Membership Form

1 Step 1

Membership Form(Main Member)

Nameyour full name

Surnameyour surname

Physical AddressEnter your address

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Postal Codeyour full name

Postal AddressPostal Address(If Different)

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Postal Codeyour full name

Contact NoEnter your contact details

Emaila valid email

GenderSelect your gender

MaleFemaleOther

Upload your Identiy Documentupload

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Co-Applicants / Dependents Information

Name & Surnamefull name & Surname

ID Number(s) (Attach Copies)upload

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Membership Plan Selection

Select your planSelect a Plan

Silver Package (3 Members)Gold Package (5 Members)Platinum Package (8 Members)

Payment MethodSelect your mode of payment

CashEFTDebit Order

I acknowledge that there is a 6-month waiting period before claiming benefits.

I understand that one missed payment will lapse my policy, requiring me to restart the waiting period.

I agree that fraudulent claims will result in the immediate termination of my policy.

I confirm that the details provided are correct and that I agree to the terms and conditions of Batho Pele Burial.