Student Personal Accident Cover

The AMACO Student personal accident cover, insures you incase of death, permanent total disablement and medical expenses arising from an accident during internship at the place of work and in the learning institution during the specified period of cover.

Options

Clear

1Student Personal Information

2Education Institute Details

3Student Personal Cover Details

Student Personal Information
Full Name*

Student's Full Name
ID/Passport Number*

National ID or Passport Number
Mobile Number*
Active mobile or telephone number
Email*
Enter Email Confirm Email

This is where your details will be sent to.
Student's Address and Postal Code

Example: Postal Box Number - Postal Code, City, Country.
Next of Kin*

Full Name of Next of Kin
Relationship*

Relationship with the stated next of kin

Education Institute Details
Name of University / College*
Admission Number*

Student Admission Number.
Course*

Course undertaking at stated institution.

Personal Accident Cover Details
Intended Place of Attachment*

Company name where you intend to be attached.
Period of Cover Starting Date*
DD slash MM slash YYYY
Period of Cover End Date*
DD slash MM slash YYYY

Preferably upto end of internship/attachement or 3, 6 months.
Have you previously held a student personal accident cover?*
- Yes
- No
Insurer of your student personal cover.*

You ticked yes on the field above. State the insurer you previously held a student personal accident cover from.
Have you sustained accidents while at work during the last 5 years?*
- Yes
- No
While at student internship.
Give details of all accidents you have sustained during the last five years.*
Total Premium*
Please enter a number from 600 to 1500.
Kindly confirm your total premium. either 600, 1000 or 1500
Hidden
Gross Premium
Hidden
Training Levy
Hidden
Stamp Duty
Please enter a number from 40 to 40.
Hidden
P/Holders fee
Hidden
Death or total and permanent disability
Hidden
Medical
Declaration*
- Yes
- No
I declare that to the best of my knowledge the particulars given in the proposal are true and complete and that I have not withheld any material information.

Student Personal Accident Cover

Student Personal Information

Education Institute Details

Personal Accident Cover Details

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Student Personal Accident Cover

Student Personal Information

Education Institute Details

Personal Accident Cover Details

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