Thewini Funeral Centre

Policy Application Form

Branch

Plan Type

Burial Type

Details Of Policy Holder

Surname

Full Name

ID Number

Telephone

Main Member Age Next Birthday

Address

Details Of Spouse

Surname

Full Name

ID Number

Telephone

Address

Details Of Children

Name	Surname	ID Number	Date Of Birth	Gender

Health Disclosure

Are you and your family in good health? if not, please provide details (Non Disclosure is an Offence)

I have read and accepted the Terms And Conditions

No Medical Requirements.
Thekwini Funeral Centre reserves the right to this policy to carry out al funeral arrangements. ‘Should you choose another undertaker al funds wil be forfeited and there wil be no refunds or re-imbursemens
‘Should you choose a coffin other than the one specified under the benefits of this policy then the difference in the cost must be paid in advance by the person/s who makes the request for a more expensive coffin.
If member is obese extra costs wil incur upon family since there may be a need for a larger than normal coffin
“The policy provides a two pole marquoe and 100 chairs in the PhoenixVerulam area only an ‘amount of R300 wil bo given towards the above f the funeral is out of Phoenix/Verulam area. ‘Should you not require a marquoe, there will be no refund.
‘There willbe a choice of burial place or crematorium. Should you want o reopen and existing family grave site, the costs incurred will be made by you and the Cemelry concerned. If its a new grave, undertaker and family goes half and half with the burial fees.
In the event of a death any branch of Thekwini Funeral Centre must be contacted immediately. Only Thekwini Funeral Centre consultants wil carry out al funeral arrangements
Funerals will be carried out within a 60km radius. There wil be an extra cost for any distance beyond this radius. We must be notified of a change of address.
Premium only increase as per age. No age restrictions on policy. We only cover biological children.
When the dependant reaches twenty one (21) years of age, they automatically off from the policy.
“There will be a six (6) month waiting period from the date of inception for deaths through natural causes and 1 year wailing period for AIDS, Cancer, TB. and who joins the policy or takes out the policy at the age of 64 years. You wil not be entitled io any benefits in the event of death is through suicide, However, there will be no wailing period in the event of death through accident.
All hospital including doctor's and B.1. 1663 wil be to the costliabity of the family. Thed undertaker is not responsible for any B.1. 1663 and doctors fees.
Cover will Lapse if three (3) months in arrears No claims wil be honoured for member or dependants. Should you decide to cancel policy there will be no refunds since these policies provide a service and does not accumulate a cash value.
You may pay monthly premium in advance should you choose 1o do so. However the six (6) ‘months waiting period stil applies. You can pay your premiums at any branch of TFC.
Popi Act - All Personal information is kept confidential and is not shared with no one. nor is there: any theft or damage to personal information.

Principle Member Signature