Kan satu kesatuan dan bagian yang tidak terpisahkan dari Polis dan menjadi dasar Pertanggungan Asuransi yang dinyatakan dalam Polis PT AXA Life Indonesia (selanjutnya disebut sebagai Penanggung) dengan Pemegang Polis. Kami yang bertanda-tangan di bawah ini : 1. Nama Pemegang Polis Pekerjaan Saat Ini 2. Nama Tertanggung Pekerjaan Saat Ini 3. No Polis 4. Alamat Saat ini Kode Pos (R), 5. No Telepon (K), (HP) 6. Alamat Email Nama Lengkap Tertanggung & Payor Tinggi Badan (Cm) Berat.

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How to fill out the Form Spaj Kosong online

Filling out the Form Spaj Kosong online is an essential process for requesting policy recovery. This guide provides a clear walkthrough, ensuring you complete the form accurately and efficiently.

Follow the steps to fill out the Form Spaj Kosong online:

  1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
  2. Begin by entering the 'Nomor SPAJ' or policy number in the designated field.
  3. Fill in the names of the policyholder and the insured person along with their current occupations.
  4. Provide the current address, including the postal code, phone number, and email address.
  5. Enter the insured person's and payor's full name, height in centimeters, and current and previous weight in kilograms, along with the reason for any weight changes.
  6. Respond to the health-related questions by marking 'YES' or 'NO' and providing detailed explanations where necessary, especially if you respond positively.
  7. Complete the declaration and authorization section. Ensure that all answers provided are accurate and accountable.
  8. Make sure to sign and date the form at the end, confirming your approval.
  9. Once completed, save your changes. You may then download, print, or share the finalized form as needed.

Ready to start? Fill out your Form Spaj Kosong online today.

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