Build Africa Funeral Application Form
Name
First Name
Last Name
Email
Verification
Identity or passport number
how did your hear about us?
beneficiary name and surname (even surnames are not the same
Id number
signature
1
Name of country (if you from a Foreign country)
type of policy
method of payment(Cash or Bank or Direct Debit)
day of payment (any day before the 7th of every month)
signature
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
BAF(Build Africa Funeral & SHELL GARAGE BURIAL POLICY
Should be Empty: