GROUP PERSONAL ACCIDENT PROPOSAL FORM








    LIST OF EMPLOYEES
    Please ATTACH a list of all Employees to be Insured in the format below:

    No: | Full Name | Age | Designation | Annual Salary | Sum Insured


    Only PDF, Excel & Word Files accepted

    Type of cover required (Please tick if opting)
    Death onlyPermanent Total & Partial disabilityTemporary Total disability (Weekly benefits)
    Medical Expenses per head in hospital required

    Repatriation Expenses required