AFYA Takaful Form

Afya Takaful Application Form

Thank you for your interest in taking a medical cover with us. Kindly take time to respond to the queries below. We also request you to provide us with copies of identity card/passport for you and your spouse(s):

Fields marked with an * are required

Surname *

First Name *

Other Names

ID / Passport Number *

Gender *

Date of Birth *

P. O. Box

Email Address *

Phone Number *

Occupation *

Name of Organisation *

1st Dependant Particulars

Surname

First Name

Other Names

Date of Birth

Gender

Relationship

2nd Dependant Particulars

Surname

First Name

Other Names

Date of Birth

Gender

Relationship

3rd Dependant Particulars

Surname

First Name

Other Names

Date of Birth

Gender

Relationship

4th Dependant Particulars

Surname

First Name

Other Names

Date of Birth

Gender

Relationship

Please provide spouse's ID/Passport number

I/We hereby declare that all statements made in this proposal and other documents submitted in connection with this application are complete and true to the best of my/our knowledge and belief. I/We agree that this declaration and all statements made above shall from the basis of the Takaful contract between Me/Us and Takaful Insurance of Africa (hereinafter referred as the Takaful Operator) and they are deemed to be incorporated in the contract.

NOTE:The Operator reserves the right to obtain Medical Reports from the applicant's doctor, if required at any time.

Date *

Intials of participant *

020 7909299

Afya Takaful Application Form

A Bond Beyond Insurance

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020 7909299

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AFYA Takaful Form

Afya Takaful Application Form

A Bond Beyond Insurance

About Us

Quick Links

Phone Numbers

HQ Contacts

Takaful Chat Bot