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Thusanyo Funeral Undertakers
Funeral Scheme - Nomination Form
Exclusive to BOFUS Members
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
1
Member's Details
2
Spouse's Details
3
Children's Details
4
BOFUS Masika
Layout
Type of application
*
New
Amendment
Amount of Cover
*
--Select amount of cover--
P25 000.00 (Presidential Funeral Benefit)
P15 000.00 (Masika Funeral Benefit)
Layout
Omang No
*
Date of Birth
*
Layout
Title
Mr
Mrs
Ms
Names
*
First
Last
Email Address
*
Home Address
*
Postal Address
*
Layout
Tel (H)
Tel (W)
Layout
Employer
*
Region
*
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Spouse's Amount of Cover
Spouse's Omang No
Spouse's Title
Mr
Mrs
Ms
Spouse's Names
First
Last
Spouse's Date of Birth
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Maximum of 6 children below 21 years
Layout
Child's Full name
Gender
Gender
Male
Female
Child's Date of Birth
Relationship
Amount
Layout 2
Child's Full name
Gender
Gender
Male
Female
Child's Date of Birth
Relationship
Amount
Layout 3
Child's Full name
Gender
Gender
Male
Female
Child's Date of Birth
Relationship
Amount
Layout 4
Child's Full name
Gender
Gender
Male
Female
Child's Date of Birth
Relationship
Amount
Layout 5
Child's Full name
Gender
Gender
Male
Female
Child's Date of Birth
Relationship
Amount
Layout 6
Child's Full name
Gender
Gender
Male
Female
Child's Date of Birth
Relationship
Amount
Layout
TOTAL MONTHLY PREMIUM FOR IMMEDIATE FAMILY (Member, Spouse and Children)
TOTAL MONTHLY PREMIUM FOR IMMEDIATE FAMILY (Member, Spouse and Children)
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BOFUS Masika Funeral Benefits
BOFUS Masika Layout 1
Full name
Gender
Gender
Male
Female
Date of Birth
Relationship
Amount
BOFUS Masika Layout 2
Full name
Gender
Gender
Male
Female
Date of Birth
Relationship
Amount
BOFUS Masika Layout 3
Full name
Gender
Gender
Male
Female
Date of Birth
Relationship
Amount
BOFUS Masika Layout 4
Full name
Gender
Gender
Male
Female
Date of Birth
Relationship
Amount
BOFUS Masika Layout 5
Full name
Gender
Gender
Male
Female
Date of Birth
Relationship
Amount
BOFUS Masika Layout 6
Full name
Gender
Gender
Male
Female
Date of Birth
Relationship
Amount
BOFUS Masika Layout 7
Full name
Gender
Gender
Male
Female
Date of Birth
Relationship
Amount
Layout Amount
TOTAL MONTHLY PREMIUM FOR EXTENDED FAMILY
TOTAL MONTHLY PREMIUM FOR EXTENDED FAMILY
Layout Amount 1
TOTAL MONTHLY PREMIUM (SECTION A + B)
TOTAL MONTHLY PREMIUM (SECTION A + B)
DECLARATION
*
I hereby declare that the information stated above is true and complete to the best of my knowledge. I understand that if I have deliberately given false information or withheld any information regarding any situation, I am liable for prosecution for fraud and/or perjury.
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