Full 1PRE PAID PRODUCTSSilent Private Cremation Read MoreFull 1OUR PRODUCTSFull Cremation ServiceRead MoreFull 1OUR PRODUCTSBurial serviceRead More APPLICATION FORM Title (Main Member): First Names and Surname: Email Address Address Tel ID No Age Sex MaleFemale Policy No Cover BurialFamilySingle Are all the members listed in good health? YesNo I, the undersigned, wish to become a member of the Funeral Scheme, I understand that cover will only apply to my dependents as set out below. I abide by all the rules, regulations and exclusions as set out in my policy document / burial book. I understand that any incorrect ID's, Date of Birth's, wrong information or non information (no Birth Dates) given by me will NULLIFY a claim. Tick, if you the policy holder agree SPOUSE CHILD CHILD If extra dependants, please add information, you must inform us of new births and marriages: Debit Order - Payers Details I, the undersigned, request you to arrange with my bank to collect the premiums payable in terms of a Debit Order. Please note that F.N.B. Savings Account (BOBSAVE) UNITED HELP U PLUS, Afican Bank & Post Office Accounts are not debitable. Particulars of Account Holder (Surname, Initials): ID No Date of Birth Bank Branch Date of First Withdrawal (25th or 1st only) Type of Account Account No Branch code Tick, if you agree the above information is correct Date R100.00 ONCE OFF JOINING/ADMIN FEE MUST BE PAID IN CASH WITH APPLICATION.