Members Details
Spouse (Wife/Husband) Details
Compulsory Funeral Cover for Children
Optional Funeral Cover for Parents

BENEFITS- Tick (✔) Premium/Benefit require

I authorise you to deduct from my salary or direct form my bank account held at Bank Account Number Branch on the of every month. Salary payment group 1 or 2 (Tick). I understand that membership will effect once first subscription has been deducted from my salary. Cut off date is the 20th of every month. This contract shall remain in force until cancelled by me in writing after giving three months calendar notice, (Cancelations includes any claims and refunds). Membership shall cease if subscription fees are not paid for three consecutive months and all the benefits will cease too. I understand that reinstating my cover will attract waiting periods as per the contract.


Date : 22-02-2019