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    Home | StarLife Diaspora Insurance Form

StarLife Diaspora Insurance Form

  • A. PERSONAL DETAILS

  • B. PAYMENT DETAILS

  • C. COVER DETAILS

    Scope of Cover : Death/ Total & Permanent Disability (TPD)
  • PRINCIPAL

    PEOPLE TO BE COVERED Principal assured/Policy Owner (Optional)
  • FAMILY MEMBERS

    (Please specify relationship eg: Parents, Parent in-laws, Spouse & Children allowed)
  • If at the time of claim it is discovered that the assured was more than the age limit at the inception of the policy the company would only refund premiums
  • TRUSTEE

    Where the beneficiary is below 18years of age
  • D. DECLARATION

    I declare that every statement in response to questions asked in this application is true and correct to the best of my knowledge. I agree that this application shall serves as the basis and form part of the contract. All the questions have been explained to me in the language that I understand and I have been made to under that this contract shall not become operative until all of the following conditions have been met:
    1. This application has been approved by StarLife Assurance Company Limited
    2. The appropriate premium has been paid
    3. I certify that all the conditions precedent to the policy especially those pertaining to my health and that of all the proposed lived assured.
    4. All the persons proposed for cover are alive and in good health


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