Appliaction form

Apply here

Apply for a Bophelo life funeral cover policy

Simply fill in the form below to apply  for a cover.

    1

    Personal Information

    2

    Policy Selection

    3

    Members & Dependents

    4

    Beneficiary Nomination

    5

    Consent

    6

    Debit Order Authorization

    Please ensure that the first names and surname match the details on your identification document. Enter a valid phone number and email address for communication purposes. The address should be your primary residence address.

    Please select the policy cover that best suits your needs, such as member-only or family cover. Ensure that the cover amount and premium are accurate for your desired plan. As displayed under Funeral Policies Page.

    Please list the full names, ID numbers, and your relationship to each dependent. These individuals will be covered under your selected policy plan.
    For each extended relative, provide their full names, ID numbers, and your relationship to them. Additionally, specify the benefit each relative will receive under the policy.

    Please provide the beneficiary's full name, contact information, and email address. The beneficiary will receive any benefits under your policy in the event of a claim.

    You must consent to the processing of your personal information for underwriting purposes. Additionally, indicate whether you consent to receive marketing communications related to affiliated products.

    Please select your preferred debit date and provide the details of the bank account that will be used for the premium payments. Ensure the account holder’s name matches the one on the bank records.