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1 Policyholder Details

* Mandatory Fields

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Surname *

First & Middle Name *

(As on NRC)

NRC# *

Confirm NRC# *

Email Address

Date Of Birth *

Gender :

Male Female

Mobile *

Telephone :

Occupation :

Physical Address *

(Note : Add Postal Code if you have.)

Do you wish to upgrade your policy every 3 years cycle to facilitate Cover and Premium increase? :

Yes No