Appeal Letter – Current Inforced Policy Exclusion Or Loading

Form Name:
REQUEST FOR CONTRACTUAL CHANGES WITH HEALTH DECLARATION  ( PSF02 )

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Remark
– For Appeal, policy must inforce at least ONE year

Policy Owner Address.

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MENARA GREAT EASTERN
303, JALAN AMPANG,
50450 KUALA LUMPUR.                                                                                                                                                                     DD/MM/YYYY

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Attention: Policy Processing Department

Dear Sir/ Madam,

Appeal for (Removal of Exclusion Clause/ Cancel of Loading)  for

Policy No: XXXXXXXXX

The policy above refers.

(Exclusion Clause / Loading)  as per LCA:

(Kindly Copy Paste the Exclusion Clause or Loading  in the LCA)

 

Report Result:

(Write in the report result of client want appeal the Exclusion Clause or Loading)

 

 

Herewith attached the latest Kind of Report dated DD/MM/YYYY for your perusal.

Appreciate company may consider to (remove the exclusion clause / cancel loading)
since… (write the client body or health situation or condition want to appeal)

 

 

 

Thank you.

Yours faithfully,

 

…………………………………..
(Name)
NRIC:

– Submit above Form (PSF02) and Appeal Letter via ICM or CS counter.

– And also submit latest medical report for the appeal (If any)