Aljazira Takaful - Medical Malpractice Insurance

Policy Holder Details

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I agree to grant Aljazira Takaful Ta'awuni the right to inquire from any related agency about my data or any other data.

Policy Details

Has a previous insurance

Has your previous medical malpractice insurance application declined, premium increased, special restrictions imposed, terminated or not renewed?

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Have any claims or suits for malpractice been made against the proposer or any of his partners, assitants, nurses or technicians during the past five Years?

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Is the proposer or any of his partners, assistants, nurses or technicians aware of any circumstances or incidents which may result in a claim?

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Are You Politically Exposed Person (PEP)?

YES ,Family member or relatives

PEP is a member of the royal family or has currently in a public position or tasks in the state such as a head of state - senior government official - minister - senior military - judge - the senior executive for an institution or a state owned corporation - person who’s assigned for an administrative position in an International organization– or a first degree relative of the mentioned above.

I declare that the statements and particulars mentioned above are true and that I have not misstated or suppressed any material facts. I agree that this information, together with any other information supplied by me, shall form the basis of any contract of insurance effected thereon. In case the above information is incorrect, Aljazira Takaful reserves the right to repudiate the claim/policy with no refund.