Whole Life Assurance

For Whom

People who wish to provide huge sums at comparatively low contribution as premium for their dependants can take this policy. Under this plan, an individual gets coverage for the whole of his life i.e the term is the whole life from inception of the policy.

Product

Life Products > Individual Life > Whole Life Assurance

Personal Information

* required fields

Name Of Proposer *

Name Of Guarantee

Permanent Address*

Place Of Birth*

Marital Status

For Female Proposal

Are you Pregnant
If yes, how many months?

Image*

Religion

Identification Type*

Upload Image Of Identification

Cover Detail

Term of Assurance (years): *

Plan of Assurance:

Term of Assurance (years): *

Term of Assurance (years): *

Term of Assurance (years): *

Term of Assurance (years): *

Commencement Date: *

Term of Assurance (years): *

Provisional Premium:

Term of Assurance (years): *

Frequency:*

Term of Assurance (years): *

Method of Payment:*

Term of Assurance (years): *

Additional Benefits (Riders):

Term of Assurance (years): *

Term of Assurance (years): *

Commencement Date: *

Occupational Detail

Exact Nature Of Occupation*

Employer*

If self-employed, describe business activities:

Have You Changed Your Job In The Last 3 Years?*

If yes please give details:

Are There Any Notable Accident And/Or Diseases Associated With You Occupation?*

If yes please give details:

How Often Do You Travel Within The Country?*

How Often Do You Travel Outside The Country?*

Medical Details

Detail Of Your Personal Physician(s) Within The Last 3 Years*

Name:

Date:

Address:

Reason for Consultation:

Name:

Date:

Address:

Reason for Consultation:

Has Any Of Your Relatives(father,mother,brother,sister,wife,husband,uncle,cousin,nephew)Ever Suffered From*

Tuberculosis?

If yes please give details:

Insanity?

If yes please give details:

Epilepsy?

If yes please give details:

Diabetes?

If yes please give details:

Physical Defect Or Infirmity?

If yes please give details:

Clinical Depression?

If yes please give details:

High Blood Pressure?

If yes please give details:

Any Surgical Operation?

If yes please give details:

If A Woman ;Any Disease Of The Breast,Miscarriage,Premature Birth,Still Birth Or Caesarian Operation?

If yes please give details:

Sum Assured: *