Section 1:

Application Form: Details of Member

Title:
Surname:
First Name:
ID Number/Reg. No.
Date of Birth:

Physical Address:

Postal Address:

Postal Code:

Postal Code:

Telephone:

(w)
(h)
Cell:
E-mail:

Section 2:

Details of Beneficiary

Title:
Surname:
First Name:

ID Number:

Date of Birth:

Relationship to Principal Member:

Section 3:

Bank Details (Deposits Only)

Account Holder:
Bank:
Account No.
Branch:

Account Type:

 

Current Account

Savings

 

Section 4:

Bereavement Support

In the event of the principle members death, the family will receive R1250.00 for Bereavement Support.

 

It is Important for people to talk about the following undesirable topic and treat it like an unexpected guest arriving at your door. This unexpected guest also comes with severe financial burdens. This guest we are talking about is DEATH. Whether you are financially ready or not, it is coming and cannot be avoided. Therefore, should the unexpected happen, we will support your relatives in their time of need.

Section 5:

Member Declaration

I ID

hereby declare that I have  read the declaration on the reverse side of my copy, agree, and understand it. Furthermore I agree that the aforementioned declaration be seen as a brief summary of my Membership.

 

Once-off Premium of Benefits are applicable for 12 months.
Date:

Signature of Member