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Lay Claims / Renew Policy
Proposal/Application Form
Uni-Group Cover
Product
→
Uni-Group Cover
Status
*
→
Customer
→
Payment Mode
*
→
Online
OverDraft
Variant (Cover type)
*
→
Bronze
Silver
Gold
Diamond
No of Members to be insured
→
Amount Insured
₦
Amount Payable
₦
THE PROPOSER/APPLICANT
Group name
*
→
Group type
*
→
Registration number
*
→
Date of registration
*
→
Group Contact Address
*
→
First Person Name
*
→
Phone Number
*
→
Second Person Name
*
→
Phone Number
→
Group Email Address
*
→
LIST OF GROUP MEMBERS TO BE INSURED
Member 1
Fullname
Gender
Male
Female
Occupation
Date of birth
*
Next-of-Kin
Phone number
Enter your Policy Number
→
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