1. System Generated Field Panel
2. Author Entered Field Panel
3. Form Title Panel
4. End-user Entered Field Panel
5. Thank You and Error Message Panel
6. Hidden Panel

• System Generated Field Panel
• Author Entered Field Panel
• Form Title Panel
• End-user Entered Field Panel
• Thank You and Error Message Panel
• Hidden Panel

System Generated Field Panel 

 Author Entered Field Panel

Author Input Panel - Required fields

*Type of Form Integration siteComponent slider contactCardForm

*Region ASIA APAC EMEA LATAM USA

*Country Bangladesh Australia Hongkong United Kingdom Turkey Kuwait Bahrain Egypt Jordan Greece Oman Lebanon Romania Bulgaria France Poland Portugal Spain UAE Italy Russia Portugal Argentina Columbia Brazil USA Malaysia

*Type Of Form Contactform Inquiry Grievance

Form Title  Panel

All fields are required.

End-user Entered Field Panel

Name

Phone Number

Date Of Birth

Email Address

State

Select State Johor Darul Ta'zim Kedah Darul Aman Kelantan Darul Naim Malacca Negeri Sembilan Darul Khusus Pahang Darul Makmur Penang Perak Darul Ridzuan Perlis Indera Kayangan Sabah Sarawak Selangor Darul Ehsan Terengganu Darul Iman Kuala Lumpur Labuan Putrajaya

Qualification (SPM or Equivalent)

Yes

No

Please read and accept the Privacy Policy, Terms and Conditions, and Declaration of Personal Data

By submitting this electronic form, I agree to the Terms & Conditions, Privacy Policy and Declaration of Personal Data use by AmMetLife Insurance Berhad (the Company). Any personal information relating to myself will be used solely by the Company, its related companies and agents in accordance to the Personal Data Protection Act 2010.

SUBMIT

Thank You/Error Panel Configuration

Message Option Same page-fadeout Same page-fixed New page

Option One/Two Configuration

Message Delay

Sorry submission fail.

Please try again

Thank you!

 Submission was successful.

Option Three Configuration

Error Page

Thank You Page

Page Target Same Tab New Tab

Hidden Panel