SINGLE MEMBER FUNERAL PLAN Step 1 of 4 – PERSONAL DETAILS 25% CommentsThis field is for validation purposes and should be left unchanged.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. This field is hidden when viewing the formTotal 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.