Personal Accident

Personal accident cover offers compensation for death, permanent disablement, temporary loss of income due to disablement and medical expenses arising from an accident.

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1
Personal Details
2
Insurance Details
3
Insurance Company Selection

Personal Details

Enter your personal details

First Name

Last Name

Phone

Address

Occupation

Insurance Details

Enter your insurance details

Do you work with tools or machinery?

Yes

Are you engaged in manual work?

Yes

Do you supervise manual work?

Yes

Are you insured elsewhere against accidents?

Please select

Yes

If ‘Yes’ give details

Have you ever had an accident requiring medical attention?

Please select

Yes

If ‘Yes’ give details

Have you ever made a claim or received compensation for injuries?

Please select

Yes

If ‘Yes’ give details

Have you ever suffered from

Gout?

Yes

Diabetes?

Yes

Paralysis of any kind?

Yes

A fit of any kind?

Yes

A rupture?

Yes

Varicose veins?

Yes

If ‘Yes’ to any of the above, give details of condition and treatment received

Are you currently suffering from any illness, physical defect or infirmity?

Please select

Yes

If ‘Yes’ give details

Has any Insurance Company ever;

Cancelled your Policy?

Yes

Declined to insure you?

Yes

Declined to renew your Policy?

Yes

Imposed any special terms?

Yes

Declined any claim?

Yes

If the answer to any of the above is „YES‟, please give brief details below.

Insurance Company Selection

Below are some of the insurance companies in Kenya. Kindly select the insurance company whose policy you prefer.

Insurance Company Selection

Note: If your selected Insurance company does not offer this policy, we will notify you and guide you in your selection.

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+254 723 836 400

voolimobile@gmail.com

24th Floor,Britam Towers, Nairobi

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