Application Form – Khulanathi Insurance

Based on the information in the application form a formal quote indicating cost will be sent to you
Cover will be effective after receipt of first payment
A copy or proof of cover will be sent to you electronically with the original policy document to follow via post

Company/Group : *

Email : *

Contact Number : *

Contact Person : *

Postal Address : *

Number of staff: : *

Nationalities of staff (ordered respectively): : *

Countries where operational (ordered respectively): : *

Occupations of staff group (ordered respectively): : *

Death by Natural causes / Accidental Death and disability including illness : *

Income replacer / per month : *

Medical Casevac - Up to R10 million per person available : *

Ransom/Kidnap Cover per event : *

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