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

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Policy Application Forms

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Forces

Disciplined Forces Application Forms

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Claim Form

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Policy registration form

POLICY APPLICATION FORM - THARI DOC.

POLICY HOLDER'S PERSONAL DETAIL

Tittle*

Surname*

Other Names*

Birthdate*

Phone*

Street

City*

Country*

Marital Status*

Postal Code*

Email*

Gender*

Male Female

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
			Male Female
			Male Female
			Male Female
			Male Female

3. DEPENDENTS

Surname	Other Names	Relationship	Gender	Date of Birth
			Male Female
			Male Female
			Male Female
			Male Female

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

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