1Declaration Acceptance

2Personal Information

3Payment Details

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First Name(Required)

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Last Name(Required)

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YYYY/MM/DD(Required)

YYYY slash MM slash DD

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Age(Required)

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Gender(Required)

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Mobile Number(Required)

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Email(Required)

Who do you want to be
Covered Under the SHIELD?

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Who do you want to be covered under the shield?(Required)

Myself

Me & My Family

Others

Plans(Required)

PKR
60,000

PKR
100,000

PKR
200,000

PKR
350,000

PKR
500,000

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Click on the desired COVERAGE you need

60,000

100,000

200,000

350,000

500,000

Salamati Plan

Annual Plan Coverage

PKR 350,000

For each family member

Emergency Evacuation

Accidental Emergency Expense

Daily Room and Board

Maternity Coverage

Monthly Premium

PKR 30,000

For 4 family member
The insurance amount for each family member is PKR 6,256 per month

Aram Plan

Annual Plan Coverage

PKR 60,000

For each family member

Emergency Evacuation

Accidental Emergency Expense

Daily Room and Board

Maternity Coverage

Monthly Premium

PKR 30,000

For 4 family member
The insurance amount for each family member is PKR 6,256 per month

Aafiyat Plan

Annual Plan Coverage

PKR 100,000

For each family member

Emergency Evacuation

Accidental Emergency Expense

Daily Room and Board

Maternity Coverage

Monthly Premium

PKR 30,000

For 4 family member
The insurance amount for each family member is PKR 6,256 per month

Rahat Plan

Annual Plan Coverage

PKR 200,000

For each family member

Emergency Evacuation

Accidental Emergency Expense

Daily Room and Board

Maternity Coverage

Monthly Premium

PKR 30,000

For 4 family member
The insurance amount for each family member is PKR 6,256 per month

Rahat Plan

Tahaffuz Plan Coverage

PKR 500,000

For each family member

Emergency Evacuation

Accidental Emergency Expense

Daily Room and Board

Maternity Coverage

Monthly Premium

PKR 30,000

For 4 family member
The insurance amount for each family member is PKR 6,256 per month

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Maternity Coverage(Required)

Remove Maternity Coverage

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Maternity Coverage for family(Required)

Maternity Coverage

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Select Hospital Checkbox(Required)

CHILDLIFE FOUNDATION

ZINDAGI TRUST

SAYLANI

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Select Inshu(Required)

CHILDLIFE FOUNDATION

ZINDAGI TRUST

SAYLANI

The Hunar Foundation

Indus Hospital

JDC

Hussaini Foundation

Patients Aid Foundation

Panah

I don’t want to contribute

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I don’t want to contribute(Required)

I don’t want to contribute

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Gender male

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Gender female

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Gender x

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Add Wife

Please enter a number from 0 to 4.

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Add Husdand

Please enter a number from 0 to 4.

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Add son

Please enter a number from 0 to 6.

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Add daughter

Please enter a number from 0 to 6.

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No of Members

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Wife’s Birthday

YYYY slash MM slash DD

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2nd Wife’s Birthday

YYYY slash MM slash DD

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3rd Wife’s Birthday

YYYY slash MM slash DD

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4rth Wife’s Birthday

YYYY slash MM slash DD

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Son’s Birthday

YYYY slash MM slash DD

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2nd Son’s Birthday

YYYY slash MM slash DD

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3rd Son’s Birthday

YYYY slash MM slash DD

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4rth Son’s Birthday

YYYY slash MM slash DD

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5th Son’s Birthday

YYYY slash MM slash DD

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6th Son’s Birthday

YYYY slash MM slash DD

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Daughter's Birthday

YYYY slash MM slash DD

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2nd Daughter's Birthday

YYYY slash MM slash DD

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3rd Daughter's Birthday

YYYY slash MM slash DD

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4rth Daughter's Birthday

YYYY slash MM slash DD

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5th Daughter's Birthday

YYYY slash MM slash DD

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6th Daughter's Birthday

YYYY slash MM slash DD

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Selected Products

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Products Number

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Annual Plan Coverage

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Maternity Aaram

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Maternity Salamati

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Maternity Aafiyat

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Maternity Rahat

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Maternity Tahafuz

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Aram without Mat

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Aram with Mat

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Salamati without Mat

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Salamati with Mat

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Aafiyat without Mat

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Aafiyat with Mat

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Rahat without Mat

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Rahat with Mat

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Tahafuz without Mat

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Tahafuz with Mat

01 Of 07

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Are you presently in good health?

