Dollar Life Plan Application
COMPLETE THE FORM BELOW AND SUBMIT. WE WILL THEN ENGAGE WITH YOU DIGITALLY VIA THE EMAIL YOU SUPPLIED IN YOUR APPLICATION.
Has a previous application for life insurance ever been rejected or accepted with special conditions?
The Insurer reserves the right to confirm the status of previous applications with other Insurers.
How tall are you?
How much do you weigh?
Have you smoked any form of cigarette, e-cigarette or tobacco in the last 12 months?
Have you ever used recreational drugs, such as cocaine, heroin, ecstasy, cannabis (marijuana), amphetamines or crystal methamphetamine?
Do you travel outside the borders of the Resident Country you have elected in this application for more than 60 days per annum?
The Insurer reserves the right to contact your Doctor directly in order to confirm any medically related responses contained in your application.
Do you currently have, or have you ever had/or received treatment for any of the following:
Heart disease/heart attack, stroke, diabetes, cancer, tumours, kidney disease and/or HIV/AIDS?
High blood pressure, high cholesterol, any form of depression and/or asthma?
Any serious head injury, fits/epilepsy or seizures?
Are you currently disabled and require the use of a wheelchair or mobility aid to move around?
Have you recently had/or are awaiting results of any medical tests/investigations or experiencing symptoms that require you to seek medical advice or treatment in the next 6 months?
Have you been prescribed or taken chronic medication or been admitted to a hospital/clinic or had surgery during the last 2 years? ((excluding tonsilitis, cesarean, flu,ingrown toe nail, hysterectomy)
At least one Beneficiary has to be nominated at this stage and you can add up to 4 beneficiaries at any time.
I declare that I understand the information provided and that this is correct.
After you click on the SUBMIT, you will receive an email confirming that we have received your application and are urgently processing this.
Terms & Conditions
Copyright 2014-2019. Zing Holdings Limited. All rights reserved. Zing Life Assurance PCC is a registered Seychelles Insurer (no: 210290) - “ZingLife”.