Contact

Main Member Basic Information

Marital Status

Name

First

Last

S.A ID No. (Main Member)

Please double check that its correct

Cellphone No.

Please provide direct contact no.

Physical Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Select Your Policy

Policy Type

Dependents Name(s)

First

Last

S.A ID Number

Please double check

Add More Dependents

Beneficiary Information

Families can confidently assign beneficiaries knowing that their rights, entitlements and benefits are safeguarded

Name

First

Last

Your Copy Member

S.A ID Number (Beneficiary)

Please double check!

Phone

Please double check!

Physical Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Upload Copy of Main Member ID

Drag & Drop Files, Choose Files to Upload

If you are using smart card ID, please copy back and front

TERMS & CONDITIONS

-No joining fee
-Non contribution for 2 months policy will lapse
-Contribution dates should be between 20th to

7th of each month

-6 Months waiting period
-Immediate cover for accidental death

-Suicide waiting period is 12 months

Main Member Basic Information

Select Your Policy

Add More Dependents

Beneficiary Information

TERMS & CONDITIONS

Phone

Address

Email