Spring Into Cover Application Form

Spring Into Cover Electronic Funeral Policy Application

Complete your details, choose your plan and benefit, confirm eligibility and monthly premium, then review and e-sign before submitting.
Applicant Information
Applicant full name

First NameMiddle NameLast Name
South African ID / passport number
Email address
example@example.com
Physical address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred contact method
Plan Selection and Benefit Pricing
Plan Selection
Benefit Amount
Dependants and Spouse Details
Plan-specific dependant details
Complete the applicable fields based on the selected plan
Spouse(name and surname)
Extended Member/Child - 1
Child / Extended Member 1 relationship
Child / Extended Member 1 date of birth

MonthDayYear
Child / Extended Member 2 full name
Child / Extended Member 2 relationship
Child / Extended Member 2 date of birth

MonthDayYear
Child / Extended Member 3 full name
Child / Extended Member 3 relationship
Child / Extended Member 3 date of birth

MonthDayYear
Child / Extended Member 4 full name
Child / Extended Member 4 relationship
Child / Extended Member 4 date of birth

MonthDayYear
Child / Extended Member 5 full name
Child / Extended Member 5 relationship
Child / Extended Member 5 date of birth

MonthDayYear
Age eligibility checks apply to all listed dependants and spouse details based on the selected plan
Payment Details
Preferred Debit Date
Preferred payment method
Account holder / payer full name

First NameMiddle NameLast Name
Contact number
Please enter a valid phone number.Format: (000) 000-0000.
Email address for payment confirmation
example@example.com
Beneficiary Details
Applicant full name

First NameMiddle NameLast Name
South African ID / passport number
Mobile / WhatsApp number
Please enter a valid phone number.Format: (000) 000-0000.
Banking Details
Account holder name

First NameLast Name
Bank name
Account number
Branch code
Account type
Full name

First NameMiddle NameLast Name
Contact number
Please enter a valid phone number.Format: (000) 000-0000.
Email address
example@example.com
Declarations, POPIA Consent, and Signature
I confirm that the information I have provided is true, complete, and correct
Applicant Declaration
I confirm that the information provided is true and complete, and I accept the applicable policy terms.
Submission date

DDMMYY
I consent to the collection, use, and processing of my personal information in terms of POPIA and the privacy policy
Should be Empty:

Spring Into Cover Electronic Funeral Policy Application

Applicant Information

Plan Selection and Benefit Pricing

Dependants and Spouse Details

Payment Details

Beneficiary Details

Banking Details

Declarations, POPIA Consent, and Signature

Applicant Declaration