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Benefit Selection

         
       

Select your preferred Takaful Contribution below:
 

Health Questions

Please answer a few simple health questions before we proceed with your application.
1. Have you ever had, or do you have cancer, stroke, heart disease, coronary artery disease, kidney failure,
    diabetes, liver disorder, hepatitis, chronic lung disease, SLE, HIV, AIDS or any physical or mental
    impairment, or any other serious illness not mentioned in this question?
 
2. Have you ever had an application, renewal or reinstatement of a Life policy or Family Takaful certificate,
    declined, postponed, rated or subjected to special terms?
 
3. Do you intend to surrender or terminate any of your existing Life Insurance policies or Family Takaful
    certificates due to this new application?