{"id":9750,"date":"2026-07-30T16:18:22","date_gmt":"2026-07-30T16:18:22","guid":{"rendered":"https:\/\/mollyslive.co.za\/?page_id=9750"},"modified":"2026-07-30T16:18:26","modified_gmt":"2026-07-30T16:18:26","slug":"policy-member-application","status":"publish","type":"page","link":"https:\/\/mollyslive.co.za\/?page_id=9750","title":{"rendered":"Policy &#038; Member Application"},"content":{"rendered":"\n<section class=\"intake-page-hero\">\n  <div class=\"intake-eyebrow\">MOLLY\u2019S FUNERAL HOME<\/div>\n  <h1>Policy &#038; Member Application<\/h1>\n  <p>One carefully guided application for membership, family cover, supporting documents and debit-order authorisation.<\/p>\n  <div class=\"intake-trust-row\">\n    <span>Private &#038; confidential<\/span>\n    <span>Clear document checklist<\/span>\n    <span>Assisted review by our team<\/span>\n  <\/div>\n<\/section>\n<div class=\"intake-security-notice\">\n  <strong>Your information matters.<\/strong> Never submit a bank PIN, online-banking password or card CVV. Molly\u2019s will only use the information supplied for application assessment, verification, policy administration and authorised communication.\n<\/div>\n\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f9749-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"9749\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F9750#wpcf7-f9749-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"9749\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f9749-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"mollys-intake-form\">\n\t<div class=\"intake-intro\">\n\t\t<h2>Policy & Member Intake\n\t\t<\/h2>\n\t\t<p>Complete this secure application so our team can assess your needs and prepare the correct policy documentation. Fields marked with * are required.\n\t\t<\/p>\n\t<\/div>\n\t<fieldset class=\"intake-section\">\n\t\t<legend>1. Application Details\n\t\t<\/legend>\n\t\t<div class=\"intake-grid\">\n\t\t\t<p><label class=\"field field-full\">Application type *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"application-type\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"application-type\"><option value=\"\">Select an option<\/option><option value=\"New policy application\">New policy application<\/option><option value=\"Add or update a dependant\">Add or update a dependant<\/option><option value=\"Update member details\">Update member details<\/option><option value=\"Debit order update\">Debit order update<\/option><option value=\"General policy enquiry\">General policy enquiry<\/option><\/select><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Preferred branch<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"preferred-branch\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Branch or town\" value=\"\" type=\"text\" name=\"preferred-branch\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Preferred contact language<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contact-language\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"contact-language\"><option value=\"English\">English<\/option><option value=\"Afrikaans\">Afrikaans<\/option><option value=\"Sepedi\">Sepedi<\/option><option value=\"Sesotho\">Sesotho<\/option><option value=\"Setswana\">Setswana<\/option><option value=\"isiZulu\">isiZulu<\/option><option value=\"isiXhosa\">isiXhosa<\/option><option value=\"Other\">Other<\/option><\/select><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset class=\"intake-section\">\n\t\t<legend>2. Main Member Details\n\t\t<\/legend>\n\t\t<div class=\"intake-grid\">\n\t\t\t<p><label class=\"field\">Title<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"title\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"title\"><option value=\"Mr\">Mr<\/option><option value=\"Mrs\">Mrs<\/option><option value=\"Ms\">Ms<\/option><option value=\"Dr\">Dr<\/option><option value=\"Other\">Other<\/option><\/select><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Full first names *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"first-names\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"given-name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"first-names\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Surname *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"surname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"family-name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"surname\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">SA ID \/ Passport number *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"identity-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"identity-number\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Date of birth *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-of-birth\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Marital status<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"marital-status\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"marital-status\"><option value=\"Single\">Single<\/option><option value=\"Married\">Married<\/option><option value=\"Customary marriage\">Customary marriage<\/option><option value=\"Divorced\">Divorced<\/option><option value=\"Widowed\">Widowed<\/option><option value=\"Other\">Other<\/option><\/select><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Mobile number *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"mobile\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" autocomplete=\"tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"mobile\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Alternative number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"alternative-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"alternative-phone\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field field-full\">Email address *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field field-full\">Residential address *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"residential-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"street-address\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"residential-address\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Suburb \/ Village *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"suburb\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"suburb\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Town \/ City *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"address-level2\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Province *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"province\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"province\"><option value=\"\">Select province<\/option><option value=\"Eastern Cape\">Eastern Cape<\/option><option value=\"Free State\">Free State<\/option><option value=\"Gauteng\">Gauteng<\/option><option value=\"KwaZulu-Natal\">KwaZulu-Natal<\/option><option value=\"Limpopo\">Limpopo<\/option><option value=\"Mpumalanga\">Mpumalanga<\/option><option value=\"Northern Cape\">Northern Cape<\/option><option value=\"North West\">North West<\/option><option value=\"Western Cape\">Western Cape<\/option><\/select><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Postal code *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"postal-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"postal-code\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"postal-code\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Occupation<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"occupation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"occupation\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Employer<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"employer\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"employer\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset class=\"intake-section\">\n\t\t<legend>3. Policy & Family Information\n\t\t<\/legend>\n\t\t<div class=\"intake-grid\">\n\t\t\t<p><label class=\"field\">Existing policy number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"existing-policy-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"existing-policy-number\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Preferred monthly budget<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"monthly-budget\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" step=\"1\" aria-invalid=\"false\" placeholder=\"R\" value=\"\" type=\"number\" name=\"monthly-budget\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field field-full\">Policy or cover required *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cover-required\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Tell us what type of cover you need and who should be covered\" name=\"cover-required\"><\/textarea><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Spouse \/ partner full name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"spouse-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"spouse-name\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Spouse \/ partner ID number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"spouse-id\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"spouse-id\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Dependant 1 \u2014 name, relationship & ID<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dependant-1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dependant-1\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Dependant 2 \u2014 name, relationship & ID<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dependant-2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dependant-2\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Dependant 3 \u2014 name, relationship & ID<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dependant-3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dependant-3\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Dependant 4 \u2014 name, relationship & ID<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dependant-4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dependant-4\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field field-full\">Beneficiary \/ next-of-kin details *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"beneficiary-details\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Full name, relationship, ID number and contact number\" name=\"beneficiary-details\"><\/textarea><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset class=\"intake-section debit-section\">\n\t\t<legend>4. Debit Order Mandate\n\t\t<\/legend>\n\t\t<p class=\"section-note\">Only provide an account that you are legally authorised to debit. Molly\u2019s will never ask for your bank PIN, password or card CVV.\n\t\t<\/p>\n\t\t<div class=\"intake-grid\">\n\t\t\t<p><label class=\"field\">Account holder *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"account-holder\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"account-holder\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Bank *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"bank-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"bank-name\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Account number *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"account-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"account-number\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Branch code *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"branch-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"branch-code\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Account type *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"account-type\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"account-type\"><option value=\"\">Select account type<\/option><option value=\"Cheque \/ Current\">Cheque \/ Current<\/option><option value=\"Savings\">Savings<\/option><option value=\"Transmission\">Transmission<\/option><\/select><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Preferred debit date *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"debit-date\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"debit-date\"><option value=\"\">Select debit date<\/option><option value=\"1st\">1st<\/option><option value=\"7th\">7th<\/option><option value=\"15th\">15th<\/option><option value=\"20th\">20th<\/option><option value=\"25th\">25th<\/option><option value=\"Last working day\">Last working day<\/option><\/select><\/span><br \/>\n<\/label><br \/>\n<label class=\"field field-full\">Monthly debit amount, if agreed<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"debit-amount\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" step=\"0.01\" aria-invalid=\"false\" placeholder=\"R\" value=\"\" type=\"number\" name=\"debit-amount\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"consent-card\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"debit-consent\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"debit-consent\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I authorise Molly\u2019s Funeral Home and its authorised payment service provider to debit the agreed premium from the account above on the selected date. I understand that the mandate remains in force until cancelled in writing, subject to the policy terms and applicable law.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset class=\"intake-section\">\n\t\t<legend>5. Supporting Documents\n\t\t<\/legend>\n\t\t<p class=\"section-note\">Accepted formats: PDF, JPG or PNG. Maximum 5 MB per file. Upload clear, readable copies only.\n\t\t<\/p>\n\t\t<div class=\"intake-grid uploads-grid\">\n\t\t\t<p><label class=\"field\">Applicant ID \/ passport *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"id-document\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file wpcf7-validates-as-required\" accept=\".jpg,.jpeg,.png,.pdf\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" name=\"id-document\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Proof of residential address *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"proof-address\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file wpcf7-validates-as-required\" accept=\".jpg,.jpeg,.png,.pdf\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" name=\"proof-address\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Bank confirmation letter or statement<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"bank-proof\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.pdf\" aria-invalid=\"false\" type=\"file\" name=\"bank-proof\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Dependant IDs \/ birth certificates<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dependant-documents\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.pdf\" aria-invalid=\"false\" type=\"file\" name=\"dependant-documents\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field field-full\">Other supporting document<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"supporting-document\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.pdf\" aria-invalid=\"false\" type=\"file\" name=\"supporting-document\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset class=\"intake-section declaration-section\">\n\t\t<legend>6. Declaration & Consent\n\t\t<\/legend>\n\t\t<div class=\"consent-card\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"information-accurate\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"information-accurate\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I declare that the information supplied is complete and accurate, and I understand that incorrect or omitted information may affect the application or policy.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"consent-card\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"privacy-consent\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"privacy-consent\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I consent to Molly\u2019s Funeral Home processing my personal information and uploaded documents for application assessment, policy administration, verification, regulatory compliance and necessary service communication, in accordance with applicable South African privacy law.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"intake-grid signature-grid\">\n\t\t\t<p><label class=\"field\">Electronic signature \u2014 type full name *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"electronic-signature\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"electronic-signature\" \/><\/span><br \/>\n<\/label><br \/>\n<label class=\"field\">Signature date *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"signature-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"signature-date\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<div class=\"intake-submit\">\n\t\t<p>By submitting, you confirm that you are authorised to provide the information above.\n\t\t<\/p>\n\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit Secure Application\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>MOLLY\u2019S FUNERAL HOME Policy &#038; Member Application One carefully guided application for membership, family cover, supporting documents and debit-order authorisation. Private &#038; confidential Clear document checklist Assisted review by our\u2026<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"class_list":["post-9750","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Policy &amp; Member Application - Mollys Funeral Home<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/mollyslive.co.za\/?page_id=9750\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Policy &amp; Member Application - Mollys Funeral Home\" \/>\n<meta property=\"og:description\" content=\"MOLLY\u2019S FUNERAL HOME Policy &#038; Member Application One carefully guided application for membership, family cover, supporting documents and debit-order authorisation. 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