- I declare that the above statement and answer are true and complete to the best of my knowledge and belief.
- I hereby authorise any hospital, clinic, person or organisation to disclose when requested to do so by HL Assurance Pte. Ltd., all information with respect to any illness, injury, medical history, consultations, prescription or treatments and copies of all hospital/medical records.
- I authorise to disclose information about the insured person if this claim is made on behalf of them.
- A photocopy of this authorisation shall be effective and valid as the original.
- I agree that the list of supporting documents required is not exhaustive and HL Assurance Pte. Ltd. reserves the rights to request from me any additional information or documentation.
- I agree that I have to bear the costs of providing medical reports or supporting documents to HL Assurance Pte. Ltd.
I, the claimant agree to abide by the terms and conditions, and agree that an electronic version of this authorisation shall be valid as original.