cash funeral solution

URL
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Personal Details
Prefix
Prefix
Full Name*
First Last
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Age*
ID Number*
Please upload your ID
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 32 MB.
Marital Status*
Gender*
Contact Number*
Email
Enter Email Confirm Email
Physical Address*

Plan Options
Please select cover for you as a SINGLE MEMBER or select MEMBER & SPOUSE/PARTNER for you and your spouse/partner.
Plan Option*
- Single Member – R75
- Member & Spouse/Partner – R150
Main Member’s entry age must be below 70 years
ADDITIONAL CASH BENEFIT inclusive of:
- R8 000: Cash Memorial benefit
- R5 000: Cash benefit for tent, food etc
- R5 000: Retail store virtual voucher
- Vehicle Access for 4 days: Avis/Europ Car. Class C
Spouse/Partner details
NOTE: “Spouse” means the person with whom the principal insured person is joined in marriage. These details must be submitted to us during the spouse’s life for them to be covered. A nomination remains in force as long as the principal insured person is joined in marriage to the person stated on the policy. In the event of the principal insured person wanting to insure the second spouse the relevant details must be provided to us during the second spouse’s life for them to be covered.

“Life Partner” means someone who is in a serious, committed relationship with someone else, but they’re not married. A life partner can be anyone in any type of relationship, whether it’s heterosexual or homosexual. They can choose to have children or not.
Spouse
Full Name
Identification/Date of Birth
ID No. OR Date of Birth
Contact Number
Contact Number
Total 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 Name
ID or DoB*
ID No. OR Date of Birth
Contact Number*
Contact Number
Relationship
Relationship

Acceptance Of Terms
Verification*
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 Conditions
POPIA*
I have read, understand and accept the POPI Act
Statutory Notice*
I have read, understand and accept the Statutory Notice

Debit Order Information
Account Holder Name*
Bank*
Account Number*
Account Type*
Branch Code*
Preferred Debit Order Date*
Debit Order Mandate*
I hereby consent and authorise Infussion Financial Services to perform a Debit Order Mandate.
PLEASE NOTE: Once you click on Submit you will be redirected to sign by using your mouse or finger.