Strydom Begrafnisdienste t/a Strydom Funerals
Tel: 044 279 1009 / 079 516 0145
Email: info@strydomfuneralhome.co.za

Online Application Form

Funeral Policy Application
Backoffice / Pending Applications

Recall Previous Application

Gebruik Policy Number, ID Number of Cellphone Number om ’n vorige aanlyn aansoek oop te maak.

Main / Oldest Member Details

Policy number & Pay@ number: Word eers outomaties gegenereer wanneer die live aansoek gesubmit word, om dubbele nommers te voorkom indien twee persone gelyktydig werk.
Calculated Premium: R0
Bereken vanaf hooflid/oudste lid se ID, Service Plan en Product Plan.

Representative / Agent Details

Contact Details

Dependants Details

NameSurnameID NumberRelationshipAdditional premium

Extended Family Members

Vir Cash Cover word uitgebreide familie se premie per lid bereken volgens elke lid se ouderdom en gekose dekkingsbedrag.
NameSurnameID NumberRelationshipAdditional premium

Nominated Beneficiary

Payment Method

Required Documents Upload Checklist

Transfer Policy / Waiver of Waiting Periods

Complete this section if the applicant is replacing or transferring from a previous funeral policy. Documented proof must be submitted with the application.

Details of Previously Insured Person(s)

NameSurnameID NumberCover Amount

Waiting Periods

TypeStandard Waiting PeriodMonths already servedApplicable waiting period
Natural Causes of Death6 Months
Unnatural / Accidental Death0 Months
Suicide12 Months

Replacement Declaration

I understand that if I replace a previous funeral policy, proper proof of previous cover and cancellation must be provided. Funeral parlour books or receipts alone may not be sufficient proof.

I understand that if the required proof is not provided, or if the previous underwriting cannot be confirmed, the full waiting periods may apply.

I understand that waiver of waiting periods may only apply to the same lives insured and may only apply up to the previous cover amount. Any additional cover may be subject to the full applicable waiting period.

I confirm that the information supplied regarding the previous policy is true and complete.

Terms and Conditions / Declaration

1. Declaration: I confirm that all information supplied in this application is true, correct and complete. I understand that false, incomplete or misleading information may result in the application being declined, amended, cancelled, or a claim being delayed or rejected.

2. Premiums: I understand that premiums are payable monthly in advance. Failure to pay premiums on time may result in arrears, suspension of benefits, lapse of cover or reinstatement conditions.

3. Inception date: I understand that cover will commence from the inception date shown on this application, subject to acceptance and payment of the required premium.

4. Waiting periods: I understand that waiting periods may apply, including waiting periods for natural death, suicide and replacement policies, unless valid proof of previous cover is accepted where applicable.

5. Covered lives: Only the main member and nominated persons listed on this application will be considered for cover, subject to acceptance, insurable interest and the rules of the selected plan.

6. Benefits and services: I understand that benefits, services and premiums are based on the selected Service Plan and Product Plan. Additional services not included in the selected plan may be charged separately.

7. Documents: I agree to provide supporting documents requested by Strydom Begrafnisdienste, including ID documents, proof of relationship, banking details, proof of previous cover and any other documents required to process the application or claim.

8. POPIA consent: I consent to Strydom Begrafnisdienste and its authorised administrators, insurers and service providers processing my personal information for application administration, verification, premium collection, policy servicing, claims processing, fraud prevention, record keeping and legal or regulatory compliance.

9. Communication consent: I agree that Strydom Begrafnisdienste may contact me by telephone, SMS, WhatsApp or email regarding this application, payment reminders, policy administration and related services.

10. Signature: By signing and submitting this application, I confirm that I have read, understood and accepted these terms and conditions.

Applicant Signature