Proposal/Application Form

School Fees Protection Plan
Product
Agent code
Amount Insured
Amount Payable
Information about the Proposer/Applicant (Parent or Guardian)
Title
Surname*
Other Names*
Gender Date of birth *
Address *
Occupation*
Phone Number*
Alternate Phone Number
Email Address*
Means of Identity [Voter's card, National ID, Int'l passport, Driver's license]*
Disclose all existing health conditions*
Information about the Beneficiary
FullName*
Address*
Gender Date of birth *
Phone Number
Email Address*
School/Institution
Address of School
Information about the Trustee
Trustee FullName*
Trustee address*
Trustee Phone Number*
Trustee Email*