Immigration Bond | Proposal

Proposer Details

Risk details

General Policy Details

Application for an entry permit

Are you Employed By the Company ?

Are you dependent and of school going age (0-25 years)?

Note:- Period selected must strictly be as per the immigration notification document (ecitizen).

Obligor : Employer, Parent or Guardian details

Proposer Type

Intermediary

Select Intermediary branch

Binder

ID Type

ID Number

KRA Pin

First Name

Middle Name

Last Name

Type of Business

Occupation

Date Of Birth

Gender

Male Female

Contact Details

Mobile No.

Telephone No.

Email Address

Postal Address

Postal Office

Town

County

Region

Earth Quake Zone

Physical Address

Which Kenya Orient branch do you want to be served from?

Risk Details

Insurance Start Date

Validity Period

Insurance End Date

Bond Value

Immigrant Details

Immigrant Passport number

Immigrant Name

Country of Origin

Occupation

Upload Copy of Passport (.doc,.pdf,.jpg,.jpeg,.png,.docx)

Copy of Entry Permit (.doc,.pdf,.jpg,.jpeg,.png,.docx)

Add

Obligor : Employer, Parent or Guardian details

KRA Pin

Name

Telephone Number

Postal address

Postal office

Town

County

Physical address

General Policy Details

Are you now or have you ever been insured for this type of policy ?

Has any insurance company ever

Declined your proposal ?

Cancelled or refused to renew your policy?

Required an increased premium or imposed special conditions?

Declined your claim?

Insurance and Loss History

Please provide below information on any insurance claims you have reported in the last 5 years

Type of loss

Year of Incident

Claim Amount/ Value

Add Loss

I confirm that this vehicle is only used for social, domestic and pleasure purposes and for my own or my employer's business. This excludes any carriage of fare paying passengers and any carriage of goods for a fee

DECLARATION AND CONSENT | Please Read Carefully *

I/ We do hereby declare that the above answers and statements are true and that I/ We have withheld no material information regarding this proposal. I/ We agree that this declaration and the answers given above as well as any proposal or declaration or statement made in writing by me/ us or anyone acting on my/ our behalf shall form the basis of the contract between me/ us and the Company. I/ We further agree to accept indemnity subject to the conditions in and endorsed on the Company’s policy.

I/We consent to Kenya Orient Insurance Kenya Ltd; (i) Collecting, using, disclosing and/or processing my/our personal data; and (ii) Transferring my/our personal data to their reinsurers and affiliated companies for the purposes of insurance as permitted by law.

CREDIT INFORMATION | Please Read Carefully *

I/we do hereby confirm that I/we have authorized Kenya Orient Insurance Limited to share my/our credit information and to access my/our credit profile from Credit Reference Bureau (C.R.B)

Immigration Bond Proposal

Application for an entry permit

Obligor : Employer, Parent or Guardian details

Contact Details

Risk Details

Immigrant Details

Obligor : Employer, Parent or Guardian details

General Policy Details

Has any insurance company ever

Insurance and Loss History

DECLARATION AND CONSENT | Please Read Carefully *

CREDIT INFORMATION | Please Read Carefully *