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Medical
Applicant
ANNUAL INPATIENT Limit (KES)
- Select -
300,000
500,000
1,000,000
2,000,000
3,000,000
5,000,000
10,000,000
DOB of Senior
- Date -
1
2
3
4
5
6
7
8
9
10
11
12
13
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15
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17
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20
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31
- Month -
January
February
March
April
May
June
July
August
September
October
November
December
- Year -
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
DOB of Spouse
- Date -
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
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26
27
28
29
30
31
- Month -
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January
February
March
April
May
June
July
August
September
October
November
December
- Year -
---
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
When cover is to start?
Applicant Details (On Behalf/Senior Himself)
First name
Middle name
Surname
Mobile Number
Email
Gender
- Select -
Male
Female
I agree with terms and condition including company
policies and terms
.
