COVID-19 Insurance Registration Form
Powered by mTek via Hillcroft Insurance Brokerage Ltd.

Four Simple Steps:

1) Provide Policy Holder Information.
2) Provide Insured Individual Information.
3) Select Package and Pay
4) You are insured and smarter #besmart

The Insurance Policy provides Coverage for a person on diagnosis and hospitalization with COVID-19 for atleast 24 hours.
More benefits and frequently asked questions :

Sign in to Google to save your progress. Learn more
Policy Holder Information
Details of the individual purchasing the policy and not necessarily the COVID-19 insured individual
Name of the policy holder: *
Date of Birth: *
National Id Number *
KRA Personal Identification Number (PIN) *
Mobile Number *
Email Address *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Hillcroft Technologies Ltd.. Report Abuse