GELFAAM Membership Update Form

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GELFAAM Membership Update Form

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To The Secretary General of GELFAAM

Email *

FULL NAME AS PER NRIC *

NRIC No. *

12 Digit number without "-"

MY GELM/GETB AGENT A/C NO. *

7 Digit number without "-"

PRESENT AGENCY RANK
*

GSM/GM NAME
*

GSM/GM AGENT A/C NO.

CORRESPONDENCE ADDRESS

MOBILE PHONE NO.
*

Min. 10 Digit number without "-"

PREFERRED GELFAAM BRANCH
*

Please select the branch in your area of residence/where you are active

DECLARATION

I hereby warrant that all information given above is true and complete. I understand that the Association reserves the right to decline an application with valid reason. I agree that any material omission of information known or ought to be known by me or the inclusion of any information that is false will be considered as sufficient reason for the rejection of this application or, subsequently, for an expulsion from membership.

Required

I hereby authorise GELFAAM to arrange to deduct and to receive from Great Eastern Life Assurance (Malaysia) Berhad / Great Eastern Takaful Berhad all dues relating to my membership in the Association.

Required

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A copy of your responses will be emailed to the address you provided.

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