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 *Please list one person per line: Name - Relationship - ID number

Next Of Kin - Name

Next Of Kin - Relationship

Next Of Kin - Contact Number

Contribution Type *

South African ID / Passport *

Drag and Drop (or) Choose Files

Proof Of Address (Not Older Than 3 Months) *

Drag and Drop (or) Choose Files

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.

PE Muslim Burial Society

Supporting Muslim households across Port Elizabeth with dignity and compassion.

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Contact

Port Elizabeth · East London · Mthatha
admin@ecmbs.org.za
+27 (0)41 000 0000