Apply Online Damaan Islamic Insurance CompanyICBF - LIFE INSURANCE SCHEME ENROLLMENT FORM INSURED DETAILS *NameDate of BirthQID NoPassport No.Mobile No.EmailGender Male Female NationalityAssociation/Company NamePermanent Address & Contact No.NotesPlease attach a copy of QID and Passport of the insured member Premium QAR 125/- (for two years) ICBFNOMINEE DETAILS Nominee NameRelationNominee Permanent AddressNominee Phone NoNominee EmailDECLARATIONI, declare, to the best of my knowledge, that I am in a good health, do not suffer from any disease and I am not undergoing any medical treatment. I agree to the terms and conditions of the Policy. I also hereby authorize to disburse the policy amount to the nominee mentioned above in case of any incident and indemnify ICBF from any legal responsibility whatsoever. NameDateSignature Fields with (*) are compulsory.