Policy

Life Assurance Policy

Receipt No ……………………………………….. Policy No …………………………………
Date             ..……………………………………… Agent        ………………………………..
   
1. The Assured agrees with full knowledge that the statements and answers contained in the proposal and
   medical examination report form basis of the contract which will be made between him/her and
   this Company and that in case those statements and answers contain a false or untrue item or items,
   the contract (policy) shall become null and void.
   
2. Having agreed accordingly, the Assured is bound to pay premiums as shown below and this Company undertakes
   and promises to pay the claim to the Assured or the Assignee(s) subject to the benefits, conditions and 
  endorsements contained in this Policy on the happening of the event for payment of claim stated below.
   
3. This life assurance policy attaches from the time at which the first installment of the premium is received by this Company.
   
Policy No. Type of cover Sum assured . kyats Table     Term Years
Assured’s name   Age at next birthday  
Address   Age admitted or not  
Occupation   Date of risk (inception 
Of Insurance)
 
     
Sum assured Premium
Kyats -   Annual premiums . kyats  
    Installment.  
Assignee(s)   Due date(s) Annually
Event for payment of On maturity (            ) or Period for payment of Up to (                               )
claim on earlier death the sum permiums Or earlier death
  assured will be paid    

 

……………………………………………… ………………………………………………
(Date) (Managing Director)