Policy Application
Personal Details
Main Member
Policy Option
Single Member 65 years
Family 65 Years
Single Member 65 to 74 years
Family Cover 65 to 74 years
Single member 75 and above
Select option from the table above
Name
First Name
Last Name
ID Number
*
Id Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Cellular Phone Number
*
-
prefix
number
Email
*
example@example.com
Spouses Details
Secondary Member
Name
First Name
Last Name
ID Number
*
Id Number
Details Of Children (under 21 years of age)
(should proof of tertiary studies be in progress cover is valid till 25 years of age)
Type a question
Rows
Name
Surname
Date Of Birth
Child 1
Child 2
Child 3
Child 4
Payment Details
Account Holder
Name
First Name
Last Name
Name of Bank
*
Absa / First National Bank / Standard Bank / etc.
Branch
*
Area
Account Type
*
Cheque
Savings
Description
Account Number
Account Number
Debit Date
*
25 / 30 / 1 / 5 / 7 / 15
Premium
R 95.00 Single member under 65 years
R 100.00 Family under 65 years
R 145.00 Single member 65 to 74 years
R 150.00 Family 65 to 74 years
R 170.00 (30k cover) Single member under 65 years
R 180.00 (30k Cover) Family under 65 years
Total due per month
Attach a photograph of the ID document
Upload a copy of South African Id Document
Browse Files
alternatively you may whatsapp a picture of the id to 084 564 0993
Cancel
of
KGA Life Limited is a registered insurer and authorized financial services provider FSP 15980 Reg No. 1998/0236567/06 All policies are underwritten by KGA Life Newlands City Funeral Services is a juristic representative of KGA Life Limited, a registered Insurer and Authorized financial services provider. T's And C's Apply. A detailed copy of the terms and conditions will be made available upon request from admin@ncfs.co.za
*
I Agree to The above Terms and Conditions
I do NOT agree
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