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Policy Holder Personal Details

Pick your date of birth
Select your identification document type from the list

Policy Holder Employment Details

The job that you do e.g. artisan, plumber, doctor
Post Office Box Adress(P.O. Box)
Your email address
Your employer's fax number, if applicable

Dependants/Beneficiary Details

The dependant/beneficiary's surname
The dependant/beneficiary's first name(s)
How is the beneficiary related to the policy holder
Pick the dependant's/beneficiary's date of Birth

Person Making Payment

Select this option if the policy holder specified above will be responsible for payment

Policy Details

The type of policy

Payment Details