Seniors Cover Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail Address *Phone Number *The age of the person you are taking the cover for (between age 60yrs - 84yrs). Please Write the date of birth Example 7th March 1959 *Gender *MaleFemaleDo they have any underlying condition? Do you have a spouse to include in the cover?YesNoSpouse age (between 60- 84years) Please indicate the date of Birth Example 8th March 1960GenderMaleFemaleDo they have any underlying condition?What benefits are you looking for? *InpatientOutpatientDentalOpticalWhat is your annual budget range? *Less than KES 60,000/yearKES 60,000–120,000/yearKES 120,000–240,000/yearKES 240,000–600,000/yearAbove KES 600,000/yearOtherPreferred contact method *EmailWhatsAppPhoneSubmit
