Client Identification Form

CLIENT IDENTIFICATION FORM

Tel: (+233)0302-678130,672356,663389,678126,66696 / Fax:(0302)671072, 671072 / Email:claims@siclife.com.gh : www.siclife.com.gh

CLIENT IDENTIFICATION IN THE ABSENCE OF SCANNED PROPOSAL FORM

POLICY NUMBER

FULL NAME

DATE OF BIRTH

CURRENT AGE

PLACE OF BIRTH

NAME OF ANY ONE BENEFICIARY

Attach other documents

PHOTOCOPY OF CLIENTS ID CARD

I AGREE that the entries provided for each field above is accurate and thereby consent to the processing of personal data necessary to achieve the required objective. Agree Do Not Agree

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