Application for Funeral Cover

Cover from R250/month. Complete the form below. Required fields are marked.

Policyholder Full Name South African ID/Passport Date of Birth Email Phone Address

Cover Options Plan Lives Assured Beneficiary Beneficiary Relationship

Payment Method Debit Day (if debit order)

Declarations I consent to processing of my personal information in terms of POPIA. I have read and agree to the Terms & Conditions and disclosures. I declare that the information provided is true and correct.

Courtesy of Funeral Assist 24.

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