Mukuru
Funeral Cover

Online Application Form

First Name(s)(Required)

Surname(Required)

Gender(Required)

Male

Female

ID/Passport No(Required)

Marital Status(Required)

Date of Birth(Required)

Email Address(Required)

Cell no(Required)

Address(Required)

First Name(s)(Required)

Surname(Required)

Gender(Required)

Male

Female

ID/Passport No(Required)

Cell no(Required)

Please enter(Required)

Relationship to Main Member(Required)

Cover Options	Send Me Home	Send Me Home Gold	Send Us Home Parent	Send Us Home Family
Cover Options	(Cover for individual known as the Main Member)	(Premium Cover for an individual known as the Main Member)	(Cover for a Main Member, Spouse and 4 Children)	(Cover for a Main Member, Spouse and 4 Children)
Monthly Premium	R30	R55	R80	R120
Main Member total cash pay-out	R15 000	R30 000	R25 000	R30 000
Spouse				R22 000
Child (14-21)			R7 500	R7 500
Child (6-13)			R5 000	R5 000
Child (0-5)			R2 500	R2 500
Accidental Death	R15 000	R15 000	R15 000	R15 000
Repatriation*	Every country in Southern Africa
Value assistance lines*	Teacher \| Legal \| Trauma \| Debt & Credit
Extended Family Benefits		You can add 4 family members from 21 years and older as per premiums shown	You can add up to 4 adults and 2 children as per premiums shown	You can add up to 4 adults and 2 children as per premiums shown
SELECT YOUR OPTION	Send Me Home	Send Me Home Gold	Send Us Home Parent	Send Us Home Family

*Non-Guardrisk product

All cover plans are subject to a six(6) month waiting period for accidental death

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Cover Options(Required)

Send Me Home

Send Me Home Gold

Send Us Home Parent

Send Us Home Family

Details of spouse and children

First Name(s)

Surname

Date of Birth

ID/ Passport no

Gender

Full time Student?

*Applies to natural, adopted or stepchild under the age of 21.

Not applicable to Send Me Home Applicable to Send Me Home Gold (Age 21 - 85) Applicable to Send Us Home Parent & Send Us Home Family (Age 0 - 85) Select in the yellow block the cover and premium according to age.
	OPTION 1			OPTION 2			OPTION 3
Age Category	Cover	Monthly Premium		Cover	Monthly Premium		Cover	Monthly Premium
0-11 Months	R1 500	R3.50	0-11 Months	R3 000	R7.00	0-11 Months	R4 500	R10.50	0-11 Months
1-5 Years	R2 500	R3.50	1-5 Years	R5 000	R7.00	1-5 Years	R7 500	R10.50	1-5 Years
6-13 Years	R3 500	R3.50	6-13 Years	R7 000	R7.00	6-13 Years	R10 500	R10.50	6-13 Years
14-18 Years	R5 000	R3.50	14-18 Years	R10 000	R7.00	14-18 Years	R15 000	R10.50	14-18 Years
19-55 Years	R5 000	R20.00	19-55 Years	R10 000	R40.00	19-55 Years	R15 000	R60.00	19-55 Years
56-65 Years	R5 000	R25.00	0-11 Months	R10 000	R50.00	0-11 Months	R15 000	R75.00	0-11 Months
66-75 Years	R5 000	R30.00	66-75 Years	R10 000	R60.00	66-75 Years	R15 000	R90.00	66-75 Years
76-85 Years	R5 000	R40.00	76-85 Years	R10 000	R80.00	76-85 Years	R15 000	R120.00	76-85 Years
Waiting Period	All cover plans are subject to a six (6) month waiting period from the commencement of cover for natural death. There is no waiting period for accidental death.

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0-11 Months

Option 1

Option 2

Option 3

none

Hidden

1-5 Years

Option 1

Option 2

Option 3

none

Hidden

6-13 Years

Option 1

Option 2

Option 3

none

Hidden

14-18 Years

Option 1

Option 2

Option 3

none

Hidden

19-55 Years

Option 1

Option 2

Option 3

none

Hidden

56-65 Years

Option 1

Option 2

Option 3

none

Hidden

66-75 Years

Option 1

Option 2

Option 3

none

Hidden

76-85 Years

Option 1

Option 2

Option 3

none

DETAILS OF EXTENDED FAMLY

First Name(s)

Surname

Relationship

Date of Birth

ID/Passport no

Premium selected in Section E

Main Policy Monthly Premium (Section C)

Total Extended Family Funeral Cover Monthly Premium (Section E above)

Hidden

Total

Consent

Hereby apply for “MUKURU FUNERAL COVER” in accordance with:

The conditions and exclusions of the plan as set out in this form and policy document. I understand the policy document, including my personal details, chosen benefits and claims procedures will be sent to me by email or SMS with a download link. In accordance with Rule 4 of the Policyholder Protection Rules, I have 31 days from receipt of the policy documents to cancel this policy. If this policy is cancelled within 31 days, any payment that has been received will be refunded provided no claim has been lodged or any benefit paid. I am aware of the waiting periods applicable to this policy. I have familiarised myself with the maximum cover for each member of the MUKURU FUNERAL COVER. There is a limit of one policy per main member of the MUKURU FUNERAL PLAN.

