Popup after self KYC – Tpllife

This field is hidden when viewing the form

First Name(Required)

This field is hidden when viewing the form

Last Name(Required)

This field is hidden when viewing the form

YYYY/MM/DD(Required)

YYYY slash MM slash DD

This field is hidden when viewing the form

Age(Required)

This field is hidden when viewing the form

Gender(Required)

This field is hidden when viewing the form

Mobile Number(Required)

This field is hidden when viewing the form

Email(Required)

Who do you want to be
Covered Under the SHIELD?

This field is hidden when viewing the form

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

Myself

Me & My Family

Others

Plans(Required)

PKR
60,000

Annual Coverage

PKR
100,000

Annual Coverage

PKR
200,000

Annual Coverage

PKR
350,000

Annual Coverage

PKR
500,000

Annual Coverage

This field is hidden when viewing the form

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

This field is hidden when viewing the form

Maternity Coverage(Required)

Remove Maternity Coverage

This field is hidden when viewing the form

Select Hospital checkbox(Required)

CHILDLIFE FOUNDATION

ZINDAGI TRUST

SAYLANI

This field is hidden when viewing the form

Select Hospital(Required)

CHILDLIFE FOUNDATION

ZINDAGI TRUST

SAYLANI

This field is hidden when viewing the form

I don’t want to contribute(Required)

I don’t want to contribute

PKR

350,000

FOR

1 years

FOR

1 Individual

PKR

60,000

FOR

1 years

FOR

1 Individual

PKR

100,000

FOR

1 years

FOR

1 Individual

PKR

200,000

FOR

1 years

FOR

1 Individual

PKR

500,000

FOR

1 years

FOR

1 Individual

This field is hidden when viewing the form

Gender male

This field is hidden when viewing the form

Gender female

This field is hidden when viewing the form

Gender x

This field is hidden when viewing the form

Add Wife

Please enter a number from 0 to 4.

This field is hidden when viewing the form

Add son

Please enter a number from 0 to 6.

This field is hidden when viewing the form

Add daughter

Please enter a number from 0 to 6.

This field is hidden when viewing the form

No of Members

This field is hidden when viewing the form

Wife’s Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

2nd Wife’s Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

3rd Wife’s Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

4rth Wife’s Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

Son’s Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

2nd Son’s Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

3rd Son’s Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

4rth Son’s Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

5th Son’s Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

6th Son’s Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

Daughter's Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

2nd Daughter's Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

3rd Daughter's Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

4rth Daughter's Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

5th Daughter's Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

6th Daughter's Birthday

YYYY slash MM slash DD

This field is hidden when viewing the form

Selected Products

This field is hidden when viewing the form

Products Number

This field is hidden when viewing the form

Annual Plan Coverage

This field is hidden when viewing the form

Maternity Aaram

This field is hidden when viewing the form

Maternity Salamati

This field is hidden when viewing the form

Maternity Aafiyat

This field is hidden when viewing the form

Maternity Rahat

This field is hidden when viewing the form

Maternity Tahafuz

This field is hidden when viewing the form

Aram without Mat

This field is hidden when viewing the form

Aram with Mat

This field is hidden when viewing the form

Salamati without Mat

This field is hidden when viewing the form

Salamati with Mat

This field is hidden when viewing the form

Aafiyat without Mat

This field is hidden when viewing the form

Aafiyat with Mat

This field is hidden when viewing the form

Rahat without Mat

This field is hidden when viewing the form

Rahat with Mat

This field is hidden when viewing the form

Tahafuz without Mat

This field is hidden when viewing the form

Tahafuz with Mat

01 Of 07

This field is hidden when viewing the form

Are you presently in good health?(Required)

Yes

No

02 Of 07

This field is hidden when viewing the form

Are you presently taking any medication, therapy/treatment?(Required)

Yes

No

03 Of 07

This field is hidden when viewing the form

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

Yes

No

04 Of 07

This field is hidden when viewing the form

Do you smoke or indulge in Alcohol?(Required)

Yes

No

05 Of 07

This field is hidden when viewing the form

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?(Required)

Yes

No

06 Of 07

This field is hidden when viewing the form

Does your job involve any hazardous activity(ies)?(Required)

Yes

No

07 Of 07

This field is hidden when viewing the form

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

Yes

No

Last

This field is hidden when viewing the form

Are you pregnant?(Required)

Yes

No

This field is hidden when viewing the form

Skip charity

Skip Charity

We sincerely appreciate your participation in the questionnaire!

You now have the option to swiftly navigate to the Health Declaration form or continue onward with Insurity.

Great Job!

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

Thank you!

You now have the option to swiftly navigate to the Health Declaration
form or continue onward with Inshu Charity.