Life Insurance Application

Basic Information

First Name

Last Name

Email

Phone

Date of Birth

Gender

Occupation

Home Address

Choose Your Plan Details

Cover Type?

Pure Life

Life & Investment

Education

Savings

How much coverage do you need?

₦5m

₦10m

₦20m

₦50m

How long do you want the cover?

10 years

15 years

20 years

For life

How do you want to pay?

Quick Health Check

Good health with no major conditions?

Yes

No

Do you smoke tobacco?

Yes

No

Who Gets Protected?

Beneficiary 1 Primary

Full Name

Relationship

I confirm all information provided in this application is true and accurate to the best of my knowledge. I understand that false statements may lead to claim denial.

Your Request Has Been Received.

Thank you for reaching out. Our team is currently reviewing your details and will get back to you shortly.

What Happens Next

Step 1

Our underwriting team reviews your submitted details within 24 to 48 hours.

Step 2

Your personalised quote is prepared based on your information.

Step 3

Your quote is sent directly to your registered email address along with next steps for payment and activation.

Your Submission Summary

Request Type Life Insurance Quote

Submitted By Jane Doe

Email Address jane@example.com

Reference Number QR-2026-84923

Date Submitted Feb 22, 2026

Please check your inbox and spam folder for our email. If you do not hear from us within 48 hours, contact our team directly.

Need help in the meantime? Reach us here.

Call Us

09160001429
Mon-Fri, 9am-6pm

Email Us

hello@cubecover.ai
We respond within 24h

CubeCover is licensed by the National Insurance Commission N NAICOM. Your information is handled securely and will never be shared without your consent.