[MY B2B] Prudential Medical Examination Form

Tele-MER Services

General Line (for enquiries only): +6011 4166 1246 (Monday - Friday: 9a.m. to 6p.m.)

Part 1: Details of the Customer To Be Examined
Proposal / Policy No.*
Full Name (as per NRIC/Passport)*
NRIC/Passport No.*
Date of Birth*

DayMonthYear
Gender*
Contact Number*
Email Address*
Note: Please download Microsoft Teams (MS Teams) for Tele-MER service (video consultation)
Tele-MER Date and Time
Note: Please make booking at least 24 hours in advance before examination date
First Preference*
Tele-MER Date and Time
Note: Please make booking at least 24 hours in advance before examination date
Second Preference
* Please note the preferred times above are subject to availability. Speedoc will try its best to allot the time selected, but due to high demand may offer a different appointment time.

Part 3: Requirement Letter
Service: Tele-MER Service
Please attach the latest copy of the requirement letter issued by PAMB *

Cancelof
Remarks / Special Instructions (optional)
Date

DayMonthYear
Date
Please verify that you are human*
Should be Empty:

Tele-MER Services