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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
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Declaration

Declaration

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 statements and answers are full, complete and true. I agree that these statement and statements made to any medical practitioner shall be the basis on my life. Ceylinco Life Insurance Ltd. shall not be liable for any claim account of illness, injury or death, the cause of which was known prior to approval of my request for assurance and I have not withheld or concealed anything in the above statements.

I authorize any representative, legal advisor or a medical practitioner of Ceylinco Life Insurance Ltd to peruse or obtain the bed health 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.