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St. Gregorios Orthodox Church, Sharjah
MEMBERS GROUP LIFE INSURANCE & PERSONAL ACCIDENT SCHEME 2020
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Email
*
Your email
SGOC Membership No.
*
Use format "X-123"
Your answer
Area of Residence
*
Choose
ABS - Abu Shagara Area
AJK - Ajman Karama Area
AJS - Ajman Sanaiya Area
AKZ - Al Khazamia Area
AND - Al Nahda Area
AWK - Al Wahda Area
BMW - BMW Area
DXB - Dubai Area
MLN - Maisaloon Area
MSL - Musalla & Yarmouk Area
OAI - Old Airport & Immigration
RLA - Rolla Area
SJC - Sharjah Cinema Area
SJU - Sharjah University Area
SRQ - Sharq Area
UAQ - Umm Al Quwain Area
Member Name
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
Profession
*
Your answer
Beneficiary
Your answer
Tel No.
Your answer
DEPENDENTS DETAILS
Dependent 1 - Name
Your answer
Dependent 1 - Date of Birth
MM
/
DD
/
YYYY
Dependent 1 - Relation
Your answer
Dependent 1 Beneficiary
Your answer
Dependent 2 - Name
Your answer
Dependent 2 - Date of Birth
MM
/
DD
/
YYYY
Dependent 2 - Relation
Your answer
Dependent 2 - Beneficiary
Your answer
Dependent 3 - Name
Your answer
Dependent 3 - Date of Birth
MM
/
DD
/
YYYY
Dependent 3 - Relation
Your answer
Dependent 3 - Beneficiary
Your answer
Dependent 4 - Name
Your answer
Dependent 4 - Date of Birth
MM
/
DD
/
YYYY
Dependent 4 - Relation
Your answer
Dependent 4 - Beneficiary
Your answer
Dependent 5 - Name
Your answer
Dependent 5 - Date of Birth
MM
/
DD
/
YYYY
Dependent 5 - Relation
Your answer
Dependent 5 - Beneficiary
Your answer
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