Health Insurance

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In case of incomplete or incorrect statement will be invalid insurance contracts. Questions about the health of the insured's identity and the truth will be answered fully and appropriate.

Customer Information

Name *

First

Last

Telephone *

Email *

Height *

Weight *

Packages *

Package 1: TL 10,000
Package 2: £ 25,000
Package 3: £ 50,000

Gender *

Male
Female

Date of birth *

Place of Birth *

Profession *

Identification Number *

Insured Age *

Address *

Mother's Name *

Father's Name *

Insured Declaration of Health

Did you have a serious disease so far? *

Do you have any disability? *

Did you have surgery or cancer treatment? *

Are you now completely sihhatt? *

Policy Start Date

Policy Start Date *

Agent

Payment and Delivery

Payment *

Credit card
Advance
Mail Order
Installment

Delivery Method *

Delivered Agents
Home delivery
Delivered Central

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