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Insured Details

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Payment

Sum Insured (BHD)

Occupation

Lawyer / Advocate

Not Working / Retired

Site Worker (Labour)

Date of Birth

Age

I hereby certify that the Date of Birth given is the same as the one will be entered for the account registration. I understand that providing invalid information will result in my insurance policy to be void.

I hereby certify that the above given information is true and correct to the best of my knowledge, and I agree to cooperate fully by providing all requested documents before payment. I understand that providing invalid information will result in my insurance policy to be void. I also read and agree on the Policy Specification of this Insurance product.

CPR/Passport:

CPR/Passport of Beneficiary:

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Total Premium

NaN

BHD

Premium0.000 BHD

VAT 10%NaN BHD

Total PremiumNaN BHD

Promo Code

Dear customer, please ensure that below full details of the employer (in case of domestic helper) or policy holder in general must be entered correctly during registration.

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