Benefit Application Form

Product Onboarding FORM

Product Onboarding

PREMIUM PAYER

Select Product :

Title :

Surname :

First Name :

DOB :

Gender :

Male

Female

Marital Status :

Home language :

Individual Profile

Nationality :

Occupation :

Source of Income :

Net Household Income :

ID Type :

ID Number :

Addresses

Phone Number :

Email Address: :

Postal Address :

Area :

Digital/Residential Address :

INSURED LIFE (CHILD)

Title :

First Name :

Surname :

Gender :

Male

Female

Place of Birth :

DOB :

Relationship to Contract Owner :

Home language :

Beneficiary

Surname :

First Name :

DOB :

Benefit % :

Total Benefit % :

Add Product

Commencement Date :

Basic Premium: :

Term :

AIM :

Additional Benefits :

Total Premium Ghc:

PREMIUM PAYMENT

Payment Method :

Payment Frequency :

Bank :

MoMo/Account/Staff No:

Declaration

Declaration and Agreement

I warrant that the information in this application and all documents submitted to Metropolitan Life Insurance Ghana Ltd (herein referred to as Metropolitan Life) are true, correct, and complete. These will form the basis of the proposed contract.
To facilitate risk assessment and any claim consideration, I irrevocably authorize Metropolitan Life:
1. To obtain any necessary information from any person;
2. To share information with other insurers, either directly or via an industry database, even after my death.
I waive my right to privacy to the extent permitted in this authorization.
I agree that if any information regarding the risk on the Premium Payer is not fully disclosed or is incorrect, Metropolitan Life may cancel my cover and retain all premiums paid.
I understand I can cancel this application within 30 days of receiving the acceptance letter. I will receive a refund of premiums paid, minus any cover or investment enjoyed. This applies to increases in premiums as well.

Upon policy maturity, Metropolitan Life may automatically extend the policy under the same terms. I will be notified, and it's my responsibility to redeem it. This extension is in my best interest, though subject to market conditions.
Replacement of contract: I understand it is not in my best interest to replace an existing contract with a new one.
If the received premium differs from the agreed amount, Metropolitan Life may issue the policy based on the received premium.

Sigature

Supporting Documents

Upload Ghana Card

Review

Premium Payer Detail

Firstname:

Lastname :

Gender :

DOB :

Marital Status :

Nationality :

Language :

Occupation :

Nationality

Income :

ID Type :

ID Number :

Phone Number :

Email Addresses :

Postal :

Area :

GPS :

Beneficiary

Product Details

Commencement Date :

Premium :

Term :

AIM :

Total Premium :

Aditional Benefit :

Payment Detail

Payment Method :

Payment Frequency :

Payment Source :

Payment Account :

Pay First Premium :

Yes