Last Expense Insurance Questionnaire Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Date of Birth *Who are you looking to cover? *MyselfMyself & My SpouseMyself, My Spouse and My ChildrenMy immediate family and members of extended familyMyself, My Spouse, My parents and My in-lawsOtherOtherWhat are the ages of the family members you want to cover? E.g My Mother-50 Years OldWhat level of cover are you looking to receive? *KES 200,000KES 500,000KES 800,000KES 1,000,000KES 2,000,000KES 3,000,000What is Your Preferred Method of Contact? *E-mailPhone CallText/WhatsappPlease share your contact if you chose phone call or text/whatsappAny additional informationSubmit
