JAMII COVER

This is a family last expense cover

that provides for the payment of
the sum assured to the dependents
of a deceased member to take care
of the funeral expenses.

Type of Plans

Platinum Gold Silver Bronze

Kshs. 500,000 Kshs. 200,000 Kshs. 100,000 Kshs. 50,000

Scope of Cover
Eligible members include: 1 Principal Member, 1 Spouse, 4 Children, 2 Parents & 2 Parents-in-law.

The benefit shall be paid as a cash lumpsum within 48 hours subject to full documentation, to the beneficiaries
as per the percentage allocation.

Age Limits: Principal or Spouse (up to 65 years), Children (1month up to 24 years), Parents (up to 80 years).
Parents above 80 years subject to further consideration.

Zamara Risk & Insurance Brokers Limited:

10th Floor, Landmark Plaza, Argwings Kodhek Road T 0709 469 000
P.O. Box 52439 - 00200 Nairobi, Kenya E bd@zamara.co.ke
W www.zamara.co.ke
Insurance Brokers | Pension | Actuaries | Consultants
MEMBER APPLICATION FORM
Member Details

Employer/ Association

Member’s Full Names

National I.D No. (attach copy) Date of Birth

Email: Mobile Number

Plan Benefit Premium Premium Premium

(Per Family) (Parents Excluded) (Parents Included) (Extra Child)
Platinum Kshs. 500,000 Kshs. 6,000 Kshs. 31,500 Kshs. 1,000

Gold Kshs. 200,000 Kshs. 2,200 Kshs. 10,500 Kshs. 400

Silver Kshs. 100,000 Kshs. 1,000 Kshs. 5,400 Kshs. 200

Bronze Kshs. 50,000 Kshs. 500 Kshs. 2,700 Kshs. 200

Payment Details
Paybill No: 810300 A/C No: Zamara Last Rites Amount: ……………………........... Mpesa Code: ……………………….............

Dependant’s Detail
No. Member’s Full Name Relationship Date of Birth (dd/mm/yy)
1. Spouse
2. 1st Child
3. 2nd Child
4. 3rd Child
5. 4th Child
6. Parent (Father)
7. Parent (Mother)
8. Parent-In-Law (Father)
9. Parent-In-Law (Mother)
10. Extra Child

Are you and your dependants in good health? Yes No

If no, please explain …………………………………………………………………………………………………………………………………………………………….........................

Beneficiary Details (persons to be contacted/paid in the event of principal member’s demise)

No. Beneficiary’s Full Name Relationship Percentage Mobile No.

1.
2.

Declaration
I declare that all statements to the above are complete
and true and shall form part of my application. I further declare that I have not withheld any material information in regard to this application
that ought to be disclosed to the company. I fully understand the terms, conditions and benefits of the policy and agree that if the above
declaration is not true, the benefits under this scheme shall be null and void.
Member Signature: Date:

Cover confirmation subject to payment of premiums. Digital certificates to be issued on purchase of product.