Enrolment Page

01 applications form

Child Insured Applications form

Parent / Payor Name as in Identity Card

Mobile tel

Office tel (optional)

Kad Pengenalan

E-mail address

Citizenship

Gender

Race

Height (cm)

Weight (kg)

Occupation

Nature of Work

Monthly Income (RM)

Employment

Source of Income

Religion

Method of Payment

Savings Account Number (for claim payment purposes)

Bank Name

Mailing Address

Company Name & Address

Kad Pengenalan (Front)

Kad Pengenalan (Back)

Debit Card (Front Only)

illness history diagnosed by hospital (if any)

Name of Child Insured as in Identity Card

MyKid / IC Number

Religion

Weight (kg)

Height (cm)

Gender

Citizenship

MyKid / IC (Front)

MyKid / IC (Back)

Surat Beranak (Birth Certificate)

Illness history diagnosed by hospital (if any)

press submit & sign below

02 e-signature

e-sign your applications below

your applications will be processed immediately

Thank You for Choosing us

We are the only Malaysia life insurer company that helps Malaysians, forever for you.

MCIS Life is Comply with Personal Data Protection Act PDPA 2010
the form is strictly used for MCIS life product sign up only.

Macoob CARE

Enrolment Page

01

applications form

Child Insured Applications form

02

e-signature

e-sign your applications below

Thank You for Choosing us

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