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Please complete all steps to submit your application

TINGO Funeral Plan Application

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Choose your Cover

Cover amount chosen is for you, your spouse and biological/legally adopted children. All members must be under the age of 65 and children must be under the age of 21.*

Premium calculated as: cover amount x risk premium R2.964 + Phakama admin fee R15 + commission (50% markup) = total premium.
Please choose a cover
SCH: -
Premium calculated as: cover amount x risk premium R2.964 + commission (50% markup) = total premium.
No top-up selected
SCH: -
Slide left to select “No top-up”.

Main Member Personal Details

A Main Member must be between 18 and 64 years old when applying.
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Accepted formats: PDF, DOC, DOCX, JPG, JPEG, PNG, GIF (Max 10MB)

Spouse Details

A Spouse must be between 18 and 64 years old when applying.
Spouse
Accepted formats: PDF, DOC, DOCX, JPG, JPEG, PNG, GIF (Max 10MB)

Children Details

Children must be younger than 22 when applying. A maximum of five children are allowed.

Extended Family Member Cover (optional)

An Extended Family Member must be younger than 75 years when applying.
Cover is per person and not per family.

"Extended Family" Cover (optional)

Cover is per family not per person.
Add one or more Extended Families. Each family starts with a Main Extended member, then you can add that person's spouse and children.
Extended Main Member and Extended Spouse must be between 18 and 65 years old. Extended Child must be between 0 and 21 years old.

Beneficiary Details

Please add at least one beneficiary. Total percentage must equal 100%.

Banking Details

I hereby authorise Phakama on behalf of Ducome Brokers/Tingo Life to commence a debit order withdrawal from my account on the date selected and monthly thereafter for the premium applicable for the cover selected. I understand that the debit order will be run on the date selected. If for any reason it is not honoured, two withdrawal runs will be done the next month. In the event of this second run being dishonoured, the policy will lapse. I understand it is required that this signed document reaches Phakama offices 10 working days prior to the selected deduction date, if not, the deduction will only qualify for the following calendar month's deductions. In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will automatically be the preceding ordinary business day. Should the relevant premium rate be adjusted by the Institution as a result of an inflation related increase in subscription/premium/payment rate, I confirm that the adjusted premium rate may be deducted. I agree that although this Authority and Mandate may be cancelled by me, such cancellation will not cancel the Agreement. I shall not be entitled to any refund of amounts which you have withdrawn while this Authority was in force, if such amounts were legally owing to you. I acknowledge that this Authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.

The User Abbreviated Name as Registered with the Bank will reflect as follows on your bank account: Ducome followed by your policy / membership number.

Review & Submit

ℹ Please review your information before submitting. You can go back to previous steps to make changes.

Declaration and Terms & Conditions

Please Note: In accordance with FICA, the Insurer must perform mandatory FICA and screening checks during onboarding and on an ongoing basis. Your cover will only become active once these checks are successfully completed, so it is essential to provide accurate and complete information when applying.

Signature