I select coverage for my dependents and agree to pay semi-annually / Annually the indicated premium for the benefits selected.
I declare that the answers shown above are complete and true and I understand they form the basis upon which insurance will be made effective and coverage under this plan is restricted to the maximum amount allowed per life insured.
I authorize my physician, hospital or other medically related facility to disclose to Sagicor Life Jamaica Limited any additional information about my health habits or my medical history.