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  *School Safety policy.
  *Travel & Tours Insurance.
  * Hospitality Plus Insurance.
  *A re-branded auto Insurance
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   WHOLE LIFE ASSURANCE POLICY :::

PROPOSAL FORM FOR LIFE ASSURANCE

(1) Name in Full
Maiden Name if married
Postal Address 1
Postal Address 2
Residential Address 1
Residential Address 2
Are you self-employed? YES NO
Exact nature of occupation
Name and Address of Employer
Marital Status: Married Single Widowed
Place of Birth Date of Birth
Note: Evidence of age must be produced in form of either Birth Certificate,
Passport, Baptismal Certificate or Statutory Declaration of Age
2. (a) Sum to be Assured
(b) Class of Assurance
(c) Date of Commencement
(d) Duration
(e) Is extra Benefit for Death by Accident to be covered? YES NO If yes, please state amount (50% or 100%) of basic sum assured (maximum N50,000)
(3).(a) Name and Address of your Medical Attendant
(b) Name and Address of any other consulted in the past and reason for consultation:
(4) (a) Has any proposal on your life been made at any time to this or any other Insurance Company?
YES NO . If yes, state in each case:
(i) Name of Insurance Company
(ii) Date of Proposal
(iii) Sum Assured Proposed
(iv) What amount carries Accidental Death Benefit?
(v) Whether accepted or postponed or declined ACCEPTED POSTPONED DECLINED
  If ACCEPTED whether at ORDINARY terms or SPECIAL terms
(5) (a) Do you travel in non-scheduled private flight? YES NO
(b) What sports do you engage in?
6. Do you know of any other circumstances affecting your eligibility for assurance which ought to be stated:
7. FOR EDUCATION ENDOWMENT ONLY:
(1) NAME OF CHILD
(2) DATE OF BIRTH
8. What payment have you made with this proposal and in what form?
9. DETAILS OF BENEFICIARY
Full Name Age Relationship Address
Except as otherwise directed (a) the proceeds are to be divided equally among all persons who are named as beneficiary and who survive the assured (b) the right to change the beneficiary is reserved.
10. IF THE POLICY IS TO BE GRANTED TO A PERSON OTHER THAN THE LIFE TO BE ASSURED THE FOLLOWING DECLARATION SHOULD BE COMPLETED AND SIGNED:
Name in full of the person to whom the policy is to be granted
Address
Occupation
Relationship to Life to be Assured
Nature of the insurable interest
I, the person to whom the Policy is to be granted declare that I know nothing involving the health or the habits of the life assured that might cause the life to be ineligible for assurance. I agree that this declaration and statements made by the life to be assured in this proposal and to the Company or its Medical Examiner in connection with this Proposal shall b e the basis of the contract of assurance and request that the Company to issue the Policy in my name.
11. GENERAL
Is there any other fact, circumstances or information regarding your health and way of living which was not specifically mentioned above?
DECLARATION:

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