I Hereby apply for a membership on the Master Policy held by Dichabe Funeral Services for the cover contained in this document and I declare that I have not withheld any material information. I accept that this application and the declaration shall be the basis of the Membership Contract between Dichabe Funeral Services. Furthermore, I understand and that any inaccurate or untrue statement may render my membership null and void and all premiums paid will be forfeited to Dichabe Funeral Services. The underwriter reserves the right to decline this application within 30 days of signature, I understand that subject to Underwriter approval, the membership will only come into effect after Dichabe Funeral Services has received the 1st premium payable.
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