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Level Term Assurance Plan

A simple and cost effective insurance policy that provides a basic cover for a set number of years.

If you're considering this type of policy you should know:

  • It requires a regular premium payment
  • It pays out a lump sum on the policyholder's death
  • If the policy expires and the holder is still alive, no payment is made
  • The policy pays out only if you expire before it does

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Rs

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Years

Personal

Are you a resident / national of any country other than Pakistan?

Please state your Net Monthly Income

Feet
Inches
Kg

Beneficiary

%

Medical

  • Are you presently in good health?

  • Have you ever suffered from, experienced symptoms of, or been diagnosed with : heart disease, lung disease, kidney disease, circulatory disorder, cancer/tumour/ cyst/any growth, high blood pressure, stroke, diabetes, blood disorder, brain/nervous system disorder, liver disorder, Hepatitis B or C, HIV/AIDS related condition, physical disability or impairment, or any other disease or disorder not mentioned above?

  • Are you currently or have you ever in the past been involved in any legal, religious political activities or are you engaged or ever had any involvement in any civil or criminal ligation or police case?

  • Are you involved or intend to be involved in any of the dangerous/ hazardous activities, including but not limited to, motor racing, aviation, mountaineering, paragliding, skydiving, parachuting etc.?

  • Does your travelling involve exposure to high risk areas as defined by local and international authorities?

  • Does your job involve any hazardous activities?

  • Have you consulted any doctor in the last 5 years for any reason other than for trivial complains such as common cold/flu?

  • Has any insurance proposal on your life ever been rated up, declined, rejected, postponed, cancelled or is any proposal on your life pending for decision with any insurer?

  • Do you smoke 20 cigarettes or more per day?

  • Do you use tobacco (other than cigarettes) or alcohol or drugs or any form of prescribed medicines/therapy/treatment on a regular basis?

Product

Prospective Policyholder Name

Gender

Sum Issured

Date of Birth

Age

Plan Term

Application Underwriting Decision

Total Premium

Policy document will be issued after verification.

I have studied the above information, have read and agree with the term and conditions

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Payment & Confirmation

Declaration:


* TPL Life Insurance Limited is under no obligation to accept any proposal for insurance. If we accept a proposal for insurance, it shall be subject to the policy terms and conditions and we shall have no liability to make any payment if premium is not received by us in full and in time or is not realized in account of TPL Life. I do hereby declare that the statements in the proposal form are true and complete and I hereby give my consent to TPL Life to seek information from my doctor(s) who have ever attended me and from my employer, friend, relative or any Life insurance to which a proposal on my life at any time been made, and the giving of such information is hereby authorized. I understand that it is my responsibility to inform TPL Life if the given status (health, occupation, financial details) provided by me in this proposal form for insurance changes or is no longer valid while my proposal is being processed. I also authorize TPL Life to transmit and share my personal, financial and health related information in connection with this Proposal for Insurance with the Central Depository Company of Pakistan Limited (CDC) allowing it to maintain Centralized Information Sharing Solutions for the Insurance Industry (CISSII).
* I agree that the insurance benefit available to me shall become void in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any particulars in the form, personal/financial statement, medical information, declaration and connected documents or if any material information has been withheld by me or anyone acting on my behalf. I hereby declare that I am not aware of any neglect or omission or error or existence of any circumstances or pre-existing conditions likely to give rise to a claim thereof. I hereby declare that in case of false declaration, TPL Life shall have all the rights to reject/repudiate the claim.

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