ZIMBABWE ASSOCIATION T/A ZIM BURIAL SOCIETY MEMBERSHIP
REGISTRATION FORM
First Name: __________________________________________
Surname: ____________________________________________
Marital Status:
Single
Married
Divorced
Widowed
Date of birth: -------------------------------------------------------------Membership Type: -----------------------------------------------------------Gold/Policy Owner
(Tick to confirm you will be the Policy Owner)
Nationality: ----------------------------------------------------------------------I.D Number: -----------------------------------------------------------------Other I.D Type (Specify):-------------------------------------------------------------Name: _________________________________________
Address: _____________________________________________
______________________________________________
Home telephone: ______________________________________
Mobile: ______________________________________
Email address: ________________________________________
Beneficiaries
In the event of you passing away, name two persons whom you would like to receive your funeral benefits and in
trust them with your funeral arrangements and indicate their contact details below;
1. First name:_____________________________________
Surname: ______________________________________
Date of birth: ___________________________________
Address: ______________________________________
Home telephone: _______________________________
Mobile:
_______________________________
Email address: __________________________________
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2. First name:_____________________________________
Surname: ______________________________________
Date of birth: ___________________________________
Address: ______________________________________
Home telephone: _______________________________
Mobile : _______________________________
Email address: __________________________________
Joining fee and Monthly Subscriptions
It would be very convenient for the Burial Society if you can set up a Bank Standing order for your monthly payments.
Account to be provided upon registration
The amounts you will pay are:
Joining fee: £20-00
Monthly payments as a subscription will be £5.00 per for Gold membership/Policy owner
Silver members.
and £2 for your
A member shall have a maximum of 5 beneficiaries
Your list of Silver members
Number
Name
Surname
I.D Number
Relationship to
applicant
Full Address of Silver Member
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Signed: __________________________________
Date: _________________________________
Contact Details:
Secretary Ruth Mutaki
14 Almond Close
Salford
M6 5AT
admin@zimassociations.com
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