Flexi Funeral Plan | Diasporameds

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Package *Children below 17: $3.00Members below 66: $3.50Members 66 to 75: $7.00

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Diaspora Meds Flexi Funeral Plan Application Form

PERSONAL INFORMATION

NEXT OF KIN INFORMATION:

DETAILS OF PERSONS COVERED IN THIS POLICY

Please give details of everyone to be covered, including self, your family/other dependents.

Declaration

I, the undersigned, hereby declare that the information provided by me and required of me on this application is true and correct and that I understand the product terms and conditions.

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