Proposal/Application Form

School Fees Protection Plan
Product
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Agent code
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Payment Mode*
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Amount Insured
₦
Amount Payable
₦
Information about the Proposer/Applicant (Parent or Guardian)
Surname*
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Other Names*
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Gender
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Date of birth *
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Address *
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Occupation*
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Phone Number*
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Alternate Phone Number
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Email Address*
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Means of Identity [Voter's card, National ID, Int'l passport, Driver's license]
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Disclose all existing health conditions*
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Information about the Beneficiary
FullName*
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Address*
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Gender
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Date of birth *
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Phone Number
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Email Address*
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School/Institution
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Address of School
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Information about the Trustee
Trustee FullName*
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Trustee address*
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Trustee Phone Number*
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Trustee Email*
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By submitting this form you agree that the above details provided are true and complete and the insurance company issues a Policy in its usual terms and conditions.

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