Registration Test

Basic Information
NewReinstatement

Lapsed policy will attact 40% on basic premium

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Practice Information
Internship Information
Add More Internships
Post Internship Information
Add More Post Internships
Registration Information
YesNo
Would you need to do any of the following
YesNo
YesNo
Do you do any of the following:
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Rate Calculation

Overseas coverage adds 25% to your premium.

Laser surgery adds 15% to your premium.

Laproscopic surgery adds 20% to your premium.

Health tourism adds 100% to your premium.

New policy Renewal / Reinstatement Yes No

A lapsed policy adds 40% to your basic premium.

I HEREBY DECLARE: that the above statement and particulars are true and that I have not suppressed or misstated any material facts and I agree that this Proposal Form and any supplementary information sheet(s) attached hereto shall be the basis of the contract with the MAJIF TRUST.

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