Membership Application | Mpolokeng Sechaba Burial Society

Personal Information

First Name *

Last Name *

South African ID Number *

Date of Birth *

Gender *

Phone Number *

Email Address

Occupation

Residential Address

Street Address *

Suburb *

City / Town *

Province *

Postal Code

Next of Kin

Full Name *

Relationship *

Phone Number *

Email Address

Dependants

Important: A member may register a maximum of five (5) dependants. Dependants will only become active after the application has been approved.

Declaration

I declare that all the information provided in this application is true and correct. I understand that providing false or misleading information may result in my application being declined or my membership being cancelled.

Membership Joining Fee

A once-off joining fee of R50.00 is payable before your application can be processed.

Once your application has been reviewed and approved, you will receive confirmation together with your membership details.

Required Supporting Documents

Please upload clear copies of the following documents.

Certified Copy of ID

Proof of Residence