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AXA Mansard Form 2

Are You An Amali Agent?

Terms & Conditions

This health insurance product is provided by AXA Mansard Health Ltd through Amali Inclusion Partner.

  1. Conditions for Cover

1.1. Receipt of duly completed application form.

1.2. Receipt of all upfront fees.

1.3. Premium must be promptly and continuously paid to ensure cover.

1.4. Maximum age limit on this product is 60 years.

1.5. The minor surgery benefit will not be covered or provided in the first year of the commencement of the scheme.

  1. Payment

2.1. Payment can made monthly or annually.

2.2. The initial payment is made upon completion of the application form.

​2.3. All new and recurring subscription payments are to be made to:
Account Number: 1004656988
Bank: VFD Microfinance Bank

Once payment has been made, kindly send your proof of payment to via email to [email protected] or WhatsApp: 09088050644 with your full name and your phone number

2.4. Where an enrolee’s monthly premium is not paid within seven (7) days from the date the previous premium lapses, upon subsequent payment of thepremium, a new policy shall be incepted for the Beneficiary. The Beneficiary shall no longer have access to any of the accrued benefits from the expired policy and moratorium shall apply to the new policy.

2.5. By submitting this form, you authorize Amali Inclusion Partner to set up a standing order instruction for payments of your premium as and when due.

2.6. AXA Mansard Health and Amali Inclusion Partners reserve the right to vary the terms and conditions. Any such variation will become effective uponnotice to the enrolee by any means AXA Mansard Health and Amali Inclusion Partners considers reasonable in the circumstance.

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