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Sign Up for Mukuru Funeral Cover

Please complete the form below. We will contact you to finalise your application. To apply you need a valid South African ID or passport.

"*" indicates required fields

A. Details of Main Member

First Name(s)*

Surname*

Gender*

Male

Female

ID/Passport No*

Marital Status

Date of Birth*

Email Address

Cell no*

Physical Address

B. Details of Nominated Beneficiary

The person who will receive the benefit payment in the case of the main member passing.

Beneficiary's First Name(s)*

Surname*

Gender*

Male

Female

ID/Passport No

Cell no*

Date of Birth*

Relationship to Main Member*

C. Funeral Cover Policy Options

	Send Me Home Cover for individual known as the main member	Send Me Home Gold Premium cover for an individual main member	Send Us Home Parent Cover for a main member & 4 children	Send Us Home Family Cover for a main member, spouse & 4 children
Monthly Premium	R37.50	R62.50	R87	R135
Main Member total cash pay-out	R20 000	R32 500	R30 000	R35 000
Spouse	None	None	None	R26 250
Child (0-5)	None	None	R3 000	R3 500
Child (6-13)	None	None	R6 000	R7 000
Child (14-21)	None	None	R9 000	R10 500
Accidental Death	R17 500	R22 500	R22 500	R25 000
Repatriation*	Every country in Southern Africa – 8 Seater Van
Additional value assistance*	Teacher \| Legal \| Trauma
Extended Family Benefits	None	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*

Send Me Home

Send Me Home Gold

Send Us Home Parent

Send Us Home Family

D. Details of Children (Max 4)

Children between the ages of 22-25 who are not full time students can not be covered as a child under this product.

D. Details of Spouse (Max 1) and Children (Max 4)

Children between the ages of 22-25 who are not full time students can not be covered as a child under this product.

Spouse details

First Name(s)

Surname

Gender

ID/ Passport no

Date

Family Members

First Name(s)

Surname

Gender

ID/ Passport no

Date

Fulltime Student?

Add more

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

E. Extended Family Funeral Cover

The table below shows the different premium amount and cover options for the extended family. To insert extended family details, refer to section F below.

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)
	OPTION 1		OPTION 2		OPTION 3
Age Category	Cover	Monthly Premium	Cover	Monthly Premium	Cover	Monthly Premium
0-11 Months	R1 500	R3.50	R3 000	R7.00	R4 500	R10.50
1-5 Years	R2 500	R3.50	R5 000	R7.00	R7 500	R10.50
6-13 Years	R3 500	R3.50	R7 000	R7.00	R10 500	R10.50
14-18 Years	R5 000	R3.50	R10 000	R7.00	R15 000	R10.50
19-55 Years	R5 000	R20.00	R10 000	R40.00	R15 000	R60.00
56-65 Years	R5 000	R25.00	R10 000	R50.00	R15 000	R75.00
66-75 Years	R5 000	R30.00	R10 000	R60.00	R15 000	R90.00
76-85 Years	R5 000	R40.00	R10 000	R80.00	R15 000	R120.00

*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.

F. Details of Extended Family

(*Father, Mother, Brothers, Sisters, Nephews, Nieces, Uncles, Aunts and additional dependent children)

Extended Family Member

First Name(s)

Surname

Relationship

Date

ID/ Passport no

Monthly Premium & Cover Amount

Add more

Extended Child

First Name(s)

Surname

Relationship

Date

ID/ Passport no

Monthly Premium & Cover Amount

Add more

G. Monthly Premium Calculation

Main Policy Monthly Premium (Section C)

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

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Total

H. Declaration in Respect of Life Insurance Products

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 will not be changed or varied within 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 31 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.

I. Declaration in Respect of the Protection of Personal Information Act

Consent

I agree to the privacy policy.

