When someone dies, their loved ones are often left with the burden of funeral expenses. If the deceased didn't leave behind enough money to cover these costs, the loved ones may have to take out a loan or dip into their own savings to pay for the funeral. There is now a new way to help cover these costs: the Bonlife Funeral Fund Form. This form allows you to designate funds for your funeral in advance, so your loved ones won't have to worry about it when you die. Fill out the form today and rest assured knowing that your family will be taken care of after you're gone.
| Question | Answer |
|---|---|
| Form Name | Bonlife Funeral Fund Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | bonlife funeral, bonlife claim form, bonlife website, bonlife funeral covers |
BonLife
399 Main Avenue, Ferndale, Randburg, 2194
P.O. Box 3315, Randburg, 2125
Tel: 011 777 1800
Fax: 087 625 0605
Funeral Fund
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.: |
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Conirmed by: _______________ |
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Date: |
______________________ |
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Application No.: |
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Time: |
______________________ |
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Branch: ______________________ |
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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 |
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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:
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Current |
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Savings |
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Transmission |
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D D
Address Line 1
Address Line 2
Suburb
City |
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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: |
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Date: |
C C Y Y M M D D
GOVERNMENT STOP ORDER
Employer Salary Deduction: |
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Initials: |
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Surname: |
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Salary / Persal No.: |
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Organisation Code: |
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(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
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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 : |
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Date: |
C C Y Y M M D D
E&OE