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Quotation

Quotation



Death Benefit:

First 9 Months
The single premium paid will be refunded in the event of a natural death.
However, the guaranteed maturity value (Life Cover)
will be paid in the event of an accidental death.
After 9 Months
Guaranteed Maturity Value

Registration

Registration

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Questions

Yes No
Have you ever had a major medical condition such as any form of heart disease, stroke, cancer or liver disease
Do you or have you ever suffered from any chronic or long term medical condition such as diabetes, hypertension, elevated cholestrol, kidney disease, respiratory diseases or HIV/AIDS?

Beneficiaries

Beneficiaries

Beneficiary Full Name Relationship Date of Birth Beneficiary NIC Percentage
Add Row Delete Row

Declaration

Declaration

Important: This section must be read by the Life to be Assured/Life Assured and should be signed and dated at the time of policy delivery.

I do hereby declare and agree that the foregoing statements and answers are full, complete and true. I agree that this statement and statements made to any medical practitioner shall be the basis of this contract between my self and Ceylinco Life Insurance Limited (“The Company”) and that I have not withheld or concealed anything in the above statements.

I authorize any representative, legal adviser or a medical practitioner of the Company 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 authorize to obtain/share information from/to any other insurer. I / we hereby give my/our consent to Ceylinco Life Insurance Limited to verify (Online/Manual) my/our, National Identity Card particulars with the department of Registration of Persons.

I/ we agree and consent to Ceylinco Life Insurance Ltd as well as their respective representatives, agents, the Companies’ authorised service providers and relevant third parties whether within or outside Sri Lanka for collecting, using and/or disclosing my/ our personal data for purposes reasonably required by the Companies to evaluate my/ our proposal and to provide the products or services which I am/ we are applying for.

Further I do hereby agree to sign any declaration made electronically or otherwise to the Company during the negotiation and 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 Company.