Membership - Step 1

Funeral Parlour / Business Name

CIPC Registration Number

Number of Directors

Head Office Address

Postal Code

Province

Region

City / Town

Office Telephone Number

Cell Number

Email Address

Has Mortuary

Please tick if YES

Is Underwritten

Please tick if YES

Has FSP Licence

Please tick if YES

Number of Branches

Alternative Contact Person

Alternative Contact Person Role

Alternative Contact Person Number