GES - SIC LIFE GROUP LIFE INSURANCE POLICY

GES-SIC LIFE GROUP LIFE INSURANCE POLICY
Name of Employee*

First NameMiddle NameLast Name
Staff ID*
Enter your unique staff ID
District
Type your district here
Mobile Phone Number*
Enter phone number
Number of Beneficiaries*
Beneficiaries Name (1)*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Date
Relationship*
To beneficiary
Percentage*
Beneficiaries Name (2)*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Date
Relationship*
To beneficiary
Percentage*
Beneficiaries Name (3)*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Date
Relationship*
To beneficiary
Percentage*
Beneficiaries Name (4)*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Date
Relationship*
To beneficiary
Percentage*
Beneficiaries Name (5)*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Date
Relationship*
To beneficiary
Percentage*
BENEFITS OF POLICY

· Life Cover of GH¢,18,000.00 for deaths.

· Permanent Disability Cover up to GH¢18,000.00 for permanent disability arising out of an accident or illness.

· Critical illness of GH¢9,000.00 on diagnosis of a critical illness: Cancer, Stroke, Kidney/Renal Failure, Heart Attack, Deafness, Loss of Sight, Paraplegia, Loss of Speech, Coronary Artery Bypass, Major Organ Transplant, Multiple Sclerosis, Coma, Aortic Surgery.

· Cashback of 10% per member after 3 years of no claims.
DECLARATION

I declare that I want to join the GES-SIC Life Group Policy and I am willing to pay a monthly premium of GH¢10.00.

I hereby authorise COntroller and Accountant General Department to deduct the GH¢10.00 premium and pay same to SIC Life.
Should be Empty:

GES-SIC LIFE GROUP LIFE INSURANCE POLICY