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  • REQUEST FORM real-ayjkgtJQTM

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    ihimamaka
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    The policyholder, Akinwale Fikayo Adinlewa, paid a total premium of ₦240,000 and is requesting a policy loan due to dissatisfaction with service from the insurance provider. They provided their current contact details including phone number and email, and signed the request form on 20-11-2023 to process the policy loan in a timely manner due to dissatisfaction.

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    The policyholder, Akinwale Fikayo Adinlewa, paid a total premium of ₦240,000 and is requesting a policy loan due to dissatisfaction with service from the insurance provider. They provided their current contact details including phone number and email, and signed the request form on 20-11-2023 to process the policy loan in a timely manner due to dissatisfaction.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    13 views1 page

    REQUEST FORM real-ayjkgtJQTM

    Uploaded by

    ihimamaka
    The policyholder, Akinwale Fikayo Adinlewa, paid a total premium of ₦240,000 and is requesting a policy loan due to dissatisfaction with service from the insurance provider. They provided their current contact details including phone number and email, and signed the request form on 20-11-2023 to process the policy loan in a timely manner due to dissatisfaction.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Policy Benefits Request Form

    Policy Information

    Policy Number CFLN117861


    Assured Name AKINWALE FIKAYO ADINLEWA
    Total Premium Paid ₦ 240,000 -

    Contact Details

    Current Phone Number 07033578292


    Current Email Address fikayoadinlewa@gmail.com
    Current Contact Address 38 Sijuwola Street, Ago Palace Way, Okota Lagos

    Type of Request

    Premium Refund
    To meet financial obligation
    Policy Loan
    Dissatisfied with service (please specify)
    Maturity
    Others
    Surrender/Termination

    IF SURRENDER, PLEASE SELECT THE REASON BELOW


    Financial Constraint Relocation abroad
    Not OK with policy terms and conditions Others

    Customer's Signature Date 20-11-2023

    Kindly ensure that accurate information is provided to enable us process this request timely

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