Welcome to
Quality Life
Assurance Company Limited!
(+233) (0) 556589662
support@qlacgh.com
Home
Products
Make a Claim
Pay premium
Our Agencies
Contact
User Area
Register
Login
Forgot Password?
Our Products
Home
Our Products
Individual Products
Group Products
Micro-Insurance Products
Maturity Claim Form
"
*
" indicates required fields
1
2
3
4
5
6
Applicant's Details
First Name
*
First
Middle Name
Last name
*
Email Address
Residential Address
*
Street Address
Phone Number
*
Policy Number
Staff Number
Request Details
Hidden
Claim Type
Amount (GHS)
*
Mode of Payment
Your preferred payment mode is
*
Your preferred payment mode is
Open Cheque
Crossed Cheque
Bank Transfer
MTN Momo(Only)
Note that QLAC supports currently only MTN transfer for Mobile Money option.
You have selected Cheque Option. Please confirm beneficiary name below.
Beneficiary's Name
First
You have selected Bank Transfer Option. Please provide details below.
Bank Account
*
Account Name
*
Bank Name
*
Bank Branch
*
You have selected MTN Mobile Money Transfer option. Provide details below.
MTN Momo No.
*
Wallet Name
*
Terms and Agreements
1. QLAC will not be liable for payments made into wrong MoMo/Bank accounts provided by you. Kindly attach a valid ID and present same when collecting your cheque in person 2. Statements made shall be investigated. A person who makes a Claim based on any representation of existence of a statement of fact, knowing fully well that the representation if false, stands the risk of having the claim repudiated as well as being prosecuted for defrauding by false pretence to contrary section 131 of the Criminal Code Act. 29.
*
1. QLAC will not be liable for payments made into wrong MoMo/Bank accounts provided by you. Kindly attach a valid ID and present same when collecting your cheque in person
2. Statements made shall be investigated. A person who makes a Claim based on any representation of existence of a statement of fact, knowing fully well that the representation if false, stands the risk of having the claim repudiated as well as being prosecuted for defrauding by false pretence to contrary section 131 of the Criminal Code Act. 29.
I agree to the terms and conditions.
Signature
*
Date of application
*
MM slash DD slash YYYY
Upload Required Documents
Please all required documentations below.
Policy documents
Upload your policy certificate
Accepted file types: pdf, doc, docx, Max. file size: 25 MB.
ID Card (Front view)
*
Accepted file types: jpg, jpeg, png, gif.
ID Card (Back view)
*
Accepted file types: jpg, jpeg, png, gif.
Hidden
PREVIEW ENTRIES
Click
"NEXT"
to confirm your Entries Summary.>>>
Entries Summary Preview
Email
This field is for validation purposes and should be left unchanged.
×
Quality Mortgage Protection Plan
The policy is used to insure the outstanding balance of a mortgage facility obtained by the insured individual…
+
Quality Investment Plan
Accumulate substantial funds towards your retirement through consistent, regular periodic contributions
+
Quality Education Plan
The policy develops Investment Account and Cash Values through periodic contributions.
+
Quality Funeral Support Plan
A whole life insurance with level premium payments that provides level death benefits in the event of death…
+
1
2
Quality Group Welfare Plan
This is an annual renewable term policy that provides welfare cover, disability and critical illness as a rider. It is…
+
Quality Group Schooling Plan
This is an annual renewable term policy that provides education cover, disability and critical illness as a rider. It is…
+
Quality Group Mortgage Protection Plan
The policy is used to insure the outstanding balance of a mortgage facility obtained by the insured against death of…
+
1
2
Fa Bi Sie
The Quality Life “Fa Bi Sie” Plan is a pure term insurance policy with a savings (i.e. Susu…
+
Wo Ba Daakye
The Quality Life “Wo Ba Daakye” Plan is a term insurance policy with a savings (i.e. Education Fund)…
+
Emma No Ento Wo Ansa
This is a term life insurance policy with a Savings Plan (i.e.Susu Fund) geared towards providing level death…
+
