Online Application Form Funeral Policies MAIN MEMBERTitle*Please selectMrMrsMsDrProfPastorMain Member: Name & Surname* NAME SURNAME ID NumberPhysical Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email BENEFICIARY DETAILSBeneficiary: Name & Surname* NAME SURNAME ID NumberPhone*PLANSCHOOSE A PLAN*Please selectSilver Plan 1 + 5 Under 74Silver Plan 1 + 5 Under 85Silver Plan 1 + 5 Under 94Silver Plan 1 + 9 Under 74Silver Plan 1 + 9 Under 85Silver Plan 1 + 9 Under 94Silver Plan 1 + 13 Under 74Silver Plan 1 + 13 Under 85Silver Plan 1 + 13 Under 94Gold Plan 1+5 Under 74Gold Plan 1+5 Under 85Gold Plan 1+5 Under 94Gold Plan 1+9 Under 74Gold Plan 1+9 Under 85Gold Plan 1+9 Under 94Gold Plan 1+13 Under 74Gold Plan 1+13 Under 85Gold Plan 1+13 Under 94EXTENDED FAMILY DETAILS1. NAME SURNAME ID Number2. NAME SURNAME ID Number3. NAME SURNAME ID Number4. NAME SURNAME ID Number5. NAME SURNAME ID Number6. NAME SURNAME ID Number7. NAME SURNAME ID Number8. NAME SURNAME ID Number9. NAME SURNAME ID Number10. NAME SURNAME ID Number11. NAME SURNAME ID Number12. NAME SURNAME ID NumberUpload ID copies Drop files here or Select files Max. file size: 64 MB. Consent* I agree to the privacy policy.1. No medical examination required. 2. Every option has a joining fee of R180. This is non–Refundable and compulsory. 3. The inception date is on the day we receive first premium not joining fee. 4. Waiting period for all members is six (6) months (after paying joining and 1st premium) 5. Should payments be missed for 3 consecutive months (90 days) policy will lapse, 6 (six) months waiting period will apply. 6. The first premium plus joining fee to be paid to the agent completing the necessary documentation, and the monthly premiums to be paid at your nearest branch. Please note that if you pay monthly premium to our agents you are doing it at your own risk, as we accept no claim without proof of payment. Always make sure you get proof of payment (receipt) after making payment. 7. Maximum membership is only 14(fourteen) people and be guided by our PACKAGE. 8. Should a child be born to a principal member, the principal member has 90 days to update his/her application, if not the child will not be covered. Cover will be provided for one spouse, second spouse will be treated as extended member and available subject to payment. 9. Premium payment should be made on or before the 7th of every month. Policy will LAPSE after 3 consecutive months (90 days) of non-payments. 10. Please note that when a policy lapses, all members will have a 6 months waiting period and it will only commence after all the premiums are paid up to date. 11. Claims not exchanged for cash, because this is a funeral plan. 12. If one member is insured in more than one policy, only one will claim and the other policies will forfeit. 13. All claims will be subjected to a waiting period. 14. We cater for only 200 km radius. if more, a fee will be charged. 15. Premiums can increase with a 30 days’ notice. NB: FOR CLAIM PURPOSES THE FOLLOWING INFORMATION IS REQUIRED: Proof of payment , death certificate , Bi-1663,burial order , proof of marriage were applicable , certified copy of deceased ID book /card and copy of principal member ID book/card. If the cause of death is unnatural police report will be required and bank statement where applicable. A maximum of 6 months is permitted to claim, failure to do so within the period stipulated claim will forfeit. Download Application Form