Ngqongqoshe Funeral Parlour Joining Form

Ngqongqoshe Funeral Parlour Joining Form

Putting your family first
Tell Us About You

All information in this form is strictly confidential.

Only 10 members are allowed to join Clubs (5 Childrens & 5 Adults including you)

Only you & your spouse with 5 children can join Cash Funeral.

Childrens must be under the age of 21 years.
Main Member Full Name*

First NameMiddle NameLast Name
Birth Date

MonthDayYear
ID Number (please state correct ID number to avoid confusion)*
(Spouse/Beneficiary) Full Name*

First NameMiddle NameLast Name
Birth Date

MonthDayYear
ID Number (please state correct ID number to avoid confusion)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@gmail.com.com
Which Life Cover you are applying for?*
Date*

MonthDayYear
Date
Signature (by signing this you agree for representative to complete registration on your behalf)*

Clear
File Upload (Please attach all members ID copies/Birth Certificates)*

Cancelof
DEPOSIT / TRANSACTION

PLEASE USE YOUR FULL NAME AS REFFERENCE
STANDARD BANK

ACCOUNT NUMBER : 081 041 993
Please Fill in the space below
YOUR FULL NAME (MAIN MEMBER)

YOUR REF : *

Please send the proof of payment through
E-mail : info.ngqongqoshe@gmail.com
WhatsApp : 078 211 6000
After sending your payment allow up to 10 min to verify payment.
Should be Empty:

DEPOSIT / TRANSACTION