Critical Illness

This type of insurance is a product in which the insurer is contracted to typically make a lump sum cash payment if the policyholder is diagnosed with cancer, a heart attack or stroke.

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Corporate Information

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First Name*

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Critical Illness

Do You Suffer From Any Kind Of Diseases ?

If yes,kindly provide the description below:

Do You Suffer From Any Kind Of Cancer ?

If yes,kindly provide the description below:

Remarks

We hereby acknowledge and confirm that all the submitted data above are correct and We did not hide any information related to the risk to be insured. And We authorize Brokerage Insurance Brokerage in executing this insurance request with the concerned insurance company and facilitate the policy issuance, renewals and claims follow-up and communicate specific information about us and our account to third parties if needed, in accordance with the privacy policy. We also accept that this insurance application and approval be the basis of the contract and an integral part of the insurance policy.