Certificate No. Application No. Ayady Takaful (C-43/84), H.Orchid, Ameeru Ahmed Magu, Male’, 20095, Maldives [email protected]ayady.mv 1600 +960 331 0300 INDIVIDUAL HEALTH TAKAFUL PROPOSAL FORM Package (Reimbursement only) IMPORTANT NOTICE Please read through the following notes that are relevant to any of either certificate you may enroll cmOf cSwaclufWkwt clwaujiviDcnia Individual National ID Card Work Permit Company Registration Certificate Passport Female Male cnudurwf wlcaimwa cDWk.ID.iawa cTimrwp ckOv WriaWd egWfIzwv cnwn eguTcnwkilcpea /cnwn eguhIfoa /cnwn egInufcnuk cKIrWt cnwfua urwbcnwn ID.iawa urwbcnwn IrcTcsijwr (cSwtogWv iawguDWk IDwa) csercDea ImiaWd csercDea WrukuTcsOp cnwn egutWrWmia /cnwnegEg ugwm umuawg cnwn egWhIm EhejcnwLug urwbcnwn egWhIm EhejcnwLug clEmIa csckef cDOk clwTcsOp cSwvwa cSwr ,uLotwa ctwvWb egIrWfwyiv inufcnuk cTekifcTes IrcTcsijwr cTOpcsWp cnehcnwa cnehirif Occupation: Company/Office/Applicant’s Name: Date of Birth: ID No. Reg No. Permanent Address (as in ID card): Postal Address (fill below): House/Building name: Road: Nationality: Contact Name: Contact No: Email: Fax: Postal Code: District: Atoll,Island: Nature of Business: D M Y Y Y Y D M 1-3 1. Any of either certificate may have a proposer, maximum aged 59 years when applying for the certificate. 2. Any of either certificate may have a proposer, below 18 years of age, however certificate shall be under a legal guardian. 3. Any of either certificate proposers may continue health takaful up to the age of 66. 4. All documents of Medical Check-up as per the Check List provided would not be reimbursed under any of either certificate. 5.The certificate is only for those residing in the Maldives for more than 6 months in a 12 months period. This is not for overseas travelers who remain out of the country for a period more than 6 months. 6. Pregnancy and pre-existing illness will not be covered up to 12 months from certificate inception. 7. The certificate shall be discontinued if the certificate holder fails to disclose a pre-existing illness/condition before the inception of the certificate. 8. Certificate will be activated after 30 days of waiting period. 9. Certificate Coverage is for 12 months period from the issue of Takaful, whereby the certificate need be renewed before the end of the period. AL’SHIFA EXCEL AL’SHIFA BASIC Coverage INPATIENT ONLY FULL COVER
1. Any of either certificate may have a proposer, maximum aged 59 years when applying for the certificate.
2. Any of either certificate may have a proposer, below 18 years of age, however certificate shall be under a legal guardian.
3. Any of either certificate proposers may continue health takaful up to the age of 66.
4. All documents of Medical Check-up as per the Check List provided would not be reimbursed under any of either certificate.
5.The certificate is only for those residing in the Maldives for more than 6 months in a 12 months period. This is not for overseas travelers who remain out of the country for a period more than 6 months.
6. Pregnancy and pre-existing illness will not be covered up to 12 months from certificate inception.
7. The certificate shall be discontinued if the certificate holder fails to disclose a pre-existing illness/condition before the inception of the certificate.
8. Certificate will be activated after 30 days of waiting period.
9. Certificate Coverage is for 12 months period from the issue of Takaful, whereby the certificate need be renewed before the end of the period.
Nature of Work (Please tick whichever is applicable)
Persons engaged in professional, administrative, managerial, clerical and non-manual operations.
Persons engaged in work of supervisory nature but not involved in manual labor.
Persons engaged occasionally or generally in manual work which involves the use of tools or machinery.
