info@vakhandligroup.co.za
claims@vakhandligroup.co.za
claims@vakhandligroup.co.za
064 755 5674 /
076 566 1277
- Getting started
- Member's Details
- Payment Details
- Terms and conditions
- Submit Form
Step 1: Premium Payer / Proposer Details
First Names:
Surname:
SA ID/Passport:
Cell Number:
Telephone (W):
Postal Address:
Postal Code:
Email Address:
Relationship to Principal Member: (only if different from Premium payer)
Other:
Step 2: Principal member details
Title:
First Names:
Surname:
Gender
SA ID/Passport:
Maritial Status
Other:
Cell number:
Telephone:
Full Address
STEP 3: Spouse details
Name
Surname
Identity Number
Children's details
Name
Surname
Identity Number
Child 2
Name
Surname
Identity Number
Child 3
Name
Surname
Identity Number
Child 4
Name
Surname
Identity Number
Extended families and wider children of the principal member
First names
Surname
Identity No.
Relationship
Cover
Premium
Beneficiary Nomination
I hereby nominate the following person, who is my dependent or nominee, for any benefits due to be paid in the event of my death.
First Names:
Surname:
Identity No/Passport:
Relationship:
Payment Details
Mode of payment:
Frequency:
Policy Commencement date:
Funeral Plan
Family Cover
Total Extended Family and Wider Children Cover
Total Premium
Bank Details:
Name of Bank:
Name of Account Holder:
Account Number:
Branch:
Branch Code:
Account Type:
Debit order day
Terms and conditions
I have read and agree to the Terms of Service
DECLARATION BY PROPOSER/PREMIUM PAYER
Full Names and Surname
Date
Uploading Supporting Documents
ID Copy
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Other Copies
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