Get Personal Accident Proposal Form

This guide provides step-by-step instructions on how to accurately fill out the Personal Accident Proposal Form online. By following these instructions, users can ensure a comprehensive and efficient completion of the form.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Begin by entering the name of the proposer. Fill in the last name first, followed by any other names in the provided fields.
3. Provide your date of birth by selecting the appropriate date from the format indicated.
4. Enter your postal address, including the postal code for accurate delivery.
5. Input your PIN number for identification purposes.
6. Fill in your ID or passport number to verify your identity.
7. Provide your email address to receive updates regarding the proposal.
8. Enter your telephone and mobile numbers for contact purposes.
9. State your profession or occupation in the designated field.
10. If applicable, list any previous insurers you have worked with.
11. Indicate whether you will engage in any sport or pastime that poses a risk of accidental injury by selecting 'Yes' or 'No'.
12. Answer the health-related questions regarding previous accidents, disabilities, or chronic illnesses by selecting 'Yes' or 'No'. If you reply 'Yes' to any, please provide further details in the space provided.
13. Name a beneficiary and provide their relationship to you, along with their contact information and ID number.
14. Ensure the proportions of beneficiaries total 100% as required.
15. Specify the period of insurance by entering the start and end date in the provided sections.
16. Read the declaration statement and confirm that all provided information is true before signing and dating the form.
17. Attach the agency or broker information along with the proposer’s signature. If applicable, include a rubber stamp or seal.
18. Finally, ensure to summarize your selected benefits as per the premium schedule before completing the process.

Complete your Personal Accident Proposal Form online today to secure your coverage.