• Location
    No.2, 14th Ave. Benoni
  • 1501, RSA
  • Email address
    info@eastrandfunerals.co.za
  • Telephone
    011 425 0276

AUTHORISED ESSENTIAL FUNERAL SERVICE PROVIDER – K20155367341 (See here)

MAIN MEMBER DETAILS:


BENEFICIARY DETAILS:


PRODUCT DETAILS:


DEPENDANT DETAILS: (Spouse under 65 years and up to 5 children under 21 years)
Name
Surname
ID Number
Date of Birth
Relationship
EXTENDED MEMBER DETAILS: (Parents, Grandparents, Uncles and Aunts, R10 000 and R20 000 cover.)
Name
Surname
ID number
Date of birth
Relationship
Age
Cover amount
Premium
PREMIUM DETAILS: (R10 debit order fee included in total premium)
Principal member premium (ZAR)
Extended member premium (ZAR)
Debit order fee (ZAR)
Total monthly premium (ZAR)
10
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