Guarantee Letter Application

Please fill the form up together with the requirement attactment. Once submitted, we will process it and be in touch with you. We are continously improving our digital journay experience for you, so please suggest feedback to better to better improve our services.

Patient Information

Select Hospital *

Title *

Full Name*

NRIC/ Passport no.*

Phone Number

+60

Please upload the front of NRIC for registration*

Please upload the back of NRIC for registration*

Email*

Date of Birth*

Gender *

Insurance / Company Name : *

(It is advisable for patient to upload the image of your Medical Card copy in the supporting document field.)

GL Recipient *

Hello, I'm Aira, your virtual assistant from KPJ.
How can I CARE for you today?