Request for Quotation

Kindly fill up the quotation form below

Company Name:

Company Address:

Estimated number of Principals:

Estimated number of Dependents:

Name:

Email Address:

Contact Number:

Notes:

For Consultation/Lab inquiries, LOA request and follow ups please contact our 24/7 hotline 8702-3310

NOTES

Minimum of 20 enrollees to qualify for a corporate account

PRINCIPAL MEMBER
From 18 years to below 60 years old

DEPENDENTS
For MARRIED Employees
1st Priority - Legal Spouse from 18 years to 60 years old;
2nd Priority - Eldest to youngest child 90 days to not over 21 years old; single and unemployed.

For SINGLE Employees
1st Priority - Father up to below 60 years old;
2nd Priority - Mother up to below 60 years old;
3rd Priority - Brothers/Sisters 90 days to not over 21 years old; single and unemployed.