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Pay a Single Premium that covers you & three(3) other Secondary lives: your Spouse and Parents.
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(Benefiaciary)
Nothing Selected
Nothing Selected
Date of Birth : | Nothing Selected |
Email : | Nothing Selected |
Gender : | Nothing Selected |
(Dependant 1)
Nothing Selected
Nothing Selected
Date of Birth : | Nothing Selected |
Email : | Nothing Selected |
Gender : | Nothing Selected |
(Dependant 2)
Nothing Selected
Nothing Selected
Date of Birth : | Nothing Selected |
Email : | Nothing Selected |
Gender : | Nothing Selected |
(Dependant 3)
Nothing Selected
Nothing Selected
Date of Birth : | Nothing Selected |
Email : | Nothing Selected |
Gender : | Nothing Selected |
Lives covered | Benefit (GHS) |
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Member | You have not selected any plan. |
Father | |
Mother | |
Spouse | |
Child One | |
Child Two | |
Brother | |
Sister |
Premium (GHS) |
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Frequency |
I declare that to the best of my knowledge and belief, all the responses
I have provided are true and complete and I agree that, this proposal together
with the declaration shall form the basis of the contract.
I understand that, any medical history known to me about myself and any of the
secondary lives not disclosed may invalidate the policy.
By this declaration, I authorise Vanguard Life Assurance Company Ltd. To receive
premiums including any increases during the lifetime of the policy in line with
the premium payment mandate and to obtain any information it deems relevant to this
proposal from any person.
By signing this declaration, I confirm that, I have read and understood these declarations
and acknowledge receipt of the Policy Terms and Conditions attached to my proposed assurance.