MMT Care

Quotation

Please select the options below to determine your rate. Be advised that this rate is subject to change and is not considered final. For an accurate and binding quotation, kindly refer to the official document that will be sent to your email address upon submission of this form.
If you're looking for establishment quotation, click here
Primary Nature of Service
Limit of Liability (G)*
Limit of Liability (GP2)*
Limit of Liability (GP)*
Limit of Liability (GPR)*
Limit of Liability (GP-O&G)*
Limit of Liability (GP-Cos)*
Limit of Liability (Chiro)*
Limit of Liability (GD)*
Limit of Liability (GD2)*
Limit of Liability (Ortd)*
Limit of Liability (Ortd2)*
Limit of Liability (Perd)*
Limit of Liability (Perd2)*
Limit of Liability (Dent)*
Limit of Liability (Dent2)*
Limit of Liability (Endo)*
Limit of Liability (Endo2)*
Limit of Liability (Prostho)*
Limit of Liability (Prostho2)*
Limit of Liability (OrM)*
Limit of Liability (OrM2)*
Limit of Liability (OrP)*
Limit of Liability (OrP2)*
Limit of Liability (Aud)*
Limit of Liability (Aud2)*
Limit of Liability (Bld)*
Limit of Liability (Bld2)*
Limit of Liability (Ccyt)*
Limit of Liability (Ccyt2)*
Limit of Liability (Cgen)*
Limit of Liability (Cgen2)*
Limit of Liability (Ccim)*
Limit of Liability (Ccim2)*
Limit of Liability (ComH)*
Limit of Liability (ComH2)*
Limit of Liability (CosA)*
Limit of Liability (CosA2)*
Limit of Liability (Derm)*
Limit of Liability (Derm2)*
Limit of Liability (Endo)*
Limit of Liability (Endo2)*
Limit of Liability (FamMed)*
Limit of Liability (FamMed2)*
Limit of Liability (GenM)*
Limit of Liability (GenM2)*
Limit of Liability (GenitM)*
Limit of Liability (GenitM2)*
Limit of Liability (GeriM)*
Limit of Liability (GerimM2)*
Limit of Liability (Haem)*
Limit of Liability (Haem2)*
Limit of Liability (Immu)*
Limit of Liability (Immu2)*
Limit of Liability (InfD)*
Limit of Liability (InfD2)*
Limit of Liability (IntMed)*
Limit of Liability (IntMed2)*
Limit of Liability (Neph)*
Limit of Liability (Neph2)*
Limit of Liability (NucM)*
Limit of Liability (NucM2)*
Limit of Liability (OccuH)*
Limit of Liability (OccuH2)*
Limit of Liability (Onco)*
Limit of Liability (Onco2)*
Limit of Liability (Opht)*
Limit of Liability (Opht2)*
Limit of Liability (Paed)*
Limit of Liability (Paed2)*
Limit of Liability (Palia)*
Limit of Liability (Palia2)*
Limit of Liability (Patho)*
Limit of Liability (Patho2)*
Limit of Liability (PharmP)*
Limit of Liability (PharmP2)*
Limit of Liability (Physio)*
Limit of Liability (Physio2)*
Limit of Liability (PrevM)*
Limit of Liability (PrevM2)*
Limit of Liability (Psych)*
Limit of Liability (Psych2)*
Limit of Liability (RehM)*
Limit of Liability (RehM2)*
Limit of Liability (RenM)*
Limit of Liability (RenM2)*
Limit of Liability (Resp)*
Limit of Liability (Resp2)*
Limit of Liability (Rheum)*
Limit of Liability (Rheum2)*
Limit of Liability (SportM)*
Limit of Liability (SportM2)*
Limit of Liability (ThorM)*
Limit of Liability (ThorM2)*
Limit of Liability (AccE)*
Limit of Liability (AccE2)*
Limit of Liability (Anaes)*
Limit of Liability (Anaes2)*
Limit of Liability (Cardio)*
Limit of Liability (Cardio2)*
Limit of Liability (CardioT)*
Limit of Liability (CardioT2)*
Limit of Liability (ColSu)*
Limit of Liability (ColSu2)*
Limit of Liability (Cosm)*
Limit of Liability (Cosm2)*
Limit of Liability (Endo)*
Limit of Liability (Endo2)*
Limit of Liability (Gastro)*
Limit of Liability (Gastro2)*
Limit of Liability (GenSu)*
Limit of Liability (GenSu2)*
Limit of Liability (ICU)*
Limit of Liability (ICU2)*
Limit of Liability (Neo)*
Limit of Liability (Neo2)*
Limit of Liability (Neurol)*
Limit of Liability (Neurol2)*
Limit of Liability (OphtS)*
Limit of Liability (OphtS2)*
Limit of Liability (Oral)*
Limit of Liability (Oral2)*
Limit of Liability (ENT)*
Limit of Liability (ENT2)*
Limit of Liability (PaedSu)*
Limit of Liability (PaedSu2)*
Limit of Liability (Radio)*
Limit of Liability (Radio2)*
Limit of Liability (Radioth)*
Limit of Liability (Radioth2)*
Limit of Liability (ThorSu)*
Limit of Liability (ThorSu2)*
Limit of Liability (Urol)*
Limit of Liability (Urol2)*
Limit of Liability (VascuS)*
Limit of Liability (VascuS2)*
Limit of Liability (BarSu)*
Limit of Liability (BarSu2)*
Limit of Liability (CosMeSu)*
Limit of Liability (CosMeSu2)*
Limit of Liability (Gynae)*
Limit of Liability (Gynae2)*
Limit of Liability (NeuroSu)*
Limit of Liability (NeuroSu2)*
Limit of Liability (ObGyn)*
Limit of Liability (ObGyn2)*
Limit of Liability (OrthSu)*
Limit of Liability (OrthSu2)*
Limit of Liability (PlasSu)*
Limit of Liability (PlasSu2)*
Limit of Liability (SpineSu)*
Limit of Liability (SpineSu2)*
Limit of Liability (MedAst)*
Limit of Liability (Nurse)*
Limit of Liability (Std&Staf)*
Limit of Liability (Lecturer)*
Limit of Liability (Allied)*
Coverage Start Date*

