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