Bonlife Funeral Fund Form PDF Details

Securing peace of mind for one's loved ones in the event of a passing is a crucial aspect of financial planning, a need addressed by the Bonlife Funeral Fund. Operated by Bonlife, a company situated at 399 Main Avenue, Ferndale, Randburg, with Safrican Insurance Company Limited providing underwriting services, this fund offers individuals the opportunity to apply for funeral cover under the Bonami Funeral Fund. Applicants are required to furnish personal details, including their address, date of birth, and contact information, along with their employment specifics. The form presents selectable benefit options, accommodating individual preferences with Single or Double Benefit choices. It also details the required information for dependents, ensuring comprehensive coverage for family members. With a focus on flexibility, the form presents two premium payment methods: a bank debit order or an employer salary deduction, accommodating diverse financial situations. Necessary authorizations and declarations are included to ensure clear consent and understanding of the terms. This structured approach makes the application process straightforward, assisting applicants in securing this essential coverage efficiently.

QuestionAnswer
Form NameBonlife Funeral Fund Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesbonlife funeral, bonlife claim form, bonlife website, bonlife funeral covers

Form Preview Example

BonLife

399 Main Avenue, Ferndale, Randburg, 2194

P.O. Box 3315, Randburg, 2125

Tel: 011 777 1800

Fax: 087 625 0605

Funeral Fund

E-mail: info@bonlife.co.za

Sharing the Good Life

www.bonlife.co.za

This Fund is Underwritten by Safrican Insurance Company Limited - FSP No.: 15123 Application for Funeral Cover under the Bonami Funeral Fund

OFFICIAL USE ONLY

Policy No.:

 

 

 

 

 

 

 

 

 

 

Conirmed by: _______________

 

 

 

 

 

 

 

 

 

 

Date:

______________________

Application No.:

 

 

 

 

 

 

 

 

 

 

Time:

______________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Branch: ______________________

 

 

 

 

 

 

 

 

 

 

 

Principal member to complete:

Title: __________ Intitials: _________________Surname: ___________________________________

First Names: ______________________________________ ID No.:____________________________

Postal Address: ______________________________________________________ Code:___________

Date of birth: ______________________________ Home: (______) _________________________

Cell: ________________________________ Work: (______) ____________________________

Select Beneit Option:

R9 000 Single Beneit

R18 000 Double Beneit

___________________________________________________________________________________

Employer Details:

Employer: _________________________________ Division: _________________________________

Employee no: _________________________ HR Contact peson:_______________________________

Work postal addres:___________________________________________________________________

_____________________________________________________ Code:________________________

Work: (______) _____________________ Fax:(_____) _________________________________

___________________________________________________________________________________

Dependant details:

First Names

Surname

Relationship (H/W/S/D)

ID Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E&OE

Premium payment method: (Please choose one of the two):

BANK DEBIT ORDER

Debit Order:

Premium to be Deducted:

Bank Name:

Account Name:

Account No.:

(Please attach a copy of your most recent, complete bank statement)

R

Branch:

Branch Code:

Account Type:

Account Holder’s I.D. No.: Account Holder’s Tel. No.:

Account Holder’s Pay Day:

Account Holder’s Address:

 

 

Current

 

Savings

 

Transmission

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D D

Address Line 1

Address Line 2

Suburb

City

 

Postcode

 

 

 

Employer:

Tel No.:

Signature of Account Holder:

DECLARATION:

Fax No.:

Date:

C C Y Y M M D D

I hereby authorise Zenith Administration Services (ZAS) to debit my bank account with the Premium stated above on the date determined at the Administrator’s discretion. I undertake to advise ZAS of any changes to my current payment details. I have read and understood the contents of all Statutory Notices and I have viewed a quotation in respect of the policies for which I am applying. Furthermore, I declare that to the best of my knowledge, the above particulars are true and correct.

Signature of Insured Person:

 

Date:

C C Y Y M M D D

GOVERNMENT STOP ORDER

Employer Salary Deduction:

 

 

 

Initials:

 

 

Surname:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salary / Persal No.:

 

 

 

 

 

 

 

 

 

Organisation Code:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Please attach a copy of your most recent salary advice for stop order deductions)

DECLARATION:

I hereby authorise the Accountant of the Department of

C C Y Y M M D D the following amounts from my salary:

Paypoint Code:

to deduct monthly with effect from

R

to be remitted to Safrican Insurance Company Limited.

I have read and understood the contents of all Statutory Notices and I have viewed a quotation in respect of the policies for which I am applying. Furthermore, I declare that to the best of my knowledge, the above particulars are true and correct.

Signature :

 

Date:

C C Y Y M M D D

E&OE

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