Application Wizard

Policy application form

Work through each section and submit when everything is complete.

Step 1 of 6

Section 1

Personal information

Tell us who the policy holder is and how to contact you.

Gender
Marital Status
Identification Type
Source of Income

Section 2

Policy plan

Select a plan, see the premium, and list additional members if needed.

Policy Plan
Cover Amount
Age Group
Estimated Premium Select your plan, cover amount, and age group. Premiums are billed monthly.
Select a plan first

People to be covered

The policy holder from Section 1 is automatically included.

Gender

Section 3

Beneficiary information

Add the beneficiary details that should be attached to this policy.

Section 4

Banking details

Choose how you would like to make your policy payments.

Method of Payment

Section 5

Declaration

Answer the compliance questions and confirm your consent.

Are you replacing an existing policy?
Are you a politically exposed person?
Are you a domestic prominent influential person?
Are you a foreign prominent influential person?
Are you closely related to any of the above?
I declare the information provided is true and accurate.
I consent to the processing of my personal information under POPIA.

Section 6

Will drafting

Share your will status so the team can note any follow-up preference.

Do you have a Will?

By submitting this form, your application will go straight into the internal capturer workflow as a public self-service submission.