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Personal Data Information
Make sure the data is correct and according to the ID card as it will be used as Policy data.
ID card number*
Full Name*
Birth Date*
Birth Date*
Birth Date*
Gender
Male
Female
Occupation Type
Select Occupation Type
E-mail Address*
Mobile Number*
Heir Information
An heir is a person who receives cash plan if you are at risk.
Full Name*
E-mail Address*
Mobile Number*
Relationship*
Select Relationship
Address Information
Fill in the address based on ID card, not your current address.
ID Card Address*
Province*
Ex: DKI Jakarta
City
Ex: South Jakarta
District*
Ex: Kebayoran Lama
Sub-district*
Ex: Ciledug
Postal Code*
Referral Code
If you have a referral, enter your referral code below.
Referral Code
Members are not in a condition of illness and/or being hospitalized at the time the Sharia Insurance membership comes effective.
The manager will not pay any insurance allowance if the member doesn't fulfill the regulated conditions of Jasindo Sharia Insurance.
I agree to all terms and conditions in the applicable
Terms and Conditions
.
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