Yes

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Are you presently taking any medication, therapy/treatment?

Yes

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Have you ever suffered from any physical or mental illness/ medical ailment (Pre-existing condition) or any deformities?

Yes

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Do you smoke or indulge in Alcohol?

Yes

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Have you ever in the past or currently are involved in any legal, religious political activities or are you engaged or ever had any involvement in any civil or criminal litigation or police case?

Yes

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Does your job involve any hazardous activity(ies)?

Yes

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Does your job involve any hazardous activity(ies)?

Yes

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Are you a domestic/foreign “Politically Exposed Person” (PEP) or a family member/close associate of a domestic/foreign “Politically Exposed Person” (PEP)?

Yes

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Are you pregnant?

Yes

Great Job!

Words cannot express how grateful we are for your willingness to volunteer

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Skip charity

Medical Declaration

1. I am presently in good health and have never been prescribed any blood thinner medications or undergone any surgery, I have never suffered from any of these listed" diseases/conditions.

2. No proposal on my life has ever been postponed, declined, rated, cancelled or pending decision from any insurer for any reason.

3. I am not involved in any legal, religious, political activities and never had any involvement in any civil or criminal litigation or police case. I further declare that I am not involved in any of the dangerous/ hazardous activities, including but not limited to, motor racing, aviation, mountaineering, paragliding, skydiving, parachuting etc.

I hereby declare that all the information given by myself are correct to the best of my knowledge and belief. I declare that these declarations shall be the basis of the insurance contract between TPL Life Insurance Limited and myself. If the statements contained herein are untrue, the said insurance contract shall be treated as null and void. I am not a member/close associate of any domestic and foreign PEP (Politically Exposed Person). I understand that I have an option to review and correct the information already provided at any time before paying premium. I also authorize TPL Life to transmit and share my personal, financial and health related information in connection with this Proposal for Insurance with the Central Depository Company of Pakistan Limited (CDC) allowing it to maintain Centralized Information Sharing Solutions for the Insurance Industry (CISSII).

Do you accept all of these terms?

I accept

I decline

Download the Terms & Conditions | Health Declaration

Hi

This section is, specifically, for the information regarding you.

Please fill out the form. This is important for your security so that your policy is not misused.

Father's name(Required)

Mother's name(Required)

CNIC's Number(Required)

Address(Required)

Place of Birth(Required)

Religion(Required)

Nationality(Required)

Source of Income(Required)

CNIC Issuance Date(Required)

YYYY dash MM dash DD

CNIC Expire Date(Required)

YYYY dash MM dash DD

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Date

YYYY slash MM slash DD

The details of your Health Coverage are

Your Total Coverage

PKR

350,000

Your Premium for Insurance

PKR

Your Total Coverage

PKR

60,000

Your Premium for Insurance

PKR

Your Total Coverage

PKR

100,000

Your Premium for Insurance

PKR

Your Total Coverage

PKR

200,000

Your Premium for Insurance

PKR

Your Total Coverage

PKR

500,000

Your Premium for Insurance

PKR

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Untitled

Who do you want to be Covered Under the SHIELD?

Salamati Plan

PKR 350,000

PKR 30,000

Aram Plan

PKR 60,000

PKR 30,000

Aafiyat Plan

PKR 100,000

PKR 30,000

Rahat Plan

PKR 200,000

PKR 30,000

Rahat Plan

PKR 500,000

PKR 30,000

Great Job!

Medical Declaration

Hi

This section is, specifically, for the information regarding you.

The details of your Health Coverage are

Your Total Coverage

350,000

Your Premium for Insurance

Your Total Coverage

60,000

Your Premium for Insurance

Your Total Coverage

100,000

Your Premium for Insurance

Your Total Coverage

200,000

Your Premium for Insurance

Your Total Coverage

500,000

Your Premium for Insurance

Who do you want to be
Covered Under the SHIELD?