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Purchase GPA Insurance
1. Insured Person
Full Name
Gender
Select
Male
Female
Date of Birth
ID / Passport No.
Nationality
×
2. Occupation & Coverage
Occupation Class
-- Select occupation class --
Class 1 - Office / low risk work
Class 2 - Light manual / sales / travel work
Class 3 - Manual / field work
Class 4 - High risk occupation
Plan
Basic GPA
Standard GPA
Premium GPA
Premium Plus GPA
Sum Insured (USD)
5,000 USD
10,000 USD
25,000 USD
50,000 USD
100,000 USD
Effective Date
Minimum effective date is tomorrow.
3. Beneficiary
Beneficiary Name
Relationship
Select
Spouse
Child
Parent
Sibling
Other
Beneficiary Phone
4. Declaration
Existing disability or physical impairment
Chronic disease or serious medical condition
Dangerous sport / high-risk activity
Previous serious accident or claim history
Declaration Note
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