Membership application

Apply for your funeral cover

Complete the form below — it takes about 5 minutes. You'll add your family, choose how to pay, upload a copy of your ID, and create your login. Your cover starts once your first premium is received.

1 Choose a plan

Kgotso (Peace) R350.00/month Under 65 years · 1 main member + 13 dependants Bohlokwa (Precious) R430.00/month Under 65 years · 1 main member + 13 dependants Bonolo (Easy) R470.00/month Under 65 years · 1 main member + 13 dependants Hlompho (Respect) R550.00/month Under 85 years · 1 main member + 5 dependants Kgotsofalang (Be Satisfied) R310.00/month Under 65 years · 1 main member + 6 dependants

How will premiums be paid? *

Replacing an existing funeral policy?

Anything else we should know? (optional)

2 Principal member (policy holder)

Title

First name(s) *

InitialsOptional if first names given

Surname *

Identity document

ID / passport number *

Date of birthFills in automatically from a valid SA ID

Gender

Cell number *Used for login and WhatsApp updates

Telephone (home)

Telephone (work)

Email addressOptional

Residential address *

Suburb / town

Postal code

3 Spouse (optional)

Add a spouse to this policy

4 Dependants (children, parents, extended family)

Add everyone who should be covered. Your plan's dependant limit is shown once you choose a plan.

5 Payment details

6 Documents

Upload clear photos or scans. Accepted: PDF, JPG, PNG, WEBP, HEIC, TIFF and Word (DOC/DOCX) — up to 10MB each. You can select several files at once.

ID document / passport of the principal member *

Proof of address (optional)

Proof of banking (recommended for debit orders)

Any other supporting documents (optional)

7 Your login & declaration

Choose a password *At least 8 characters. You'll log in with your cell number, email or ID number.

Confirm password *

I declare that the information given on this application is true and complete, and that I understand cover only starts once my first premium has been received and is subject to the policy's waiting period. I consent to Madibeng Funeral Parlour processing my personal information, and that of the people I am adding, for administering this policy and communicating with me (including by WhatsApp), in line with the Protection of Personal Information Act (POPIA).