Life Insurance Coverage

You deserves the best

KDA Member Benefit

Life Insurance Application

Apply for comprehensive life insurance coverage as a KDA member. Complete the form below and our team will review your application within 3–5 business days.

Principal

Coverage

Beneficiaries

Health

Review

👤

Principal Member Details

Your personal and professional information

Full Name *

Date of Birth *

Age

Gender *

Marital Status *

County of Residence

National ID / Passport No. *

KDA Membership No. *

Phone Number *

Email Address *

Dental Specialty / Current Role

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Coverage Details

Select the type and level of coverage you require

Coverage Type *

Sum Assured (KES) *

Premium Payment Frequency *

Preferred Start Date

Leave blank to start from approval date

Additional Notes / Special Requirements

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Beneficiaries

Provide details of all dependants and nominated beneficiaries

🤝 Spouse

💍 Spouse Details

Full Name

Date of Birth

National ID / Passport No.

Phone Number

👧 Children

👴 Parents

Father

Full Name

Date of Birth

National ID / Passport

Mother

Full Name

Date of Birth

National ID / Passport

👴 Parents-in-Law

Father-in-Law

Full Name

Date of Birth

National ID / Passport

Mother-in-Law

Full Name

Date of Birth

National ID / Passport

🏥

Health Declaration

Please answer all questions honestly — this affects your coverage terms

Declaration: I hereby declare that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any misrepresentation may result in the cancellation of this policy.

I have read and agree to the declaration above and authorise KDA to process my application. *

📋

Review & Submit

Please confirm all details before submitting

🎉

Application Submitted!

Your life insurance application has been received. Our team will review it and contact you within 3–5 business days. A confirmation copy has been sent to your email.

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Submission Failed

Something went wrong. Please try again or contact KDA directly.