Skip to content
KNOW YOUR CUSTOMER (KYC) FORM
An Insurance Agent who assists an applicant to complete an application or proposal form for insurance shall be deemed to have done so as the agent of the applicant – Section 54 (2) Insurance Act 2003.
Please answer ALL questions in full. Use CAPITAL LETTERS.
Date of Birth:
Type of Employment:
If Employee, Name of Employer:
Address of Employer:
Date of Employment:
Employer's Tel. No.:
Please if married, give the following:
Name of Spouse:
Spouse Date of Birth:
Next of Kin:
Type of Residence:
Documents to be Submitted:
Any of the following Personal Identification Cards:
Upload Personal Identification Cards:
Social & Political Activities:
Which Social/Membership club do you belong:
Do you or your spouse belong to any political or pressure group?
Does any of your close relations belong to any political or pressure group?
I consent that my personal information can be used in line with Heirs Insurance Data Policy.
See details of the policy.
WooCommerce not Found