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Online Application Form
Main Member Information
Title
ADV
DR
HON
MISS
MR
MRS
MS
PROF
REV
SIR
Firstnames
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ID Number
Date Of Birth
Gender
Female
Male
Postal Address
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Cell/Mobile Number
Work Number
Home Number
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Product Options
ALEX BRANCH
BULAWAYO BRANCH
CAPETOWN BRANCH
COSMO CITY BRANCH
DIEPSLOOT BRANCH
EVENT BRANCH
HEAD OFFICE SANDTON
JOHANNESBURG BRANCH
MADLELA BAP
MAGSA GROUP
MAMELODI BRANCH
MIDRAND BRANCH
OUTBOUND CC
PRETORIA BRANCH
PRETORIA CALL CENTER COUNTER 1
PRETORIA CALL CENTER COUNTER 2
PRETORIA CALL CENTER COUNTER 3
PRETORIA CALL CENTER COUNTER 4
SOCIAL MEDIA
SOCIETY BRANCH
SOWETO BRANCH
Policy Number
Product
-- Select a Product --
after tears single @ 40.00
ALL IN ONE BRONZE @ 370.00
ALL IN ONE EXECUTIVE @ 790.00
ALL IN ONE GOLD @ 540.00
BLACK DIAMOND @ 410.00
BLUE DIAMOND @ 620.00
BRONZE 18-60yrs @ 110.00
BRONZE 61-70yrs @ 270.00
BRONZE 71-80 years @ 490.00
BRONZE ZIM ZW$ @ 350.00
CASH POLICY 18-90 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 @ 270.00
EXECUTIVE 61-70yrs @ 590.00
EXECUTIVE 71-80 years @ 1130.00
EXT CASKET @ 350.00
FAMILY PACK BRONZE @ 330.00
FAMILY PACK EXECUTIVE @ 810.00
FAMILY PACK GOLD @ 510.00
FAMILY PACK ZIM ZW$ @ 1000.00
GOLD 18-60yrs @ 170.00
GOLD 61-70yrs @ 390.00
GOLD 71-80 years @ 730.00
Grocery FP @ 50.00
KINGDOM PLAN EXTENDED ZIM US$ @ 0.00
KINGDOM PLAN EXTENDED ZW$ @ 0.00
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 SA @ 160.00
PALACE PLUS PLAN SA @ 240.00
PLATINUM 18-60 years @ 190.00
PLATINUM 61-70yrs @ 430.00
PLATINUM 71-80 years @ 810.00
PLATINUM ZIM ZAR @ 170.00
PLATINUM ZIM ZW$ @ 810.00
SILVER 18-60yrs @ 140.00
SILVER 61-70yrs @ 330.00
SILVER 71-80 years @ 610.00
SILVER ZIM ZW$ @ 450.00
SINGLE BRONZE 18-64yrs @ 70.00
SINGLE BRONZE 65-74yrs @ 110.00
SINGLE BRONZE 75 years + @ 170.00
SINGLE EXECUTIVE 18-64yrs @ 150.00
SINGLE EXECUTIVE 65-74yrs @ 270.00
SINGLE EXECUTIVE 75yrs + @ 410.00
SINGLE GOLD 18-64yrs @ 90.00
SINGLE GOLD 65-74yrs @ 170.00
SINGLE GOLD 75yrs + @ 260.00
SINGLE PLATINUM 18-64yrs @ 100.00
SINGLE PLATINUM 65-74yrs @ 190.00
SINGLE PLATINUM 75yrs + @ 290.00
SINGLE SILVER 18-64yrs @ 80.00
SINGLE SILVER 65-74yrs @ 140.00
SINGLE SILVER 75yrs + @ 210.00
Unknown @ 0.00
WHITE DIAMOND @ 280.00
Total Premium
Dependants
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Premium Summary
Total Premium