SINGLE MEMBER FUNERAL PLAN Step 1 of 4 – PERSONAL DETAILS 25% PERSONAL DETAILSPrefix Mr.Mrs.Ms.Dr.Prof.Rev. Prefix Full Name* First Last Age* ID Number* Please upload your IDAccepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 32 MB.Marital Status*SingleMarriedDivorcedWidowedGender*MaleFemaleCell/Whatsapp no* Email Enter Email Confirm Email Physical Address* PLAN OPTIONSPlease select cover for you as a MAIN MEMBER ONLY. It is a R15 000 death benefit cover due to natural causes.Plan Option* Main Member – R30 Main Member’s entry age must be between 18 – 64 years. HiddenTotal Cost of Cover NOMINATED BENEFICIARY(if the Main Member passes way)The beneficiary has to be any natural person over the age of 18. The beneficiary will receive 100% benefit.Beneficiary *Beneficiary* Full NameID or DoB* ID No. OR Passport No. OR Date of BirthContact Number* Contact NumberRelationshipParentsParents in lawAuntBrotherCousinGrandparentsGrandparents in lawHalf brotherHalf sisterNephewNieceSisterStep brotherStep sisterUncleSpousePartnerRelationship ACCEPTANCE OF TERMSVerification* I hereby consent and authorise Infussion Financial Services to verify my and my beneficiaries ID particulars from the Department of Home Affairs.Communication* I furthermore grant Infussion Financial Services & Infussion Brokers permission to communicate with me through WhatsApp and various communication channels in order to send me other applicable Product information.Terms and Conditions* I have read, understand and accept the Terms and ConditionsScope of Insurance* I have read, understand and accept the Scope of InsuranceStatutory Notice* I have read, understand and accept the Statutory NoticePLEASE NOTE: Once you click on Submit you will be redirected to sign by using your mouse or finger.CommentsThis field is for validation purposes and should be left unchanged.