LETTER OF GUARANTEE

LETTER OF GUARANTEE (LOG) REQUEST

Services
STEP 1 OF 7
IMPORTANT NOTE
1. A Letter of Guarantee (LOG) will only be issued for inpatient hospital treatment and day surgery procedures performed at hospitals in Singapore.
2. It does not apply to any outpatient treatment.
3. Each LOG is valid for one patient, per valid hospital admission, or per valid day surgery.
4. You may request a LOG up to 2 weeks prior to your scheduled hospitalisation or day surgery.
5. To facilitate a smooth and timely assessment, please ensure all relevant supporting documents are completed and submitted at least 5 working days before the scheduled date for admission or surgery.

I. Applicable to private hospital only
• Please ensure the Attending Physician Form is completed if the admission or surgery takes place at a private hospital
• Attending Physician Form (download from here)

II. Get your documents ready for online application for LOG

Admission to a government structured hospital:
• Admission Authorisation Form / Financial Counselling Form / Care Cost Form which is provided by the hospital in preparation for your admission / surgery
• A copy of the referring letter from a General Practitioner / Physician to the Specialist doctor or hospital (if any)
• A copy of both the front and back of a valid work permit (For Maid / Foreign Worker Medical Policy)

Admission to a private hospital:
• Attending Physician Form
• A copy of the referring letter from a General Practitioner / Physician to the Specialist doctor or hospital (if any)
• A copy of both the front and back of a valid work permit (For Maid / Foreign Worker Medical Policy)
Make a Request
STEP 2 OF 7
PARTICULARS OF REQUESTER ⓘ
If I am not the policyholder, I confirm that I have obtained his/her/their consent to submit this request on their behalf. My agreement to this submission reflects the policyholder’s agreement as well.
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STEP 3 OF 7
PARTICULARS OF INSURED PERSON
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STEP 4 OF 7
MEDICAL AND TREATMENT DETAILS
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STEP 5 OF 7
UPLOAD DOCUMENTS
Total Size : 0 MB
(Please note: Total file size should be less than 20MB.)
Accepted file: PDF, Image and ZIP format.

#1. Admission Form
For Admission to a government structured hospital:
Admission Authorisation Form / Financial Counselling Form / Care Cost Form which is provided by the Hospital in preparation for your admission / surgery.

For Admission to a private hospital:
Attending Physician Form
Delete

#2. A copy of the referring letter from a General Practitioner/Physician to the Specialist doctor or hospital (if any)
Delete

#3. A copy of both the front and back of a valid work permit (for Maid / Foreign Worker Medical Policy)
Delete
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STEP 6 OF 7
LETTER OF INDEMNITY

Please click the button below to read the Letter of Indemnity.
You must read and agree the Letter of Indemnity before you can continue.

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STEP 7 OF 7
PERSONAL DATA COLLECTION STATEMENT

To evaluate, process and administer this application or transaction, it is necessarily for us to collect, use, disclose and / or process your personal data or personal information about you. Such personal data includes information collected in this form, or in any document provided, or to be provided to us by you or processed by us, or from other sources.

A. Purpose of Collection

The personal data belonging to you and your insured/s may be collected, used and disclosed for the purposes of:
1. carrying out identity checks;
2. deciding whether to insure or continue to insure you and your insured persons;
3. providing advice for product recommendation based on your profile;
4. processing any claims under your policy, including the settlement of claims and any necessary investigations relating to the claims;
5. communicating on any matters relating to the services and / or products which you are entitled to under this policy;
6. respond to your inquiries or instructions and providing ongoing services, under your policy;
7. make or obtain payments and recovering any debt owed to us;
8. detecting and preventing fraud, unlawful or improper activities;
9. conducting market research and statistical analysis;
10. coaching employees for customer service quality assurance;
11. reinsuring risks and for reinsurance administration; and
12. complying with all applicable laws, including reporting to regulatory and industry entities.

B. Disclosure of Data

The personal data belonging to you and your insured/s may be disclosed for the purposes set out in Section A above to the parties below:
1. Third party service vendors, suppliers, agents, reinsurers, or intermediaries;
2. Medical Professionals and Institutions;
3. Local or overseas service third party vendors that provide us with services such as printing, mail distribution, data storage, data entry, marketing and research, disaster recovery or emergency assistance services;
4. Debt collection agencies;
5. Dispute resolution parties;
6. Parties that assist us to investigate, administer and adjudicate claims;
7. Financial institutions;
8. Credit reference agencies;
9. Industry associations; and
10. To any regulatory, government and statutory body to comply with applicable, laws or regulation or upon their valid request.

C. Personal Data Access and Amendments

You can request access to your personal data collected by us, and to make any corrections to your personal data so as to keep it updated. We may charge you a reasonable fee for providing you with the service.

D. Withdrawal Option of the collection and use of your personal data

You may make your request to withdraw your consent, access or correct your personal data by writing to: The Data Protection Officer, EQ Insurance, 5 Maxwell Road, #17-00 Tower Block, MND Complex, Singapore 069110. Alternatively, you can email to dpo@eqinsurance.com.sg.

Neither EQ Insurance nor any of its employees shall be liable for any loss or damage suffered by you or any user as a result of any disclosure of any personal data which you have consented to us and / or any of its employees disclosing.

Altering on this “Personal data collection statement” is strictly prohibited. Any attempt to do so will be of no effect.

DECLARATION, AUTHORISATION AND DATA PRIVACY CONSENT


1. All statements and answers provided in this form are complete, accurate, and true to the best of my/our knowledge and belief.
2. I/We understand that any false or fraudulent statements, as well as any attempt to conceal material facts related to this submission, may result in the forfeiture of all rights to claim under the policy. In such instances, EQ Insurance Company Limited (“EQI”) reserves the right to report the matter to the relevant authorities for further investigation.
3. In instances where I/we am/are not the policyholder, or where the policy is a corporate policy, I/we confirm that I/we have been duly authorised by the insured member(s) (hereafter referred to as the “Insured”) to provide relevant information for this submission. I/We accept full responsibility for the accuracy and validity of the information submitted and agree to indemnify EQI against any losses or claims arising therefrom.
4. I/We authorise and consent to the release of any and all relevant information, as requested by EQI or its authorised representatives, from hospitals, doctors, individuals, or organizations that have provided medical care, conducted examinations, or maintain medical records for me/insured. This includes, but is not limited to, information regarding illnesses, injuries, medical history, consultations, prescriptions, treatments, and related records or certifications. In the case of a corporate policy, I/we confirm that I/we have obtained the necessary consent from the relevant Insured(s) for the release of such information. A photocopy of this authorisation shall be considered as valid as the original.
5. I/We agree that EQI and my employer reserve the right to recover any outstanding amounts in the event that my total medical expenses exceed the policy coverage and/or are not covered under the policy.
6. I/We hereby grant permission and consent to EQI for the collection, usage, disclosure, and processing of my/our personal data. Additionally, I/we authorise the sharing of such pertinent information with EQI’s authorised representatives, intermediaries, third-party service providers, reinsurers, legal entities involved in the claims process, government/regulatory bodies, industry associations, courts, and other dispute resolution forums, for the purposes and uses described in EQI's Personal Data Protection Statement available at www.eqinsurance.com.sg which is in alignment with legal, regulatory obligations, and risk management procedures.
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