Name of Proposer/Organization*
Phone*
Email*
Address*
Type of Business
Place of Employment
Particulars of the Group
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 and Word Files are accepted. You can send up to 5 MB in attachments.
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
Proposed Period of Insurance:
I/We certify that the above information is true to the best of my /our knowledge and belief.