Medical Quote

AFRICAN INSURANCE AND RISK MANAGEMENT

Medical Quote

To complete this form, you will need approximately three minutes. We will be able to identify what you are looking for more easily if you answer all questions accurately. All questions marked with a * are mandatory, requiring an answer.

Medical Questions:

This can increase your premium quite considerably.
This can increase your premium quite considerably.
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6.9 Oceania - Australia, New Zealand and surrounding islands (% of time)

Please ensure total percentage equals 100%. Answers are used in quote calculation

e.g. David Paul Smith, 18 April 1969, British, Mauritius and Jane Fiona Smith, 7th February 1970, Irish, Mauritius
Please provide full names and details of current and on-going pre-existing medical conditions. Broadly speaking, the definition of a pre-existing medical condition is - Any medical condition(s) that have been suffered, or for which medical advice, treatment and/or medication has been received prior to the date of joining.
A Material Fact is defined as a confirmed or validated event, item of information, or state of affairs crucial to the interpretation of a phenomenon or a subject matter, or to the determination of an issue at hand.
I give African Risk Transfer consent to collect, process and share my information as per PRIVACY TERMS AND CONDITIONS. To meet your needs, your personal information is collected, processed, and shared internally by our staff, representatives, and sub-contractors. We are committed to ensuring the security and confidentiality of your personal information and make every effort to protect it. You may request access to your personal information with us at any time.

The quote request form below is for individuals and families. For group and or company quotes, please email our quotes team on info@africanrisktransfer.com.