Parents Care Plus

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Personal Information

Health Assessment

Confirmation & Payment

Full Name *

Date Of Birth

CNIC/NICOP

CNIC Issue Date *

Phone *

Email *

Address *

Gender *

I would like to cover *

Plan Type*

Disclaimer: Never share your OTP, card details, or payment information with anyone. Jubilee General Insurance will never request this information via phone, email, or any other channel.

Health Declaration Questions

1. Does the Insured have any existing medical conditions that require ongoing treatment, medication, or regular doctor visits? For example, diabetes, heart issues, high blood pressure or any other long-term condition (5 years or more)?*

Yes No

2. In the past 2 years, has the Insured been admitted to a hospital, undergone major surgery or been diagnosed with any serious illness?*

Yes No

3. Does the Insured help with any daily activities like walking, dressing, personal care or do you face any difficulty doing these on your own? *

Yes No

4. Is the Insured currently waiting for any test results, medical treatments or have any upcoming surgeries planned? *

Yes No

5. Has the Insured ever been diagnosed with or treated for any condition related to your heart, lungs, kidneys or any type of cancer? *

Yes No

* Insured: The person who will be covered under this plan

I declare that I have truthfully answered the health-related questions to the best of my knowledge and I understand that any incorrect or incomplete information may affect the validity of my insurance coverage or future claims.

Insurance Detail

Parents Care Plus Insurance ()

Full Name *

CNIC/NICOP *

CNIC Issue Date *

CNIC/NICOP

Gender *

Residential Address *

Spouse's Details

Billing Information

Insurance ()

Full Name *

Mobile Number *

Email Address *

Billing/Shipping Address *

Same As Your Address

Same As Your Member's Address

Another Address

Referred By

Branch *

City *

Details		Price	Qty	Premium
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Promocode
Grand Total			PKR

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