Premium Family Plan · R150.00/month

Premium Family application form.

Complete this form to apply for the Premium Family Plan. A once-off R200 onboarding fee applies and a six-month waiting period starts from your first payment.

1. Personal details

TitleFull namesSurnameID / Passport numberDate of birthOccupation

2. Contact details

Mobile numberEmailResidential addressPreferred contact methodHow did you hear about us?

3. Household members covered

Spouse / partner full nameSpouse / partner ID numberDependants (name, ID or date of birth, relationship — one per line)

4. Payment

Payment method

5. Declaration

I confirm the information is correct and accept the Service Terms & Conditions, the R200 once-off onboarding fee and the six-month waiting period.I consent to MBN Legal Consulting processing my personal information for this application, in line with the Privacy & Cookie Policy (POPIA).Signature (type full name)