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APPLICANT DETAILS
Choose your preferred options from the below fields. Your request will be automatically
forwarded to our Sales Department and an AROPE Representative will contact you shortly


First Name*
 
Father's Name*
 
Last Name*
 
Phone Number*
 
Mobile Number*
 
E-Mail*
 
Occupation*
 
PLAN DETAILS
BASIC COVER: IN - HOSPITAL
Hospital Network*
 
Hospitalization Class*

 
Cover Type*
 
ADDITIONAL FREE COVER
International Travel Assistance: Covering repatriation of insured family members to the country of residence
OPTIONAL COVERS


* Additional covers are available upon request
TABLE OF INSURED PERSONS
(Maxium allowed 5 records)
Name* Relation* Year of Birth* NSSF*
Security Code*
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