Cash Funeral Cover Plan - Benefit Application Form

PERSONAL DETAILS OF APPLICANT

Name
Gender
Mobile Number
Surname Forename(s) Relationship Date of Birth National Id/Birth Entry Cover Amount Per Dependant Premium per month

PRINCIPAL MEMBER 

Surname Forename(s)

1.1 The funeral assurance cover under the Plan shall commence on the first day of the month coinciding with or next following the payment of the first premium.

1.2 The Plan does not cover death by suicide or by the hand of Justice within a period of twenty-four (24) months from the Date of Joining the Plan.

1.3 Save as herein provided, Membership shall lapse if any premium is not paid when due and no right thereunder nor on account of previous payment shall exist.

1.4 A grace period of one calendar month is allowed for the payment of each and every premium.

1.5 Coverage under the Plan shall terminate on the death of the Principal Member or on the voluntary termination by the Principal Member or on the lapse of Membership of the Plan as a result of non-payment of premiums.

1.6 Except for deaths arising from accidental causes, all other deaths shall only give rise to claims after the expiry of three (3) consecutive months in respect of the Principal Member and any Immediate Family Member; and six (6) consecutive months in respect of an Extended Family Member, from the Date of Joining the Plan or date of reinstatement or date of registration of a dependent.

1.7 Immediate Family Member means, in respect of the Principal Member, a valid registered spouse, own children and persons under the legal guardianship of the Principal Member, and dependent natural or adoptive parents or parents-in- law.

1.8 Extended Family Member means a dependent who is not an Immediate Family Member.

1.9 The qualifying period for cover to be effective stated in paragraph 3.6 above shall apply to any increase in the funeral benefit cover of each insured person.

1.10 Claims shall be settled only if they are reported to ZB within three (3) months from the date of death of an insured person.

1.11 The maximum cover for each person shall not exceed the limit set from time to time.

Declaration

I confirm that to the best of my knowledge, the above information is true and correct and that all the persons registered above are not on medication for any disease or illness. Should anything change, I undertake to advise ZB Bank immediately.

I agree to abide by ZB Bank's standard terms and conditions as set out in the Membership Certificate that will be issued to me.

Declaration By Premium Payer (if different from applicant)

I authorise the Bank to deduct the premium stated above each month from my account when it is funded.

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