EFU Insurance Policy Form

Policy Details

Core policy configuration, dates and amounts.

Policy Type*

Goal Name*

Agent Code

Payment Frequency*

Start Date*

End Date*

Cover Amount (PKR)*

Embedded Protection (PKR)

Premium Amount (PKR)*

First Contribution (PKR)

Goal Amount SA

Rate (%)

Donation & Callback

Donation Center

Donation Amount (PKR)

Used Coins

Callback URL

Personal Information

Policyholder details and CNIC documents.

Full Name*

Date of Birth*

Gender*

CNIC*

City*

Mobile Number*

Email Address*

Marital Status

Residential Address

CNIC Details & Documents

CNIC Issue Date

CNIC Expiry Date

CNIC Front Image

CNIC Back Image

Cashless Health Plan

Select your health insurance plan, variant and package.

Plan*

Variant

Package*

Annual Coverage (PKR)*

Payment Information

Ledger entry and payment method details.

Transaction Type

Transaction Purpose

Amount (PKR)*

Discount Amount (PKR)

Payment Method*

Beneficiaries

Add one or more beneficiaries. Total allocation must equal 100%.

Beneficiary #1

Full Name*

CNIC

Date of Birth

Relationship

Allocation (%)*

Contact Number

Is Minor?

Guardian Name

Guardian CNIC

Guardian Contact

Dependents

Health plan covered members. Required for Family Shield plan.

Subscription Riders

Optional add-on covers for enhanced protection.

Rider #1

Rider Code

Rider Type

Premium (PKR)

SA Percent (%)

SA Value (PKR)

Rider #2

Rider Code

Rider Type

Premium (PKR)

SA Percent (%)

SA Value (PKR)

Review & Submit

Please verify all details before submitting the policy.

By submitting this form, you confirm that all information provided is accurate and you agree to EFU's terms and conditions.

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