Cerenity Admin Portal

Cerenity Life Funeral Services

Membership Application & Debit Order Mandate

Welcome — please complete all fields to submit your membership application.

Valid application link — Ashley Chetty

Package selection

Age group

Worked out from the main member's details below.

Package type

singlefamily

	Package	Cover amount	Monthly fee	Includes
Complete the main member details below and select a package type to view available packages.

Main member details

First name

Surname

Identification type

ID number

Date of birth

Gender

Nationality

Phone number

Email address

Physical address

Spouse detailsOptional

Spouse full name

Spouse ID number

Spouse date of birth

ChildrenOptional — up to 4, under age 21

Children aged 21 and over are not covered here — add them as extended family members below.

Child 1

Full name

Date of birth

ID / Birth cert no.

Extended family membersIncluded free — up to 2

Every package includes up to 2 extended family members at no extra cost. They share your waiting period for natural causes, and like you are covered for accidental death immediately. Maximum age 84. The ID number is optional — the date of birth is what we need.

Extended member 1

Full name

Relationship to member

Date of birth

ID number (optional)

BeneficiaryRequired — one per application

Who the cover amount is paid to. They must be 18 or over and hold a South African ID number, which is what their age is checked from. Every field here is required — this is the person a claim is paid to, so they have to be reachable. They may also be one of the extended family members above.

Full name

ID number

Relationship to member

Date of birth

Cell number

Payer details

Payer full name

Relationship to member

Payer ID number

Required — the bank account cannot be verified without it.

Bank name

Account number

Account type

Branch code

Debit order date

Debit order mandate

Selected package— Select a package above —

Age group—

Package type—

Cover amount—

Waiting period—

Monthly membership feeR —

Total monthly debitR —

Death by accident is covered immediately, from the day the first premium is paid.

I/We hereby authorise Cerenity Life Funeral Services to issue and deliver payment instructions to your banker for collection against my/our account on the selected date, the amount necessary for payment of the monthly membership fee. This authority remains in force until cancelled in writing. I/We confirm that all information provided is true and correct and that the main member falls within the stated age group.

Digital signature

Please sign below to confirm agreement to the mandate and terms above.

Draw your signature here

For queries contact Cerenity Life Funeral Services | Information handled in accordance with POPIA