• Khen Grocery Scheme Application Form

  • Member 9+1

    📌 Application Criteria ✔️ Main Member✔️ Spouse✔️ Children✔️ Parents✔️ Up to 3 Extended Family plus A R40 monthly fee applies from the 4th extended family member onwards.👴👵 Members👨 Policy must have 4 members below the of age 30 Years Maximum of 2 senior citizens [age 75-84] per application, with an additional R70 for both senior citizen.
  • (Please fill in all the information)
  • Application for voluntary grocery benefit with extended family benefits
  • Main Member Details

  • (Attach copy of ID)
  • 4. Home Address:

  • 5. Contact Details:

  • Format: (000) 000-0000.
  • 6. Beneficial Nomination

  • Additional Household Members* (Max 9) (Include full name, surname, ID number, Province, and relationship to main member)*
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  • Submission Instructions

  • Submit this form Via email or WhatsApp
    Contact Details
    Khen Grocery Scheme
    Cell: 065 709 7900
    Email: khengroceryscheme@gmail.com
    Website: khengroup.co.za
  • Payment Option Bank
    Name: FNB Account
    Name: KCSS
    Account Number: 63149453639
    Brench Code: 250655
    Account Type: Gold Business Account
    Payment deadline 07 of each Month
  • Note: Reference should be the main member Name - A once off joining fee of R75.00 is payable immediately
    We are here to help you. Choose a package that will suit your budget
  • We are here to help you. Choose a package that will suit your budget*
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  • Terms and Conditions applicable to this grocery scheme:

  • Maximum entry age for the Principal Member is 84 years

    Only 3 extended family members per policy,  an additional R40 will be charged after the 3 extended family members. 

    All policies that include cow are from 0-64 years old. Additional charges will apply for 65-74 years.

    Member and family members on group scheme of 6-12 month waiting period applies and age limit is 84 years

  • Waiting Period and Elderly Member Contribution

  • For individuals aged 75 to 84 years, a 12-month waiting period applies. Any new member who joins within this age bracket will contribute an additional R70 under the main group scheme. The scheme allows a maximum of two elderly members within this age category.
    Grocery scheme lapses if two premiums missed and if reinstatement occur full waiting period as above apply
    To claim please complete claim form that can be requested by calling Khen Grocery Scheme and submitting a claim as directed on claim form.
  • Birth of a Child or Addition of members

  • An addition of lives application form detailing out the new lives to be added must be submitted to Khen Grocery Scheme for processing.
  • Divorce of a Principal Member

  • Upon removal of a spouse the grocery scheme will convert to a single parent or individual or remain the same if spouse is replaced.
  • EXCLUSIONS

  • All Benefits will not be paid if death is directly or indirectly caused by or attributable to: Terrorism or war
    (whether declared or not).
    Radioactive contamination, whether directly or indirectly.
    Suicide will not be covered during the first 2 (two) years of membership. Unnatural causes
    of death will not be paid before finishing the waiting period
  • Cleaning and cooking, we provide cooking serving and cleaning only, this is an added service with a cost fee of
    R100.00 per month. This option is available in Gauteng at a radius of less than 100 KM's, no equipment's included
    Catering equipment's are available at a fee on quotation request
  • WAITING PERIODS

  • There is a 6 (six) month waiting period applicable to the Principal Member, Spouse, Eligible Children and
    Extended Family Members under the age 75 years, 12 months from 75 years to 84 years, 24 Months waiting
    period for suicide from the date of inception will be applicable.
  • Only one benefit option per group will be allowed where the Extended Family Member option has been
    selected. The premium rate for principal and extended will differ as per age at entry.
    In the event of electing a higher benefit from an existing Plan, the waiting periods above will apply to the
    increased portion of the benefit, not to the current benefit enjoyed.
  • PREMIUM PAYMENT

  • Premiums are payable by the main monthly in advance and at the Premium Rate as specified in the
    Schedule.
    Premiums are paid in advance and should be received before or on the 7th of every month, premiums
    received after this date will be allocated to the following month.
  • GRACE PERIOD

  • After the first year of membership, a Grace Period of 1 (one) month will be allowed for the payment of
    future premiums. The Plan will remain in force during the Grace Period.
    If the arrear premium and the premium due for that month is not paid by the end of the Grace period,
    the Plan will lapse and the 6 (six) month waiting period will apply on any reinstatement.
  • COOLING OFF PERIOD

  • The main member has a 30 (thirty) day cooling off period from the date of joining the scheme to examine
    the grocery scheme
    Provided that no death or claim has taken place in this period, should the main member not to take up
    the grocery scheme, she or he must inform Khen Grocery Scheme in writing of their intention not to
    accept.
    All premiums already paid shall be refunded, less the cost of any risk cover. (this excludes the joining
    fee)
  • CANCELLATION

  • After the 30-day cooling off period has ended, the main member, Khen Grocery Scheme reserves the
    right to cancel this grocery scheme at any time after giving the other party 3 (three) months written
  • notice of such intention.
  • CONTINUATION OPTION

  • Should a Principal Member cease to be a member of an existing fund, of which he / she has been a
    member for at least 12 consecutive months, he / she has the option of applying for a similar individual
    grocery scheme. This option must be exercised within 1 (one) month of ceasing to be a member prior to
    retirement age.
  • SURRENDER VALUES: There are no surrender values under this Plan. Benefits under this Plan may notbe ceded or pledged in any way. No loans are available under this Plan. No refund of premiums paid uponcancellation of lapse of a grocery scheme.

  • FRAUDULENT CLAIMS: If any fraudulent claim is made against this scheme, Khen Grocery Scheme will be under nofurther obligation whatsoever to pay this claim, and shall, at its own discretion, be entitled to cancel the grocery schemewith immediate effect without any refund of paid premiums.

  • SUMMARY CLAIMS PROCEDURE:

  • In the event of a death, a Claim Notification Form must be requested from a Khen Grocery Scheme office
    and submitted together with the relevant supporting documents. Failure to do so within the stipulated
    notification period will result in the benefit being forfeited.
  • DISSOLUTION

  • On dissolution of the Plan, all Khen Grocery Scheme liabilities towards the existing and any former
    Principal Members and Dependents will cease as from the day of the last premium received or the date
    of dissolution, whichever is the later.
  • Grocery scheme Number

  • The grocery scheme number will be sent to the main member upon receipt of the registration fee.
  • Our Promise

  • 1. "Thank you for choosing Khen Grocery Scheme! We're committed to providing you with the best
    products and services."
    2. "Your loyalty means the world to us! We're grateful for customers like you who make our job a joy."
    3. "We're here for you! If you have any questions or need assistance, don't hesitate to reach out."
    4. "Stay tuned for exciting updates, promotions, and new products! We appreciate your
    continued support."
    5. "Your satisfaction is our top priority! We're dedicated to ensuring you have an exceptional
    experience with Khen Grocery Scheme."
  • DECLARATION:

  • I declare to the best of my knowledge and belief that the particulars given above are true and correct. I
    understand and agree that any willful misrepresentation in this application will
    invalidate any benefit under this grocery scheme and that I undertake to abide by the terms and conditions
    of the scheme. Khen Grocery Scheme shall not be liable for any amount until it has accepted this
    application and first premium.
  • DATE*
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Should be Empty: