Call Free: 061 112 4236
info@nsbsa.org.za
15 Jubilee Road, Parktown, South Africa
Home
About Us
Member’s Benefits
Registration
Individual Membership Registration
Stokvel Registration
Stokvel Award Nomination
Gallery
Home
About Us
Member’s Benefits
Registration
Individual Membership Registration
Stokvel Registration
Stokvel Award Nomination
Gallery
Contact Us
Call Free: 061 112 4236
info@nsbsa.org.za
15 Jubilee Road, Parktown, South Africa
Home
About
Member’s Benefits
Individual Registration
Stokvel Registration
Gallery
Home
About
Member’s Benefits
Individual Registration
Stokvel Registration
Gallery
Call Free: 061 112 4236
Home
About Us
Member’s Benefits
Registration
Individual Membership Registration
Stokvel Registration
Stokvel Award Nomination
Gallery
Home
About Us
Member’s Benefits
Registration
Individual Membership Registration
Stokvel Registration
Stokvel Award Nomination
Gallery
Contact Us
User Quotation Form
Step 1 of 3
33%
Main Members Personal Detail
Name
*
Title
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
First Name
Last Name
Martial Status
*
Identity Number
*
Date of Birth
*
Date Format: DD dash MM dash YYYY
Gender
*
Select Gender
Male
Female
Other
Email
*
Contact Tell (Work)
*
Cell Phone
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
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Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
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Saint Lucia
Saint Martin
Saint Pierre and Miquelon
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Samoa
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Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
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South Georgia
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Spain
Sri Lanka
Sudan
Suriname
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Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
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Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Scheme
*
Select Scheme Type
Individual Cover
Family Cover - (Yourself, Spouse and 5 children under 21 years)
1+5 Cover - (Yourself plus any 5 family members, e.g. Parents, siblings, Uncle and in-laws)
1+9 Cover - (Yourself plus any 9 family members, e.g. Parents, siblings, Uncle and in-laws)
Cover Amount
*
Select Cover Amount
5000
10,000
15,000
20,000
Cover Amount
*
Select Cover Amount
5000
10,000
15,000
20,000
Cover Amount
*
Select Cover Amount
5000
10,000
15,000
20,000
Cover Amount
*
Select Cover Amount
5000
10,000
15,000
20,000
Age
*
Premium Payable:
R69
Premium Payable:
R78
Premium Payable:
R87
Premium Payable:
R96
Premium Payable:
R93
Premium Payable:
R127
Premium Payable:
R161
Premium Payable:
R195
Premium Payable:
R102
Premium Payable:
R144
Premium Payable:
R195
Premium Payable:
R229
Premium Payable:
R85
Premium Payable:
R98
Premium Payable:
R116
Premium Payable:
R130
Premium Payable:
R131
Premium Payable:
R193
Premium Payable:
R255
Premium Payable:
R316
Premium Payable:
R99
Premium Payable:
R129
Premium Payable:
R156
Premium Payable:
R182
Premium Payable:
R123
Premium Payable:
R1179
Premium Payable:
R231
Premium Payable:
R282
Premium Payable:
R141
Premium Payable:
R213
Premium Payable:
R282
Premium Payable:
R351
Premium Payable:
R166
Premium Payable:
R263
Premium Payable:
R356
Premium Payable:
R450
Premium Payable:
R127
Premium Payable:
R179
Premium Payable:
R235
Premium Payable:
R287
Premium Payable:
R153
Premium Payable:
R237
Premium Payable:
R315
Premium Payable:
R394
Premium Payable:
R153
Premium Payable:
R271
Premium Payable:
R365
Premium Payable:
R462
Premium Payable:
R195
Premium Payable:
R321
Premium Payable:
R441
Premium Payable:
R561
Beneficiary Appointment
Beneficiary Name
*
First
Beneficiary Name
*
Last
Beneficiary ID Number
*
Family Members Covered
Member 1
Name
First
Last
ID Number
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Select Gender
Male
Female
Other
Relation
Select Relation
Spouse
Daughter
Son
Parent
Sibling
Inlaw
Aunty
Uncle
Member 2
Name
First
Last
ID Number
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Select Gender
Male
Female
Other
Relation
Select Relation
Spouse
Daughter
Son
Parent
Sibling
Inlaw
Aunty
Uncle
Member 3
Name
First
Last
ID Number
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Select Gender
Male
Female
Other
Relation
Select Relation
Spouse
Daughter
