Retirement Planning Online

Quotation

Quotation

Years

Results

Retirement Benefits

Illustrated maturity benefit assuming 9% Contribution
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Registration

Registration

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Beneficiaries

Question

Beneficiaries

Beneficiary Full Name Relationship Date of Birth Beneficiary NIC Percentage
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Declaration of Payments

Declaration of Payments

Important: The below section must be read by the Life to be Assured/Life Assured and signed and dated at the time of policy delivery. I do hereby declare and agree that:

The foregoing answers have been given by me after fully understanding the questions, that the same are true in every aspect and that I have not withheld any information.

This declaration together with this proposal for Life assurance and any other declarations or statements made or to be made to a medical examiner or to the Company in connection with this proposal shall be the basis of the contract between me and Ceylinco Life Insurance Limited.

The Privileges,Conditions and Exclusions of the life policy and supplementary benefits therein on which the assurance will be granted, will be part of the policy.

I undertake to duly inform Ceylinco Life Insurance Limited of any change in my state of health, occupation, avocation and/or residence between the date of this proposal and the date of commencement of the assurance and also to pay any extra premiums that may be imposed on account of health, occupation,avocation and/or residence.

If I decide to withdraw this proposal for any reason before it is accepted, I agree to deduction of the cost incurred for medical examination, laboratory reports and service fee from the initial payment paid to the Company.

I ,my heirs, executors, administrators and assigns hereby agree that any physician, surgeon,medical practitioner or medical attendant who has attended upon or examined or treated me or who may hereafter attend,examine or treat me for any ailment or illness shall be at liberty to divulge, any knowledge or information regarding the state of health of mine which may have acquired whether before or after the policy is issued by the Company, to the Company, its officers and legal advisers or to any Court of law.

I authorise any representative or a Medical Practitioner of Ceylinco Life Insurance Limited to peruse or obtain the Bed Head Ticket or any other clinical notes from any Private or Government Hospital, Nursing Home,Asylum or Sanatorium and also authorise to obtain information from any other insurer.

Further I do hereby agree to sign any declaration made over the phone to the Ceylinco Life Insurance Limited, during the negotiation of the contract prior to the acceptance of the contract and also do hereby agree that the statements made by me are part of the contract entered into between me and the Ceylinco Life Insurance Limited.

Notice

You will be required to complete the payment section within a stipulated time frame or provide an additional security code depending on your credit card. Therefore, if you are using the online payment method for the first time, kindly contact your bank for further instructions.

Still if you are unable to make the payment or if the payment fails, please do not hesitate to contact the Ceylinco Life Call Centre on 0112 461 461.

Thank You!