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Buy Insurance Step 6
demo.deadhappy
2023-01-20T07:03:30+05:00
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First Name
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Last Name
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Date
DD slash MM slash YYYY
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Age
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Gender
Male
Female
Gender X
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Mobile Number
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Email
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Current Weight (kg)
(Required)
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Current Height (cm)
(Required)
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Occupation
(Required)
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Monthly Income (PKR)
(Required)
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Do you intake Tobacco or Nicotine in any form? Yes or no
Yes
No
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Do you intake Tobacco or Nicotine in any form? Yes or no
0-5 times
5 to 10 times
10 to 20 times
Can't specify
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Consume Alcohol Yes or no
Yes
No
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Consume Alcohol Yes or no
Social Drinking
Regular Drinking
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Select
Cancer
Hepatitis B
Hepatitis C
Diabetes
Coronary Artery Disease
Heart Attack
Heart Failure
Ischemic Heart Disease
Heart Valvular Disease
Cardiac Arrhythmia
Kidney Disease
High Blood Pressure
Thyroid Disorder
Liver Cirrhosis/Liver Failure
Stroke
Paralysis
Musculoskeletal Disorders
Chronic Obstructive Pulmonary Disease
Nervous Disorders (Depression, Psychiatric Disorder)
Bleeding Disorder
Anaemia
Deformity or Disability
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I don't want to contribute
I don't want to contribute
How much do you want to be insured for?
This will help us calculate your monthly price. You'll be able to amend this amount later.
Insurace amount
What is your desired term length?
This will help us calculate your monthly price. You'll be able to amend this amount later.
term length
Your annual premium
206 PKR
Do not like the price? Adjust your term length and sum assured to get a desired premium.
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