| It is agreed that this proposal shall be the basis of the contract between me and Tawuniya | A material fact is one which is likely to influence Tawuniya's acceptance or assessment of this proposal |
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| Declaration by applicant on behalf of all persons to be insured• To the best of my knowledge and belief, the above statements and particulars are complete and true and that I have not misstated or suppressed any material facts | I declare that the documents submitted for identification are original and all particulars given are true and correct |
It is also understood that the insurer reserves the right to request any document to proof the information that I entered, also the right to cancel the policy and forfeit the premiums paid in case identification particulars are not found correct.
| I hereby declare that I am the policy holder andI entered all fields by my self | |
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| None of us will be traveling against medical advice |