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Proposer

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Contact address must contain House No. and street name (i.e 7, Kufo street)
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Please state in full
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Risk Details

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Please provide details of all the locations that need to be covered under this policy and activities carried out:(Max file size: 2MB)

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Please provide details of all the accidents during the past 3 years, compensation paid/outstanding claims(Max file size: 2MB)

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If yes, attach any brochures or other related material for each product”(Max file size: 2MB)

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Declaration

I hereby undertake that the statements contained in this Proposal Form are in all material respect true, complete and devoid of errors or misstatements and I will immediately notify the Company of any changes to any information provided by me. I acknowledge that the statements contained in this Proposal Form shall form the basis of the contract between me and the Company and will be incorporated in the policy document

AXA Mansard is joining the rest of the world in being environmentally responsible. We invite you to join us in this cause by using only the electronic copy of your policy document which will be sent to your registered email address. You can also access it from your online account at www.axamansard.com or on MyAXA Plus App (available on Play Store or IOS Store).

Should you still want to receive a hard copy of your document in addition to the electronic copy, please place a request with your account officer or send an email to insure@axamansard.com. Your choice to decline making such request will serve to indicate that you do not agree to partner with us to preserve the environment.

 

Kindly ensure all payments are made directly into AXA Mansard's designated corporate account(s). All cash payments MUST be made in person, as the company shall not be held liable for cash payments made to/through other third parties apart from NAICOM licensed Insurance brokers

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