Those covered by the membership plan will include the individual who purchases the membership along with his/her spouse and unmarried children up to the age of 21. Also included are unmarried children up to the age of 21 for whom the member is the legal guardian as indicated on the application form.

First Name
Surname
ID Number
Email address
Cellphone
Fax
Tel (Day)
Tel (Night)
       
Home Address
   
Address Line 2
   
City
Province
Post Code
Payment Method
Employer
   
       
Bank
Acc Number
Acc Holder
Acc Type
First Payment Day
First Payment Month
       
Please note that a once-off R80,00 administration fee will be deducted with your first premium.