I, the undersigned, hereby declare and warrant that all information supplied herein is true and complete. I am aware and understand that any non-disclosure or misrepresentation of information, which is material to the determination of the risk by Guardrisk Life Limited, may lead to the policy being declared null and void. I am certain that the product for which I am applying meets my needs and feel that I have all the necessary information in order to make an informed decision in respect of the purchase thereof. This policy falls under the funeral risk class of business per Schedule 2 of the Insurance Act 17 of 2018 and shall come in force and effect on the inception date, provided that the offer for insurance made by the policyholder by way of the proposal form is unconditionally accepted by Guardrisk Life Limited and the first premium payable in terms of the policy was received by Guardrisk Life Limited.

I have the right to give Mukuru the authority to debit my Mukuru Card on the 2nd of every month or I will make a cash payment by the 15th through the Mukuru payment partners. A binder fee of 12.5% and commission of 22.5% for funeral cover and 3.25% for the accidental death benefit are included in your gross premium. Your premiums are guaranteed for the first 12 months and will be renewable annually and may be amended or changed, based on the following factors: past and future expected economic factors (for example, but not limited to, interest rates, tax and inflation), past and future expected lapse experience, past and future expected mortality experience, expected future reinsurance, administrative and operational costs of the Administrator, any other expected future costs to be incurred by the Administrator, any regulatory and legislative changes impacting this Policy or any other factor impacting the premium that the Insurer deems material at the time.. Any increase to the premium will be advised to the policyholder 31 days prior to the increase taking place. Premiums are payable monthly. If premiums, in whole or in part, are in arrears, and a Claim Event occurs during the Grace Period of 15 days from the premium due date the arrear amount will be deducted from any benefit payable. No claim will be valid if a claim event occurs after the expiry of the Grace Period.

Are you, any family member, or any close associate of yours, currently in a prominent or influential position in any country or have you or any of them held any such position in the recent past?

Are you, any family member, or any close associate of yours, currently in a prominent or influential position in any country or have you or any of them held any such position in the recent past(Required)

Yes

Family members are, for example, a spouse, children, stepchildren, siblings, step-siblings, aunts, uncles, nieces, nephews. A close associate is a person who is closely connected to a prominent person, either socially or professionally. A prominent influential position is: - a public political position, for example, a mayor, provincial premier, member of executive council, government minister, head of state or leader of a political party; - an important position in a state owned entity or municipality, for example, the chief executive officer of chief financial officer; - a judge, member of a royal family, ambassador or a high ranking officer in the military; - an important position in a company or international organisation, for example a member of the board of directors, chief executive officer or chief financial officer.

A premium is due on the debit date. Failure to pay a premium, subject to a grace period of 15 days, will result in a policy lapsing and all benefits being cancelled.
Premiums guaranteed for the first 12 months.
Annual increase in premiums will be notified to the main member 31 days before the increase takes effect with reasons for the increase.
All claims must be submitted against the policy within 180 days of the occurrence of death.
All benefits exclude suicide for the first 12 months from the policy commencement date.
A six (6) month waiting period for natural causes is applicable on the single, family and additional children options as per the Mukuru Funeral Plan.
A six (6) month waiting period for natural death is applicable on the extended family option.
Only one policy is allowed per main member.
Maximum entry age of main member is 65 years and adult dependent is 85 years.
Pay-out within 48 hours after submission of a valid claim and supporting documentation.
Inception is subject to first premium paid.
Spouse - The legal or common-law partner. Maximum 1 per Funeral Plan.
Child - The natural, adopted or stepchild under the age of 21 and is under the care of the main member. Maximum 4 per Funeral Plan.
The age of the child may be extended to 25 in respect of an unmarried child who is a full-time student (proof of registration from an educational institution at application and at claim stage is applicable).

Nominated Beneficiary - The person nominated by the Main Member to receive the benefits on the death of the Main Member. In all other instances, the Main Member will be the beneficiary. Maximum 1.

Extended family - (max 6) – Additional spouse/s, brothers, sisters, uncles, aunts, nephews and nieces. The maximum entry age for an extended family member is 85 years on his/her current birthday.

Cooling off period - 31-days from commencement date during which you can cancel the policy for any reason.

Complaints - [email protected]

Claims - Contact Mukuru 0860018556 or e-mail [email protected]. Alternatively, contact Siyavika Risk Solutions (Pty) Ltd to claim: 086 679 0109 | [email protected]

Mukuru’s telephone number is 086 001 8555.
Mukuru’s compliance officer is Moonstone Compliance and their contact number is 021 883 8000.
Mukuru has professional indemnity and fidelity insurance cover.
Mukuru’s policies are administered by Siyavika Risk Solutions and underwritten by Guardrisk Life Limited.
Both companies are registered Financial Service Providers.
Mukuru has a Service Level Contract in place with Siyavika Risk Solutions.
Guardrisk’s Compliance Department contact number is 011 669 1104 or email [email protected]
You have the right to cancel your policy within a period of 31 days of receiving your policy documentation.
Your policy documentation will be sent to you via an SMS link or email.
As we will be sending you the policy documentation, it is your responsibility to contact us if the documentation is not received
It is vitally important that you continue to pay the premium as failure to do so may lead to your claim not being paid.
Mukuru Financial Services (Pty) Ltd is an authorised Financial Services Provider (FSP 45517). Underwritten by Guardrisk Life Limited (FSP No 76), a licensed life insurer and an authorised financial services provider in terms of the Insurance Act.

Consultant Name

Branch / Info Office Location

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MukuruFuneral Cover

Mukuru
Funeral Cover