Medical Form Choose* INDIVIDUAL CORPORATE Name* Company Name* Email* Number Of StaffPlease enter a number greater than or equal to 5.Download Staff Biodata TemplateDownloadUpload Staff Biodata*Max. file size: 8 MB.Date of birth (DOB)* DD slash MM slash YYYY Spouse’s DOB DD slash MM slash YYYY Number of Children01234567891011121314151617181920Child 1 DOB* DD slash MM slash YYYY Child 2 DOB* DD slash MM slash YYYY Child 3 DOB* DD slash MM slash YYYY Child 4 DOB* DD slash MM slash YYYY Child 5 DOB* DD slash MM slash YYYY Child 6 DOB* DD slash MM slash YYYY Child 7 DOB* DD slash MM slash YYYY Child 8 DOB* DD slash MM slash YYYY Child 9 DOB* DD slash MM slash YYYY Child 10 DOB* DD slash MM slash YYYY Child 11 DOB* DD slash MM slash YYYY Child 12 DOB* DD slash MM slash YYYY Child 13 DOB* MM slash DD slash YYYY Child 14 DOB* MM slash DD slash YYYY Child 15 DOB* MM slash DD slash YYYY Child 16 DOB* MM slash DD slash YYYY Child 17 DOB* MM slash DD slash YYYY Child 18 DOB* MM slash DD slash YYYY Child 19 DOB* MM slash DD slash YYYY Child 20 DOB* MM slash DD slash YYYY Inpatient Limit (per family) KSH500,0001,000,0001,500,0002,000,0002,500,0003,000,0005,000,00010,000,000Outpatient Limit (per person) KSH35,00050,00075,000100,000200,000300,000500,000 Dental Optical Maternity
