I hereby apply for the benefits contained in this member application form and declare that I have not withheld any important information. I accept that this member application and declaration shall be the basis of the agreement between Cover And Above and myself. I understand that any inaccurate, false or untrue statement my render my policy null and void and premiums paid will be forfeited to Cover And Above. I have been informed of my rights of the policy protection rules and I declare that I understand and accept the terms and conditions applicable to this policy. I further declare that: 1. All information supplied in connection with this proposal, whether in my handwriting or not, is true and correct 2. I am convinced that this policy is adequate to fulfil my needs for my family regarding funeral assistance and assurance 3. I understand and accept the waiting periods applicable to my policy a. Natural Causes (6 Calendar months) | Unnatural Causes (after receipt of 1st premium) | Suicide (12 Calendar months) 4. I understand that my entry date is: a. 1st of the current month if payment is received on or before the 15th of a month, otherwise it will be the 1st of the following month 5. I understand that there is a grace period of 15 days applicable, commencing from the date the premium is due. My policy will lapse if I fail to pay 2 consecutive premiums – if a policy is reinstated within 2 months from lapsing, only the portion the waiting period which was not completed will apply. If a policy is reinstated after 2 months of lapsing, all waiting periods will re-apply 6. I understand that my premium must be paid on or before the 1st of every month in order for me to enjoy the benefit 7. My policy will lapse if I fail to pay 2 consecutive premiums – should I thereafter want to re-instate my policy I will be subject to the normal waiting periods as per above 8. Foreign nationals must have a valid Passport / ID and must have an RSA bank account. They must reside in RSA in order to qualify 9. I have read and completed the POPI declaration and consent form below