Funeral Cover Calculator Customer Care: 086 000 0556 082 305 7649 info@mosaicfunerals.co.za 1Main MemberComplete the insured life information: Personal DetailsDate of birth and Gender Day 01020304050607080910111213141516171819202122232425262728293031 Mainage_day Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Mainage_month Year 19201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Mainage_year Gender MaleFemale Mainage_gender Cover AmountUp to R30 000 Cover Amount 1000 Main_cover 2Additional MembersAdd additional members: Do you want to add additional members? Yes No Addmem_toggle Number of members Addmem_num 1st Additional Member Personal DetailsDate of birth and Gender Day 01020304050607080910111213141516171819202122232425262728293031 Addmem1_day Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Addmem1_month Year 19201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Addmem1_year Gender MaleFemale Addmem1_gender Relationship SpouseSonDaughterMotherFatherUncleAuntGrandfatherGrandmother addmem_rel1 Cover AmountUp to R30 000 Cover Amount 1000 Addmem1_cover Member rate pm 2nd Additional Member Personal DetailsDate of birth and Gender Day 01020304050607080910111213141516171819202122232425262728293031 Addmem2_day Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Addmem2_month Year 19201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Addmem2_year Gender MaleFemale Addmem2_gender Relationship SpouseSonDaughterMotherFatherUncleAuntGrandfatherGrandmother addMem_rel2 Cover AmountUp to R30 000 Cover Amount 1000 Addmem2_cover Member Rate pm 3rd Additional Member Personal DetailsDate of birth and Gender Day 01020304050607080910111213141516171819202122232425262728293031 Addmem3_day Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Addmem3_month Year 19201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Addmem3_year Gender MaleFemale Addmem3_gender Relationship SpouseSonDaughterMotherFatherUncleAuntGrandfatherGrandmother Addmem_rel3 Cover AmountUp to R30 000 Cover Amount 1000 Addmem3_cover Member Rate pm 4th Additional Member Personal DetailsDate of birth and Gender Day 01020304050607080910111213141516171819202122232425262728293031 Addmem4_day Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Addmem4_month Year 19201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Addmem4_year Gender MaleFemale Addmem4_gender Relationship SpouseSonDaughterMotherFatherUncleAuntGrandfatherGrandmother Addmem_rel4 Cover AmountUp to R30 000 Cover Amount 1000 Addmem4_cover Member Rate pm 5th Additional Member Personal DetailsDate of birth and Gender Day 01020304050607080910111213141516171819202122232425262728293031 Addmem5_day Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Addmem5_month Year 19201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Addmem5_year Gender MaleFemale Addmem5_gender Relationship SpouseSonDaughterMotherFatherUncleAuntGrandfatherGrandmother Addmem_rel5 Cover AmountUp to R30 000 Cover Amount 1000 Addmem5_cover Member Rate pm 6th Additional Member Personal DetailsDate of birth and Gender Day 01020304050607080910111213141516171819202122232425262728293031 Addmem6_day Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Addmem6_month Year 19201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Addmem6_year Gender MaleFemale Addmem6_gender Relationship SpouseSonDaughterMotherFatherUncleAuntGrandfatherGrandmother Addmem_rel6 Cover AmountUp to R30 000 Cover Amount 1000 Addmem6_cover Member Rate pm 7th Additional Member Personal DetailsDate of birth and Gender Day 01020304050607080910111213141516171819202122232425262728293031 Addmem7_day Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Addmem7_month Year 19201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Addmem7_year Gender MaleFemale Addmem7_gender Relationship SpouseSonDaughterMotherFatherUncleAuntGrandfatherGrandmother Addmem_rel7 Cover AmountUp to R30 000 Cover Amount 1000 Addmem7_cover Member Rate pm 8th Additional Member Personal DetailsDate of birth and Gender Day 01020304050607080910111213141516171819202122232425262728293031 Addmem8_day Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Addmem8_month Year 19201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Addmem8_year Gender MaleFemale Addmem8_gender Relationship SpouseSonDaughterMotherFatherUncleAuntGrandfatherGrandmother Addmem_rel8 Cover AmountUp to R30 000 Cover Amount 1000 Addmem8_cover Member Rate pm 9th Additional Member Personal DetailsDate of birth and Gender Day 01020304050607080910111213141516171819202122232425262728293031 Addmem9_day Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Addmem9_month Year 19201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Addmem9_year Gender MaleFemale Addmem9_gender Relationship SpouseSonDaughterMotherFatherUncleAuntGrandfatherGrandmother Addmem_rel10 Cover AmountUp to R30 000 Cover Amount 1000 Addmem9_cover Member Rate pm 10th Additional Member Personal DetailsDate of birth and Gender Day 01020304050607080910111213141516171819202122232425262728293031 Addmem10_day Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Addmem10_month Year 19201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Addmem10_year Gender MaleFemale Addmem10_gender Relationship SpouseSonDaughterMotherFatherUncleAuntGrandfatherGrandmother Addmem_rel10 Cover AmountUp to R30 000 Cover Amount 1000 Addmem10_cover Member Rate pm Premium Total Main Member Total: pm Additional Members Total: pmPremium Total: pm Enquire on Premium Name Name Location location Phone Phone Email Email Send ‹›×× ×
