Clinical abstract application form 2026

1. Click ‘Get Form’ to open the clinical abstract application form in the editor.
2. Begin by entering the particulars of the life assured. Fill in the 'Name' field, followed by the 'Identity Card / Passport No.' and 'Contract No.' to ensure accurate identification.
3. In the Authorisation section, specify the name of the Doctor or Medical Officer-in-charge, along with their clinic or hospital details. Make sure to include the complete address for clarity.
4. Next, provide your authorization by filling in your name and NRIC/Passport number. Clearly state that you authorize the medical report to be furnished to AVIVA LTD regarding the patient.
5. Indicate the admission and discharge dates in their respective fields. This information is crucial for processing your request accurately.
6. If you are 21 years old or above, sign as the patient; otherwise, have a parent or legal guardian sign on your behalf. Include their relationship to you if applicable.
7. Finally, enter the date of signing and ensure all fields are completed before submitting your form.

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