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Title

First Name *

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I consent to Comfort Insurance processing my personal information and contacting me regarding my enquiry and insurance products.

I have read and accept the Terms and Conditions.

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Plan

You

Spouse

Children

Family

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Compliance

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Choose Your Plan

Select the cover level that works for you and your family.

Cover Summary

Cover Category	Basic	Standard	Silver	Dignity	VIP	Executive

Compliance & Declaration

Please read and confirm each of the following disclosures.

Disclosure Checklist

I confirm that I have been given the opportunity to read and understand the Policy Wording, Key Information Document, and Schedule of Benefits applicable to my selected plan, and I accept the terms thereof.

I understand that this is a funeral insurance policy and that the benefit will only be paid upon the death of a covered member. This policy does not accumulate a cash value or provide any savings or investment component.

I acknowledge that a waiting period applies to natural death claims. No waiting period applies in the event of accidental death. Extended Family members are subject to a 6-month waiting period from the date they are added to the policy.

I understand that premiums must be paid on time. Should my premiums fall into arrears, Comfort Insurance reserves the right to lapse or cancel my policy in accordance with the policy terms. A grace period of 30 days applies.

I confirm that all information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any misrepresentation or non-disclosure of material facts may result in a claim being repudiated or the policy being cancelled.

I consent to Comfort Insurance verifying my personal and banking information with relevant third parties where necessary to process this application and administer my policy, in accordance with the Protection of Personal Information Act 4 of 2013 (POPIA).

I have been informed of my right to a 31-day cooling-off period from the date of policy inception, during which I may cancel this policy without penalty, provided no claim has been submitted.

Signature

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You're Covered!

Thank you for your application. A Comfort Insurance consultant will be in touch with you shortly to finalise your cover.

Funeral Cover That Protects Your Family

Individual Funeral Cover

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Choose Your Plan

Principal Member

Spouse Details

Children's Details

Extended Family

Beneficiary Nomination

Payment Details

Compliance & Declaration

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You're Covered!