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GE - Authorization Form

The document is a letter from an insurance company requesting policyholders to complete an anti-money laundering form and appoint authorized personnel. It explains that the form must be completed by an executive and provides sections to provide details of up to three authorized personnel and their signatures.

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Yiki Tan
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156 views

GE - Authorization Form

The document is a letter from an insurance company requesting policyholders to complete an anti-money laundering form and appoint authorized personnel. It explains that the form must be completed by an executive and provides sections to provide details of up to three authorized personnel and their signatures.

Uploaded by

Yiki Tan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Dear Policyholder(s)

In compliance with the regulatory requirements on Prevention of Money Laundering and Countering the
Financing of Terrorism, kindly complete the below section and return the completed form to us at Menara
Great Eastern, Level 8 Group Insurance Department, 303 Jalan Ampang, 50450 Kuala Lumpur.

This form must be completed by a Person having the executive authority (i.e. Directors/ Partners)
in the company.

Appointment/ Authorization Notice

I _____________________________________ (Name in block letters) ____________________ (NRIC/


Identity No) hereby authorized the following personnel to sign on all types of insurance related forms/
documents from Group Insurance Department of Great Eastern Life Assurance (Malaysia) Berhad
(hereinafter referred to as “GELM”)

Full Name as per NRIC : ________________________________________


(Please provide Certified True Copy of NRIC/ Passport)

Designation : _________________________________________ Specimen of Signature

Residential Address : _________________________________________

_________________________________________

_________________________________________

Full Name as per NRIC : ________________________________________


(Please provide Certified True Copy of NRIC/ Passport)

Designation : _________________________________________ Specimen of Signature

Residential Address : _________________________________________

_________________________________________

_________________________________________

Full Name as per NRIC : ________________________________________


(Please provide Certified True Copy of NRIC/ Passport)

Designation : _________________________________________ Specimen of Signature

Residential Address : _________________________________________

_________________________________________

_________________________________________
If I wish to terminate this appointment/ authorization or appoint/ authorize a replacement or if
my appointed/ authorized personnel stated above is unable to act for any reasons whatsoever,
I shall immediately inform Group Insurance Department of GELM of the same and the
appointed personnel stated above shall immediately cease to have any authority to sign any
types of insurance related forms/ documents from Group Insurance Department on behalf of
the Company (Policyholder), until and unless I have delivered a duly signed new letter of
appointment to GELM . I shall sign and deliver to GELM a similar letter of appointment to
appoint/ authorise the Company’s (Policyholder) new personnel for the purpose of signing
documents in relation to policy purchased from Group Insurance Department of GELM.

___________________________________
Signature
Name:
Designation:
Company Stamp:

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