Policy Number
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Agent / Broker: Policy No.
Issue Date: Total Premium(PKR):
Policy Details Insured Details
Type: Name:
Plan: CNIC No.:
Plan Type: Passport No.:
Travel Destination: Date of Birth:
Geographical Limit:
Purpose of Visit: Gender:
Period of Insurance: Contact Detail:
Policy Date: From:  To: Address:
BENEFICIARY DETAILS
Name: Relationship with Insured:
Address:
FAMILY DETAILS
BENEFITS
Plan Type:
SUM INSURED PER PERSON ($)
Premium Details (Amounts in PKR)**
NET PREMIUM
TOTAL AMOUNT
UNDERWRITTEN BY:
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ADAMJEE INSURANCE COMPANY LTD. This is a computer generated E-Policy and does not require signature.
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FOR BRIEF POLICY TERMS & CONDITIONS AND SECP COMPLIANCE REFER PAGE # 2-4
 
 

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