EB SOLUTIONS FUNERAL SCHEME
INDIVIDUAL DEBIT ORDER APPLICATION FORM

Underwritten by Constantia Life & Health Assurance Company Limited, Registration Number 1952/001635/06, (The Insurer)

THE MASTER POLICY ISSUED IS THE SOURCE OF ALL BENEFITS, RIGHTS, AND OBLIGATIONS AND EXCLUSIONS. TO DETERMINE YOUR INDIVIDUAL NEEDS, WE SUGGEST THAT YOU CONTACT YOUR BROKER AND REQUEST ADVICE FROM HIM / HER.