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Home Protection Plan

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Home Protection FIRE AND BULGLARY Plan-Option D

INDIVIDUAL

Phone Number

Last Name

Other Names

Address

Gender

Date of Birth

Occupation

Business Sector

Tax identification No

Average Annual Income

State of Origin

Nationality

NIN No

Highest Academic Qualification

Hobbies

Marital Status

RISK INFORMATION (DETAILS OF COVER OR PRODUCT REQUIRED)

Address of the home to be insured

Description

Type of material - roofing

Construction material

ADD CATEGORIES OF ITEMS FOR INSURANCE

Categories	Amount

I hereby consent to the collection, processing, use and the transfer of personal data to third parties (within or outside Nigeria), for the performance of this contract and any other data processing activities which may arise therefrom between myself and Royal Exchange General Insurance Company Ltd (Royal Exchange). I affirm that I am aware and take cognizance of my rights under the relevant Data Protection Laws in Nigeria and other terms detailed in the Data Protection and Privacy Policy of Royal Exchange available on our policy
I authorize and consent that any person who may be in possession of, or hereafter acquire, any information pertaining to my records may disclose such information to Rex Insurance Limited.

CORPORATE

Registration No

Name

Address

Phone Number

Year of Incorporation

Business Sector

Tax identification No

Average Annual Turnover

Nature of Business

No of Employees

Size of Business

OWNERSHIP STRUCTURE (DETAILS OF COVER OR PRODUCT REQUIRED)

Government%

Indigenous %

Foreign %

Others %