ANNUITY LOAN APPLICATION FORM GENERAL +LIFE+ HEALTH, Tle: eZ] wen] ts, J mr oe. J othe sumame: Ly Peta other Manes AE \/Bavapere Number: [ BTL 9 FF RAP ere ole caeorsiren: = [7 Te leh [i]9 Tub) cede: (MAGE Cd Martatsews: CARLIE Tol. Number: [O76 7S3 397 Paty umber: PRP/HO [00001 22]2819 satay: [WE (Pen Emalt Adres: on rens/ Wace Lo%@ —FATCAUSResdens/ Citizens GN i: - LOAN AMOUNT KSHS. [ZS®, 66 —] DURATION (EARS pvonenunses: [O76 793 B97] PNwumore vo Nuva. 279 account uwecr: [012010003017 ACCOUNT NAME: RTRs sac nan: oi : ii ee sean i Ss E FULLNAME POSTAL ADDRESS ee eee : {PA UFE ASSURANCE LIMITED . 0. Box 30389 — 00100, Nairobi Personal data refers to all information that may directly or indirectly identify you. In order to provide you with products and services; sve nce to collect, we, share and store your personal data. Ths may include fermion provided by you or obtained from third partes. The information may be used to assist usin providing the service you ae applying for and shal be used in fulfiment of contractual aligations. We may alsa use the informacion to advise you of other products and services provided by us, to confirm, update and enhance records and to establish your Identity. The data collected may be shared/vasferred/stored/processed within or outside the Kenyan Jurisdiction. any reference to "We" of 'Us" will mean Apollo Group. Refer to our website www apainsurance.org to see the entities under Apollo Group. | authorize APA Life Assurance to obtain and use my personal infermation as per the above, Note: In case you would tke to revoke the concent, kindly end an ema to privacy apolo.co.ke + 1/We understand that the statements and all information provided in tis aplication form, whether in my/our ow handwriting or not, are compete and true to the best of my/our knowledge anc that it wil form part of the potcy + Change in amourt, classification or benefits shal be effective uress agreed &o In writing by the poicy over. + itis also agreed that APA Lite will Incur no ieility under this application until the application nas been receved and approved + \/We understand that na Intermediary has the authaity to walve the answers to any of the questions inthis aplication orto make or alter any contract for APA Life Assurance + iW consent to receive the policy agreement via the E-mail address provided in Section 1 above pa ieee Bp — = (ole telglas Tag The cover tobe provided under this proposal is death Benet only. The amount covered shall be, at times, to the extent of the outstancing Loan amount, The ameunt payable shall be pal tothe benefilary in settlement of the outstanding loan amount. The abovermentioned members to be isued with the loan amount as per the attached, ‘Amorczation Schedule with effect fram (date): [ I Authorised by: Postion in Company: Signatures Date of signing meerReceived and verified by Name: ——— SS Signature pate: (TT CI Ee |. Completion of apptieation form |. Maximum repayment perted five (5) yeas. I, An applicant shal be required to complete and execute of agreement IV. An applicant should be within three (3) years to end of guarantee period, for guaranteed annuitant Minimum annuitant recevable is 2 third (973) \. An applicant shall take 8 life cover on the loan wath APA Life. Vi, in he event of death, the tife cover Benet shall be utilized to pay the loan, Vl. A processing fee of one (1) per cent of the loan willbe applies.