PE Muslim Burial Society

Register A New Household

South African ID / Passport

Title

First Name

Last Name

Date Of Birth

Gender

Contact Number

Alternative Contact (optional)

Email Address

Preferred Communication

Residential Address

Suburb

Town / City

Postal Code

People In Household

Next Of Kin - Name

Next Of Kin - Relationship

Next Of Kin - Contact Number

South African ID / Passport

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Proof Of Address (Not Older Than 3 Months)

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I confirm that the information provided is accurate and complete.

I consent to my information being stored securely in accordance with POPIA regulations.

I understand that membership is subject to administrative approval.