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Welcome to the Emalyami funeral application form!

This form enables you to:

  • Activate your My Will Online Membership.
  • Activate free discounts like Nu Metro Movies for as low as R51, 10% off Intercape, 10% off Planet Fitness, 25% off Drum, You, Womenshealth and Menshealth, 10% of Garmin and Polar and many more!
  • Choose the funeral cover option that suites your needs.
  • Activate your Legal Assistance benefit.
  • Activate your Tutor Assist benefit for your children.
  • Activate your Repatriation benefit.
  • Activate your tombstone benefit, flowers, and many many more!
Get your documentation via email, post of Whatsapp.

Click next to get started right now!

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To personalize your package, we need your age please.

Thank you! You qualify for the following benefits:

  • Free discounts for you like Nu Metro Movies for as low as R51, 10% off Intercape, 10% off Planet Fitness, 25% off Drum, You, Womenshealth and Menshealth, 10% of Garmin and Polar and many more!
  • 24/7 Legal Assistance benefit for you.
  • My Will Online membership for you and your spouse.
  • Tutor Assist benefit for your children if you select the family option.
  • Body repatriation and body removal within South Africa for you and your family.
  • Funeral Cover as per the table below:
You can activate these benefits just for you, or for you and your family as explained above.
Select the plan below that you would like to activate either just for yourself, or for you and your family.
Select the plan below that you would like to activate either just for yourself, or for you and your family.
Select the plan below that you would like to activate either just for yourself, or for you and your family.
Select the plan below that you would like to activate either just for yourself, or for you and your family.
Select the plan below that you would like to activate either just for yourself, or for you and your family.
Select the plan below that you would like to activate either just for yourself, or for you and your family.
The stand alone VAS product offers:
  • Free discounts like Nu Metro Movies for as low as R51, 10% off Intercape, 10% off Planet Fitness, 25% off Drum, You, Womenshealth and Menshealth, 10% of Garmin and Polar and many more!
  • Emergency Medical Assistance with Intelligent Panic Button on your phone.
  • 24/7 Legal Assistance benefit.
  • My Will Online membership.
 

You can add Parents and Parents in Law on this policy.

Maximum entry age of 75, a maximum of 4 parents or parents in law are can be added.

 
If yes, how many parents?

You can also add other family to this policy.

Maximum entry age of 65, a maximum of 4 extended family members can be added.

 
If yes, how many extended family do you want to add?

Executor Fee Benefit

Pays R35,000 towards the winding up of your estate.
 
 

Additional R65,000 Benefit

The additional R65,000 cover for one of the following:
  1. Memorial Diamond benefit.
  2. Funeral Concierge Service.
  3. Full benefit paid to the beneficiary.
 
 

SPOUSE

The Birth Surname of the spouse.

CHILDREN

Maximum entry age of 21, a maximum of 5 children can be added.

PARENTS AND PARENTS IN LAW

Get the premium for the correct age of the parent above.
Get the premium for the correct age of the parent above.
Get the premium for the correct age of the parent above.
Get the premium for the correct age of the parent above.

EXTENDED FAMILY MEMBERS

Get the premium for the correct age of the family member above.
Get the premium for the correct age of the family member above.
Get the premium for the correct age of the family member above.
Get the premium for the correct age of the family member above.

SECTION 1

MAIN MEMBERS PERSONAL DETAILS.

The Birth Surname of the spouse.

SECTION 2

BENEFICIARY NOMINATION

Beneficiary to whom the money will be paid on the death of the Policyholder. Please complete the details of the beneficiary you nominate. If any of the other Insured Life’s die on this policy, you will be the beneficiary and we will pay the benefits to you. If you do not nominate a beneficiary to receive the Money in the event of your death, we will pay the money from your policy to your estate.
A secondary nominated beneficiary is advisable in the case that the Policyholder and primary beneficiary dies together.

SECTION 3

Please note that the policy has to start on the first of the month.
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PREMIUM PAYER DETAILS

BANKING DETAILS

It is important that you provide us with the correct banking details from for collection of the premium. Triarc (Pty) LTD will not be legally responsible if you give us the incorrect banking details. You must inform us if your banking details change.

I/we, the undersigned, confirm that the account information I have provided is an account in my name. This signed Authority and Mandate refers to our contract as dated on signature hereof.

I/We hereby authorise Triarc to issue and deliver payment instructions to the Bank for collection against my/our above-mentioned Bank account at my/our above-mentioned Bank(or any other bank or branch to which I/we may transfer my/our account) on condition that the sum of such payment instruction will never exceed my/our obligations as agreed in our contract/agreement and continuing until this Authority and Mandate is terminated by me/us by giving you notice in writing of not less than 20 ordinary working days, and sent to you in writing.

The payment day may be aligned to an earlier salary in December if agreed by you and Triarc.

The individual payment instructions so authorised to be issued must be issued and delivered and will continue monthly from the start date as indicated above.

In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will automatically be the very next business day. Furthermore, if there are insufficient funds in my account to meet the obligation, you are entitled to track my account and represent the instruction for payment as soon as sufficient funds are available in my account.

I/we understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks. I also understand that details of each withdrawal will be printed on my bank statement. Such must contain a number,
which must be included in the said payment instruction and if provided to me should enable me to identify the Agreement.

I/we acknowledge that all payment instructions issued by you shall be treated by me/our above-mentioned bank as if the instructions had been issued by me/us personally. I/we agree that although this Authority and Mandate may be cancelled me/us, such cancellation will not cancel the Agreement. I/we shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you. I/we acknowledge that this Authority may be ceded to or assigned to a third party if the agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.

We will confirm your Authority and Mandate in writing prior to processing the debit order against your account.

To verify the banking details, Triarc may request a bank letter, or a copy of a bank statement.

 

Triarc is an authorized financial services provider (FSP) that design, market and distribute long-term insurance products underwritten by Guardrisk Life.

Triarc’s My Last Wish online application form offers you an opportunity to complete and purchase funeral cover based on your own financial needs. This does not constitute advice.

Use a finger, a stylus or computer mouse to sign the form.
Reset Signature

About Us

TRIARC is an authorised financial services provider FSP45009. TRIARC insurance products underwritten by Guardrisk Life FSP76. Council of Medical Scheme
Number ORG 4040.

About us

TRIARC is an authorised financial services provider FSP45009. Council of Medical Scheme Number ORG 4040.

Contacts

087 231 0222
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