Operational Hub - CI Pro Universe

Section A - Policy Details

Policy No. Proposed Life Insured / Insured

Marital Status

Single Married Widowed Divorced

Religion

Muslim Non-Muslim

Up to 5 Nominees

Signed at (State)

Day Month Year

Policyowner is same as Insured

Policy Owner's Name

NIRC/Passport No.

Tap to Sign (Policy Owner)

Witness' Name

NIRC/Passport No. Mobile

Tap to Sign (Witness)

Trustee's Name

NIRC/Passport No.

Tap to Sign (Trustee)