DayMonthYear
Coverage End Date*

DayMonthYear
Calculation
Period of coverage is less than 6 months
YesNo
Coupon
If available
Gross
Final before SST & stamp
Your final rate is (RM)
incl. 8% SST and stamp

YesNo
It is recommended to include all services or sub-specialties related to your main practice if necessary. This information is important for us to better understand your practice and provide appropriate coverage. i.e. General Dentist category, you may add implant, orthodontist etc. For Anaesthetist, you may add ICU; for Neurosurgery you may add Spine.

Please note that the rate may vary and is subject to underwriting. Kindly wait for our quotation email before making any payment.

Click Yes to add, or Next to skip. Click here if you need assistance.
Please note that the rate may vary and is subject to underwriting. Kindly wait for our quotation email before making any payment.

Instructions
1. This form is intended for individual healthcare practitioners.
2. You must answer all the questions where neccessary.
3. At the end of this form, you are required to upload your Identity Card (IC) or Passport (non citizen), and Latest APC/equivalent.
4. If you have any questions concerning this proposal, please click Contact Us
5. Applying through this form, means that you have agreed with our Privacy Policy.

Application Form
Title*
title 2
Full Name (as per IC/Passport)*
Please DO NOT capitalize all character
MalaysianNon-Malaysian
NRIC*
without dash (-)
Passport*
Substring YY
DOB - CALC*
DOB - OLD (Don't delete yet)

DayMonthYear
Date of Birth*
DD-MM-YYYY
Tax Identification Number (TIN)
Optional
MaleFemale
Correspondence Address*
House / Hospital / Clinic in Malaysia only
Postcode*
City*
State*
Correspondence Address (don't delete yet)
Primary Practice Location*
Malaysian (+60)Non-Malaysian
Malaysia Mobile Number*
Malaysian phone number with WhatsApp onlyFormat: 60100000000[0].
International Mobile Number*
International Phone Number with country code (without +)Format: 00000000[0][0][0][0][0][0][0].
Phone Number
Phone Number (Whatsapp)
Email*
Please use the same email address you used to login User Portal. If you have never registered to our new User Portal, just proceed filling in this form. We will automatically create a user portal account for you using this email.

Existing / Previous Coverage
YesNo
If YES, please upload your certificate (only from STMAB)

Cancelof
Or provide the details of coverage here
Name of insurer, policy number & coverage limit
YesNo
If YES, please upload the details noting the Section number

Cancelof

Details of E-Payment

Please fill your bank details to facilitate e-payment for any amount due and payable to YOU (optional)
Bank Account Number
Account Holder Name
Bank Name

Personal Documents
Copy of IC / Passport*

Cancelof
Latest APC*

For student, please upload your student card
Cancelof

Signature*
Date

DayMonthYear
Date
Promo Code
Should be Empty: