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Online Application Form
Main Member Information
Title
ADV
DR
HON
MISS
MR
MRS
MS
PROF
REV
SIR
Firstnames
Surnames
ID Number
Date Of Birth
Gender
Female
Male
Postal Address
Physical Address
Cell/Mobile Number
Work Number
Home Number
Email Address
Product Options
ALEX BRANCH
BULAWAYO BRANCH
CALL CENTRE BRANCH
CAPETOWN BRANCH
COSMO CITY BRANCH
DIEPSLOOT BRANCH
DOES NOT EXIST
EVENT BRANCH
HEAD OFFICE SANDTON
JOHANNESBURG BRANCH
LEADS BRANCH
MADLELA BAP
MAGSA GROUP
MAMELODI BRANCH
MIDRAND BRANCH
OUTBOUND CC
PRETORIA BRANCH
SOCIAL MEDIA
SOCIETY BRANCH
SOWETO BRANCH
UNCONTACTABLE BRANCH
Policy Number
Product
-- Select a Product --
after tears single @ 40.00
ALL IN ONE BRONZE @ 390.00
ALL IN ONE EXECUTIVE @ 840.00
ALL IN ONE GOLD @ 570.00
BLACK DIAMOND @ 410.00
BLUE DIAMOND @ 620.00
BRONZE 18-60yrs @ 130.00
BRONZE 61-70yrs @ 320.00
BRONZE 71-80 years @ 580.00
BRONZE ZIM ZW$ @ 350.00
CASH POLICY 18-80 years @ 80.00
CASH POLICY 65-74yrs @ 40.00
CASH POLICY 75-120yrs @ 50.00
CASH POLICY 81-85 years @ 60.00
EDUCATION BRIGHT STAR SAVER @ 380.00
EDUCATION FOCUS SAVER @ 260.00
EDUCATION SMART SAVER @ 180.00
EXECUTIVE 18-60yrs @ 320.00
EXECUTIVE 61-70yrs @ 700.00
EXECUTIVE 71-80 years @ 1330.00
EXT CASKET @ 350.00
FAMILY PACK BRONZE @ 390.00
FAMILY PACK EXECUTIVE @ 950.00
FAMILY PACK GOLD @ 600.00
FAMILY PACK ZIM ZW$ @ 1000.00
GOLD 18-60yrs @ 200.00
GOLD 61-70yrs @ 460.00
GOLD 71-80 years @ 860.00
Grocery FP @ 50.00
KINGDOM PLAN ZIM US$ @ 6.00
KINGDOM PLAN ZIM ZAR @ 100.00
KINGDOM PLAN ZIM ZW$ @ 150.00
LEGAL PLAN (PREMIUM) @ 200.00
LEGAL PLAN (STANDARD) @ 150.00
LEGAL PLAN (START) @ 100.00
MAGSA BRONZE @ 130.00
MAGSA GOLD @ 180.00
PALACE PLAN VINTAGE @ 240.00
PALACE PLUS PLAN VINTAGE @ 360.00
PLATINUM 18-60 years @ 220.00
PLATINUM 61-70yrs @ 510.00
PLATINUM 71-80 years @ 950.00
PLATINUM ZIM ZAR @ 170.00
PLATINUM ZIM ZW$ @ 810.00
SILVER 18-60yrs @ 160.00
SILVER 61-70yrs @ 390.00
SILVER 71-80 years @ 720.00
SILVER ZIM ZW$ @ 450.00
SINGLE BRONZE 18-60yrs @ 80.00
SINGLE BRONZE 61-70yrs @ 130.00
SINGLE BRONZE 71+ years @ 230.00
SINGLE EXECUTIVE 18-60 years @ 180.00
SINGLE EXECUTIVE 61-70 years @ 320.00
SINGLE EXECUTIVE 71+ years @ 480.00
SINGLE GOLD 18-60yrs @ 110.00
SINGLE GOLD 61-70 years @ 200.00
SINGLE GOLD 71+ years @ 340.00
SINGLE PLATINUM 18-60yrs @ 120.00
SINGLE PLATINUM 61-70yrs @ 220.00
SINGLE PLATINUM 71+ years @ 340.00
SINGLE SILVER 18-60years @ 90.00
SINGLE SILVER 61-70years @ 160.00
SINGLE SILVER 71+ years @ 280.00
Unknown @ 0.00
WHITE DIAMOND @ 280.00
Total Premium
Dependants
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Product
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Debit Order
Cash
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Premium Summary
Total Premium