AFYA Takaful Form

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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

1st Dependant Particulars
2nd Dependant Particulars
3rd Dependant Particulars
3rd Dependant Particulars
4th Dependant Particulars
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.

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