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Benefit Selection

         
       

Select your preferred Takaful Contribution below:
 

Health And Other Questions

A few simple 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, systemic lupus erythematosus (SLE), HIV, AIDS
    physical impairment, mental impairment, or within the last 15 years a 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?