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Insurance Coverage of the Sri Lankans Employed in the Middle Eastern Region
Your Details
Recruitment Agent Name
Member
Covered Member Name
Date of Birth
Passport Number
Visa File Number.
Visa Country
Insured Contact Number
Insured Home Contact Number
Insured Email
Insured Address in Visa Country
Insured Address in Home Country
Beneficiary Address
Beneficiary Name
Beneficiary Email Address
Beneficiary Relationship
Beneficiary Date of Birth
Please Enter Guardian Detail
Guardian Name
Guardian Email Address
Guardian Relation With Beneficiary
Guardian Date of Birth
Policy effective Date
Policy Period
SPONSOR Detail
I
hereby declare that
I am a non-resident of the UAE.
I will be outside the UAE and will not be visiting the UAE during the effective period of the insurance policy.
I understand and agree to the terms of acceptence
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