Insured
Insured
Insured
Insurance/ Takaful History:
Declaration by Proposer:(To be read carefully before signing by the Proposer)
An application for medical or hospitalization type of Insurance/ Takaful been declined, restricted or accepted at other than normal terms?
If Yes, please state reason and provide the name of the Insurance Company/ Takaful Operator.
I/We hereby declare that the above answers and statements are true, and that I/We have withheld no information whatsoever regarding this proposal. I/We agree that this Declaration and answers given above, as well as any proposal or declaration statement made in here by me/ourselves or anyone acting on my behalf shall form the basis of the contract between me/ourselves and the Takaful Operator.
I/We hereby further declare that I/We agree that in the event the declaration shall contain any misstatement, misrepresentation, suppression and or fraud, the issuance of the certificate shall not be deemed to be a waiver of such misstatement, misrepresentation, suppression and or fraud.
I/We hereby authorise any hospital, surgeon, medical practitioner or clinic or other person who attended to me/ us for any reason to disclose to the Takaful Operator any and all information with respect to any illness or injury and to provide copies of all hospital or medical records/ certifications, including any earlier medical history. A photocopy of this authorisation shall be considered as effective and valid as the original.
I/We acknowledge that the liability of the Takaful Operator does not commence until this proposal is accepted by and contribution paid to the Takaful Operator.
I/We also upon filling the form are well aware of the cover I have chosen to enroll in. I/We have also read the Important Notice on the cover page of the proposal form and are aware of their significance and balance in clearly informing of coverage limitations.
Documents required with the Proposal:Copy of ID. Card
itekwt EhejcnwLwawSuh ukea iaWmOf
Pre-Participation Health Checkup List with Reports
Medical Examination Certificate ( filled and authorized by a Medical Officer )
This form has an ANNEX A and ANNEX B
THIS PROPOSAL WILL NOT BE IN FORCE UNTIL THE PROPOSAL HAS BEEN ACCEPTED BY THE TAKAFUL OPERATOR
(Acceptance of Proposal means Takaful certificate issued and contribution collected.)
Declaration: I/We agree to participate in this Takaful scheme based on the principle of Ta’awun and to pay the contribution on the basis of TABARRU (donation) for the purpose of helping each other participants who have suffered a financial loss due to any of the covered event (s). Based on this contribution, I/we are also entitled to the Takaful cover subject to the terms and conditions of this contract. I/We further agree that my/our contribution be credited into the Participant Risk Fund (PRF) and to appoint AYADY TAKAFUL to manage and invest the Fund according to Islamic Shariah. I/We also permit AYADY TAKAFUL to make payment for claims/Takaful benefits, provisions and reserves based on the guidelines and policies laid by the authorities, and to pay a WAKALAH (agent) fee at the rate of 34% of the contribution to AYADY TAKAFUL. I/We further agree that the money in the PRF shall be invested by AYADY TAKAFUL, and if the return from the investment exceeds 1.2%, the additional return or excess shall be retained and credited to AYADY TAKAFUL under the principle of PERFORMANCE FEE (Ujrah). Additionally, I/We authorize AYADY TAKAFUL to distribute Net Surplus of the PRF at the
end of the year (if any) among the participants. I/We understand that this Takaful Certificate will not be enforced unless this application has been accepted by AYADY TAKAFUL.
Note: • The pre-participation health checkup can be facilitated for proposer upon request• Recent medical checkups can be accepted (less than 6 months)• If an indication arise to further evaluate a specific disease condition, additional diagnostic investigation may be required.• Expenses incurred for the health checkups shall be borne by the proposer
![Takaful Insurance final for print out [Read-Only]€¦ · What is Takaful Insurance ? • Takaful—“bear ye one another’s burden.” Takaful insurance is based on the concept](https://static.documents.pub/doc/80x56/5f09a9447e708231d427e84c/takaful-insurance-final-for-print-out-read-only-what-is-takaful-insurance-a.jpg)
