BDP Brokers

Policy Details: Sanlam Maximum of 9 Members. Safrican Maximum 14 Members.

Only valid South African 13 - Digit ID’s will be covered. Incorrect ID’s, date of births will not be quoted or covered.

Name and Surname of Member 1

ID Number of Member 1

ID is invalid

Relationship with Member 1

Name and Surname of Member 2

ID Number of Member 2

ID is invalid

Relationship with Member 2

Name and Surname of Member 3

ID Number of Member 3

ID is invalid

Relationship with Member 3

Name and Surname of Member 4

ID Number of Member 4

ID is invalid

Relationship with Member 4

Name and Surname of Member 5

ID Number of Member 5

ID is invalid

Relationship with Member 5

Name and Surname of Member 6

ID Number of Member 6

ID is invalid

Relationship with Member 6

Name and Surname of Member 7

ID Number of Member 7

ID is invalid

Relationship with Member 7

Name and Surname of Member 8

ID Number of Member 8

ID is invalid

Relationship with Member 8

Name and Surname of Member 9

ID Number of Member 9

ID is invalid

Relationship with Member 9

Name and Surname of Member 10

ID Number of Member 10

ID is invalid

Relationship with Member 10

Name and Surname of Member 11

ID Number of Member 11

ID is invalid

Relationship with Member 11

Name and Surname of Member 12

ID Number of Member 12

ID is invalid

Relationship with Member 12

Name and Surname of Member 13

ID Number of Member 13

ID is invalid

Relationship with Member 13

Name and Surname of Member 14

ID Number of Member 14

ID is invalid

Relationship with Member 14

Add Member

Beneficiary Details

Beneficiary Name and Surname

Beneficiary Cell Number

Beneficiary ID Number

ID is invalid

Beneficiary Relationship

Debit order

Card payment

Pay@ + R11 on monthly premium

I solemnly swear that the information provided in this document is correct and true to the best of my knowledge. I agree that the information provided in this document can be used for the application of the policy and it represents the policy that will meet my needs. BDP Brokers will not be held liable for any losses that may occur due to the information contained in this document that is not correct, accurate or true

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Policy Holder Details:

Policy Details: Sanlam Maximum of 9 Members. Safrican Maximum 14 Members.

Beneficiary Details