Son
Parent
Sibling
Inlaw
Aunty
Uncle
Member 4
Name
First
Last
ID Number
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Select Gender
Male
Female
Other
Relation
Select Relation
Spouse
Daughter
Son
Parent
Sibling
Inlaw
Aunty
Uncle
Member 5
Name
First
Last
ID Number
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Select Gender
Male
Female
Other
Relation
Select Relation
Spouse
Daughter
Son
Parent
Sibling
Inlaw
Aunty
Uncle
Member 6
Name
First
Last
ID Number
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Select Gender
Male
Female
Other
Relation
Select Relation
Spouse
Daughter
Son
Parent
Sibling
Inlaw
Aunty
Uncle
Member 7
Name
First
Last
ID Number
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Select Gender
Male
Female
Other
Relation
Select Relation
Spouse
Daughter
Son
Parent
Sibling
Inlaw
Aunty
Uncle
Member 8
Name
First
Last
ID Number
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Select Gender
Male
Female
Other
Relation
Select Relation
Spouse
Daughter
Son
Parent
Sibling
Inlaw
Aunty
Uncle
Member 9
Name
First
Last
ID Number
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Select Gender
Male
Female
Other
Relation
Select Relation
Spouse
Daughter
Son
Parent
Sibling
Inlaw
Aunty
Uncle
PAYMENT INSTRUCTION
Payment Frequency
Frequency Plan
*
Select a Payment Frequency
Weekly
Monthly
Quarterly
Bi-Annually
Annually
Day of Payment
*
Select a Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
DEDUCTION
Date of First Deduction
*
Date Format: DD dash MM dash YYYY
Cover Amount
Your Selected Scheme Amount:
R69
Cover Amount
Your Selected Scheme Amount:
R79.15
Cover Amount
Your Selected Scheme Amount:
R98.30
Cover Amount
Your Selected Scheme Amount:
R117.45
Cover Amount
Your Selected Scheme Amount:
R136.59
Cover Amount
Your Selected Scheme Amount:
R96.37
Cover Amount
Your Selected Scheme Amount:
R132.75
Cover Amount
Your Selected Scheme Amount:
R169.12
Cover Amount
Your Selected Scheme Amount:
R205.50
Cover Amount
Your Selected Scheme Amount:
R82.42
Cover Amount
Your Selected Scheme Amount:
R104.83
Cover Amount
Your Selected Scheme Amount:
R127.25
Cover Amount
Your Selected Scheme Amount:
R149.67
Cover Amount
Your Selected Scheme Amount:
R88.82
Cover Amount
Your Selected Scheme Amount:
R117.64
Cover Amount
Your Selected Scheme Amount:
R146.46
Cover Amount
Your Selected Scheme Amount:
R163.76
Cover Amount
Your Selected Scheme Amount:
R95.47
Cover Amount
Your Selected Scheme Amount:
R130.94
Cover Amount
Your Selected Scheme Amount:
R166.41
Cover Amount
Your Selected Scheme Amount:
R199.76
Cover Amount
Your Selected Scheme Amount:
R114.05
Cover Amount
Your Selected Scheme Amount:
R168.10
Cover Amount
Your Selected Scheme Amount:
R222.16
Cover Amount
Your Selected Scheme Amount:
R276.21
Cover Amount
Your Selected Scheme Amount:
R89
Cover Amount
Your Selected Scheme Amount:
R119
Cover Amount
Your Selected Scheme Amount:
R148
Cover Amount
Your Selected Scheme Amount:
R177
Cover Amount
Your Selected Scheme Amount:
R97
Cover Amount
Your Selected Scheme Amount:
R134
Cover Amount
Your Selected Scheme Amount:
R170
Cover Amount
Your Selected Scheme Amount:
R198
Cover Amount
Your Selected Scheme Amount:
R112.75
Cover Amount
Your Selected Scheme Amount:
R165.49
Cover Amount
Your Selected Scheme Amount:
R202.41
Cover Amount
Your Selected Scheme Amount:
R257.27
Cover Amount
Your Selected Scheme Amount:
R143.38
Cover Amount
Your Selected Scheme Amount:
R226.76
Cover Amount
Your Selected Scheme Amount:
R310.15
Cover Amount
Your Selected Scheme Amount:
R393.53
Once-Off Payment
*
R150 admin fee payable with the 1st payment only!
BANK DETAILS
Name of Bank
*
Name of Branch
Account Number
*
Branch Code
and according to the agreement, If, however, the date of the payment Falls on a non-processing day(weekend or public holiday), I agree that the payment instruction may be debited against my account on the following business day.
Declaration
*
“I, the undersigned, request the Body of Stokvel Investments (Pty) Ltd to arrange with my bank to collect, by means of the debit order system, the payments in terms of the stipulations of the contract and payments in arrears (as they may be amended from time to time/where applicable/where so requested) of the above-mentioned against my account.”
Today's Date
*
Date Format: MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.
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