STRYDOM ONLINE APPLICATION

Policy Number: LA1002112
Pay@ Number: 11602990001002112
Submitted: 2026-06-26 11:06:03

EXISTING POLICY NUMBER: 
UPDATE EXISTING: 0
SERVICE PLAN: 1+9
PRODUCT PLAN: Silver
FIRST NAMES: Bitrum Edwill
SURNAME: Windwaai
ID NUMBER: 8111155175083
DATE OF BIRTH: 15/11/1981
OLDEST MEMBER AGE: 44
AGE BAND USED: 18-64
INCEPTION DATE: 01/07/2026
MONTHLY PREMIUM: R320
REPRESENTATIVE NAME: Bronwen Prins
REPRESENTATIVE CODE: AG0029
REPRESENTATIVE BRANCH: George
REPRESENTATIVE CONTACT: 0612409677
EXISTING FUNERAL POLICY NUMBER: 
CASH COVER AMOUNT: 
ADDRESS: Rooikraans Straat
Touwsranten
Hoekwil
POSTAL CODE: 6530
EMAIL: 
TELEPHONE: 0616131566
WORK NUMBER: 
CELLPHONE: 0616131566
WHATSAPP NUMBER: 0616131566
DEPENDENT 1 NAME: Christina
DEPENDENT 1 SURNAME: Windwaai
DEPENDENT 1 ID: 8501290874089
DEPENDENT 1 RELATIONSHIP: Wife
DEPENDENT 1 PREMIUM: 
DEPENDENT 2 NAME: Geneva
DEPENDENT 2 SURNAME: Botha
DEPENDENT 2 ID: 0208130835084
DEPENDENT 2 RELATIONSHIP: Daugter
DEPENDENT 2 PREMIUM: 
DEPENDENT 3 NAME: Mikelle Ariana
DEPENDENT 3 SURNAME: Windwaai
DEPENDENT 3 ID: 2207220272081
DEPENDENT 3 RELATIONSHIP: Daugter
DEPENDENT 3 PREMIUM: 
DEPENDENT 4 NAME: Chrisney Demonicia
DEPENDENT 4 SURNAME: Botha
DEPENDENT 4 ID: 1804090383088
DEPENDENT 4 RELATIONSHIP: Daugter
DEPENDENT 4 PREMIUM: 
DEPENDENT 5 NAME: Jaimie-Lee
DEPENDENT 5 SURNAME: De Swartz
DEPENDENT 5 ID: 1201231185086
DEPENDENT 5 RELATIONSHIP: Daugter
DEPENDENT 5 PREMIUM: 
EXTENDED 1 NAME: Nazily-Ann Lakhitha
EXTENDED 1 SURNAME: Botha
EXTENDED 1 ID: 1103170907084
EXTENDED 1 RELATIONSHIP: Daugter
EXTENDED 1 PREMIUM: 
EXTENDED 2 NAME: Jeremy
EXTENDED 2 SURNAME: Windwaai
EXTENDED 2 ID: 8908146002080
EXTENDED 2 RELATIONSHIP: Brother
EXTENDED 2 PREMIUM: 
EXTENDED 3 NAME: Theo
EXTENDED 3 SURNAME: Windwaao
EXTENDED 3 ID: 9205155937085
EXTENDED 3 RELATIONSHIP: Brother
EXTENDED 3 PREMIUM: 
EXTENDED 4 NAME: 
EXTENDED 4 SURNAME: 
EXTENDED 4 ID: 
EXTENDED 4 RELATIONSHIP: 
EXTENDED 4 PREMIUM: 
EXTENDED 5 NAME: 
EXTENDED 5 SURNAME: 
EXTENDED 5 ID: 
EXTENDED 5 RELATIONSHIP: 
EXTENDED 5 PREMIUM: 
EXTENDED 6 NAME: 
EXTENDED 6 SURNAME: 
EXTENDED 6 ID: 
EXTENDED 6 RELATIONSHIP: 
EXTENDED 6 PREMIUM: 
EXTENDED 7 NAME: 
EXTENDED 7 SURNAME: 
EXTENDED 7 ID: 
EXTENDED 7 RELATIONSHIP: 
EXTENDED 7 PREMIUM: 
EXTENDED 8 NAME: 
EXTENDED 8 SURNAME: 
EXTENDED 8 ID: 
EXTENDED 8 RELATIONSHIP: 
EXTENDED 8 PREMIUM: 
EXTENDED 9 NAME: 
EXTENDED 9 SURNAME: 
EXTENDED 9 ID: 
EXTENDED 9 RELATIONSHIP: 
EXTENDED 9 PREMIUM: 
EXTENDED 10 NAME: 
EXTENDED 10 SURNAME: 
EXTENDED 10 ID: 
EXTENDED 10 RELATIONSHIP: 
EXTENDED 10 PREMIUM: 
BENEFICIARY NAME: Christina
BENEFICIARY SURNAME: Windwaai
BENEFICIARY ID: 8501290874089
BENEFICIARY RELATIONSHIP: Wife
PAYMENT METHOD: Cash
SOURCE OF FUNDS: Salary
TRANSFER REPLACEMENT: No
PREVIOUS INSURER: 
PREVIOUS POLICY NUMBER: 
PREVIOUS COVER START DATE: 
PREVIOUS CANCEL DATE: 
PROOF PREVIOUS COVER: No
SAME LIVES PREVIOUS POLICY: No
WAIVER REQUESTED: No
TRANSFER 1 NAME: 
TRANSFER 1 SURNAME: 
TRANSFER 1 ID: 
TRANSFER 1 COVER AMOUNT: 
TRANSFER 2 NAME: 
TRANSFER 2 SURNAME: 
TRANSFER 2 ID: 
TRANSFER 2 COVER AMOUNT: 
TRANSFER 3 NAME: 
TRANSFER 3 SURNAME: 
TRANSFER 3 ID: 
TRANSFER 3 COVER AMOUNT: 
TRANSFER 4 NAME: 
TRANSFER 4 SURNAME: 
TRANSFER 4 ID: 
TRANSFER 4 COVER AMOUNT: 
TRANSFER 5 NAME: 
TRANSFER 5 SURNAME: 
TRANSFER 5 ID: 
TRANSFER 5 COVER AMOUNT: 
TRANSFER 6 NAME: 
TRANSFER 6 SURNAME: 
TRANSFER 6 ID: 
TRANSFER 6 COVER AMOUNT: 
TRANSFER 7 NAME: 
TRANSFER 7 SURNAME: 
TRANSFER 7 ID: 
TRANSFER 7 COVER AMOUNT: 
NATURAL MONTHS SERVED: 
NATURAL APPLICABLE WAITING: 6 Months
ACCIDENTAL MONTHS SERVED: 
ACCIDENTAL APPLICABLE WAITING: 0 Months
SUICIDE MONTHS SERVED: 
SUICIDE APPLICABLE WAITING: 12 Months
SIGNATURE NAME: Bitrum Edwill Windwaai
SIGNATURE DATE: 26/06/2026
TYPED SIGNATURE: B Windwaai

Uploads:
- uploads/LA1002112_id_copy_20260626_110603_B_Windwaai.pdf
- uploads/LA1002112_other_documents_0_20260626_110603_Document_11.pdf
