Application & Proposal

Stage 4 of 6 · Capture nominee, declarations and signature

A

Policyholder Details

Full Name
Sokunthea Prak
National ID
228994110671
Date of Birth
19 Mar 1985
Phone
+855 92 664 118
B

Nominee Details

C

Plan Confirmation

Product
Manulife Group Credit Life
Coverage
$10,000
Premium
$18/mo
Term
5 years
Frequency
Monthly
Riders
None
D

Health Declaration

Has the customer been diagnosed with any chronic illness?
Has the customer been hospitalised in the last 2 years?
Does the customer use tobacco products regularly?
E

Document Checklist

  • National ID (front & back)
  • Selfie with NID
  • Proof of address
  • Loan documentation
  • Signed proposal form
F

RM Declaration & Signature

RM Signature
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Complete nominee, signature and declaration to submit