Create policy

Step-by-step: customer info, dependants, agent & store, payment, then address and proofs.

Principal member

Plan *

First name *

Middle name

Last name *

Date of birth *

Gender *

ID Type *

ID Number *

Email *

Cell Phone *

Dependants (optional)

Add adult (20+) or child (0–19) dependants. Price will update by age.

Total monthly premium (BWP): 0

Agent & store

Agent ID

Store

Summary

Member	Price/month	Age	DOB	Gender
Total

Payment & billing

From when you would like to start your policy? *

Billing Date *

Please Select Payment Method *

Address & Source of Income

Your contact details have been captured. Please provide your physical address and source of income.

Physical address * Your primary residence must be in Botswana.

State *

City / Town *

Postal code

Source of Income / Funds

Source of Income/Funds *

Review your application

Please review all the information below before submitting. You can save a copy as PDF for your records.

I confirm that all the information provided above is accurate and complete. I consent to the processing of my personal data for the purpose of this policy application. *