more than 2 times per year) to hospital? Please chooseYesNo If Yes, kindly provide more details: Has any member suffered or is suffering from any serious condition such as cancer, organ failure, heart disease, stroke, liver disorder, arthritis or any other disorder that causes progressive irreversible functional or physical disability? Please chooseYesNo If Yes, kindly provide more details: Is there any member based outside Singapore? Please chooseYesNo If Yes, kindly provide more details: Are there any limitations or exclusions imposed on the coverage on any members? Please chooseYesNo If Yes, kindly provide more details: Is there any member engaged in hazardous occupation? Please chooseYesNo If Yes, kindly provide more details: To the best of your knowledge, is there any member engaged in hazardous sports? Yes / No (Hazardous sports eg. scuba diving, motor racing, bungee jumping etc.) Please chooseYesNo If Yes, kindly provide more details: Other Notes/Information Please upload your existing policy. I/we hereby understand that I/we need to disclose our personal data in order for the Avant GIS team to generate a quotation for me/us. I/we have read the Privacy Policy and I/we consent to the collection and use of my/our personal data in accordance with its Privacy Policy. Submit
