Why Choose Lesotho Funeral?

International award for excellence and business prestige New York 2000 Golden medal for quality and services PMR africa business excellence diamond award Member of the Golden Key association

Policy Application Forms

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Online application

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Policy registration form

POLICY APPLICATION FORM .

POLICY HOLDER'S PERSONAL DETAIL

Tittle*

Surname*

Other Names*

Birthdate*

Phone*

Street

City*

Country*

Marital Status*

Postal Code*

Email*

Gender*

Nationality*

Passport / ID Number*

Home Phone No.:

Work Phone:

Occupation:

Employer:

Empl. No.:

Spouse's Full Names*

Spouse's Date of Birth*

Spouse's contact Number*

2. CHILDREN

Surname	Other Names	Relationship	Gender	Date of Birth

3. DEPENDENTS

Surname	Other Names	Relationship	Gender	Date of Birth

4. FUNERAL BENEFITS

Basic Premium		Kharetsa
Policy Holder	Premium
Policy Holder
Dependents	Premium
Dependents	Total Policy Premiums
Policy Beneficiary		Contact Numbers

5. MODE OF PREMIUM PAYMENT


Mode of Payment	Cash
	Debit Oder
	Stop Order
Banking Details	Bank
	Account Number
	Branch & Number
Acc. Name		Passport No.
Residence		Phone No.
Occupation		Relationship with policy

6. Uploads The certified copies of ID and birth certificates

Terms and Mailing

I accept the terms of Lesotho Funeral Services.

I undertakes to honour payments of my policy premiums as agreed and signed above for the entire life of this policy or upon receipt of my written cancellation of this policy. I further aver that all information contained herein, is correct