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Life Insurance Quotation
Quote Type
*
Single Life Assured
Joint Life Assured
Personal Details (First Life Assured)
Name & Surname
*
ID Card Number
*
Occupation
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
Address
*
Phone
*
Mobile
*
Email
*
Are you a smoker?
*
No
Yes
Are you normally residing in Malta?
*
Yes
No
Please advise location of residence and duration of overseas residency in any one year.
*
Personal Details (Second Life Assured)
Name & Surname
*
ID Card Number
*
Occupation
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
Address
*
Phone
*
Mobile
*
Email
*
Are you a smoker?
*
No
Yes
Are you normally residing in Malta?
*
Yes
No
Please advise location of residence and duration of overseas residency in any one year.
*
Policy Details
Sum Assured
Term (Years)
Policy Type
*
Level Term
Loan Protection
Endowment with Profits
Other
Please specify
*
Interest Rate
*
Extensions
*
Accidental Death
Accidental Death and Disability
Critical Illness
Total and permanent disability including waiver of premium
Payment Frequency
*
Yearly
Half Yearly
Qaurterly
Monthly
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