Arope | Online payment service

1 . Policyholder Personal Details

2 . Product and Payment Details

3 . Redirection

4 . Confirmation

Personal Details

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Form is automatically Filled with your previous data.If you want to clear the form Click Here

First Name* (as shown on Policy) First name is required

Father's Name* (as shown on Policy) Father's name is required

Last Name* (as shown on Policy) Last name is required

Phone Number

Mobile Number*

Mobile number is required (ex: 96170676767)

Email* Email is required (ex: example@example.com)

Address

Building is required

Street is required

City is required

Country is required

Maximum length 500 character.

* Mandatory Fields

Product & Payment

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Product*

Product is required

Policy Number* (as shown on Policy)

Policy Number is required

Only 1 policy number allowed (ex: MTP/1234567)

Select the currency of your Credit/Debit card*

USD

LBP

Select the currency of your Insurance Policy*

USD

LBP

currency is required

Amount to be paid*

Enter the Premium Amount you would like to pay *

[%data.incurrency%] Currency rate: 1USD = [% data.rate %] LBP. Amount is required Currency is required [%amountMaxMessage%]

Currency exchange rate applied on this website is indicative only and is subject to change.

[%data.cardcurrency%]

I Agree *

* Mandatory Fields

Confirmation

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[%title%]

[%message%]

Step 3: Payment Confirmation Details & Redirection to BLOM Bank Gateway

Product

[% selectedProduct() %]

Policy Number

[% data.policy %]

Policyholder Name

[% data.firstname %] [% data.fathername %] [% data.lastname %]

Amount to Pay

[% data.currency %] [% data.amount %]

I hereby confirm that I read and approved the Privacy Policy

Are you sure you would like to cancel the Payment Transaction?