Benefits – CEEPSA

Name of CEEPSA member*
Email Address*
CEEPSA Registration number of member*
Full name of applicant*
ID number of applicant*
Contact number of applicant*
Name of next of kin of applicant*
Contact number of next of kin*
Terms and Conditions
1. Applicant must be linked to a current CEEPSA member
2. Applicant must be between the ages 18 and 65
3. Applicant must be in possession of an Identity document.
4. This will only be activated once your payment has been received
Terms and conditions*
- I have read and understood the prospectus of the CEEPSA Personal Accident Policy and accept the terms and conditions thereof
Email
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