Application Wizard

Policy application form

Work through each section and submit when everything is complete.

Step 1 of 7

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

Free Will drafting

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

Do you have a Will?

Section 7

Upload Documents

Upload your ID document and proof of residence. Only PDF, JPG, and PNG files are accepted.

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