Your privacy is of utmost importance to us. We will take the necessary measures to ensure that any and all information, provided by you or which is collected from you is processed in accordance with the provisions of the Protection of Personal Information Act 4 of 2013 and further, is stored in a safe and secure manner. You hereby agree to give honest, accurate and up-to-date personal information and to maintain and update such information when necessary. You accept that your personal information collected by us may be used for the following reasons:
• to establish and verify your identity in terms of the applicable laws;
• to enable us to fulfil our obligations in terms of this policy;
• to enable us to take the necessary measures to prevent any suspicious or fraudulent activity in terms of the applicable laws; and
• reporting to the relevant regulatory authority/body, in terms of the applicable laws.

We may share your information for further processing with the following third parties, which third parties have an obligation to keep your Personal Information secure and confidential:
• Payment processing service providers, merchants, banks and other persons that assist with the processing of any benefit payable.
• Law enforcement and fraud prevention agencies and other persons tasked with the prevention and prosecution of crime.
• Regulatory authorities, industry ombudsmen, governmental departments, local and international tax authorities, and other persons that we, in accordance with the Applicable
Laws, are required to share your Personal Information with; and
• Credit Bureau’s.

Unless consented to by yourself, we will not sell, exchange, transfer, rent or otherwise make available your personal information (such as your name, address, email address or telephone number) to any other parties and you indemnify us from any claims resulting from disclosures made with your consent. You understand that if the Administrator/Insurer has utilised your personal information contrary to the applicable laws, you have the right to lodge a complaint with Guardrisk Life Limited or with the Information Regulator.

J. Declaration in Respect of Prominent Influential Person (PIP)

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*

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.

K. Terms and Conditions

A premium is due on the debit date. Failure to pay a premium, subject to a grace period of 31 days, will result in the policy lapsing and all benefits being cancelled.
Your premiums will not be changed or varied within the first 12 (twelve) months from the Inception Date and thereafter may be reviewed annually by the Insurer 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, any regulatory and legislative changes impacting this Policy or any other factor impacting the premium that the Insurer deems material at the time. If there will be any premium increase after the first year, you will be informed with a 31-day notice period and this notice will also confirm what increase if any will take place on the benefits.
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.
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 failing which the Insurer may reject the claim unless there are extenuating circumstances acceptable to the Insurer for the late submission.
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 for all insured lives on the Mukuru Funeral Plan from the inception date of the Policy. There is no waiting period for Accidental Death.
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.
*Prices may vary according to cover. T&Cs apply. All cover plans are subject to a six (6) month waiting period from commencement of cover. Premiums will not change in the first 12 months unless there are reasonable actuarial grounds to do so. Premiums & cover amounts are subject to an annual review. Mukuru Financial Services (Pty) Ltd is an authorised FSP (FSP 45517). Underwritten by Guardrisk Life Limited (FSP 76), a licensed Life Insurer in terms of the Insurance Act.
Administered by Siyavika Risk Solutions (Pty) Ltd (FSP 44999). The Repatriation** and Value Assistance** benefits are not underwritten by Guardrisk Life Limited and are not regulated in terms of the Financial Advisory and Intermediary Services Act (“FAIS Act”). Therefore, you are not afforded the same protection which apply in respect of financial products or services which are regulated in terms of the FAIS Act. These services are offered by AZOZA – contact 080 792 9530.

Spouse – The legal or common-law partner. Maximum 1 per Funeral Plan.
Child – Natural, adopted or stepchild under the age of 21 and is under the care of the main member (subject to confirmation of insurable interest). Maximum 4 or 6 depending on the 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.

Extended family – (max 6) – Additional spouse/s, parents/parents-in-law, brothers, sisters, uncles, aunts, nephews, nieces and 2 additional children. The maximum entry age for an extended family member is 85 years on his/her next birthday.

Cooling off period – 31-days from receipt of the policy documents 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]

L. General Information

Mukuru Financial Services (Pty) Ltd is an authorised FSP (FSP45517).
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.

No waiting period for accidental death.

Assisted by Mukuru Consultant

(Required if assisted by Mukuru Consultant)

Consultant Name

Branch / Info Office Location

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.