Vaka Yako Application
Complete the form below to apply. Sections A–D are completed by you (the client). Commencement date is not selected by the client.
Verify to auto-fill your details.
SECTION A. PROPOSER
Personal details of the proposer.
SECTION C. EMPLOYMENT DETAILS
Your employment information.
SECTION B. POLICY DETAILS
Plan and payment details. Commencement date is not selected by the client.
Not selected by the client.
SECTION D. GENERAL
Please tick the appropriate box and give details in the space provided.
SECTION E. NOMINATION OF BENEFICIARY
Add up to 6 beneficiaries.
Surname Name D.O.B ID Number Relationship Share %
Ensure the total share percentage across beneficiaries is 100%.
SECTION F. DECLARATION
Confirm the declaration and provide your signature details.
Draw your signature above. It will be placed on the PDF signature box.
You can take a photo of a signature or upload an image. This will be used instead of the drawn signature.
After submission, you will be able to track your application in the portal.