Optimax e-Invoice

Patient Identity No *

Invoice / Bill Number *

Invoice Amount *

Name *

Nationality *

Tax Identification Number (TIN) *

Identification Type *

Identification Number *

Email Address *

Phone Number (e.g. +60123456789) *

Address Line 1 *

Address Line 2

Address Line 3

Postcode

City *

State *

Country *

Our Privacy Notice is available on our website at https://www.optimax2u.com/privacy-notice.html.
Please review our Privacy Notice prior to providing us with your personal information.

Optimax will not liable if e-invoice request failed after cut-off time due to incomplete or wrong information provided.

I hereby agreed to the Privacy Notice and acknowledged that all the information provided is true and complete.