Application Form

True Professionals

Fill out an application form and we will contact you to verify if you qualify.

Please choose which application type you would like to submit
- Online Application Form
- Download and Upload Form
Step One: Main Member Details
All fields are required and the form cannot be sent with out being filled out correctly.
Group Scheme Name*
Reference Number WL
Inception Date
Date of Birth
Date Format: MM slash DD slash YYYY
ID Number*
Occupation*
Address choice
Physical Address
Street Address City State / Province / Region ZIP / Postal Code Country
Postal Address
Po Box City State / Province / Region ZIP / Postal Code Country
Phone Number*
Cell Number*
Work Number
Email Address*
Step two: Dependent Details
How many dependents*
Name Surname ID Number Relationship

Please click the + to add more members
Details of Extendered Family Members*
Name Surname ID Number Relationship Sum Assured

Up to 4 Members
Please click the + to add more members
Nominated Beneficiaries*
Title Initials First Name Surname ID Number Relationship Benefits

Please click the + to add more members
|, the applicant/policy holder under this policy, hereby nominate the above-mentioned person as the beneficiary in terms of this policy, to receive all benefits payable under this policy. | hereby indemnify Workerslife against any claim by myself or by my relatives/estate in respect of the payment of the policy benefits to the beneficiary.
Step Three: Signatures and consent
This is to confirm that I was made aware of the 12 month waiting period on pre-existing terminal and critical illness for my extended family members
Signed at
On this day of
Date Format: DD slash MM slash YYYY
Sign Using Signature or Name*
Name
First
Name
Last
Main Member Signature
Step One: Download form
Please download the form supplied and fill it out. Once done please upload it using the upload option below.

Download the Application form
Step Two: Upload form
Please upload the complete form using the upload option below.*
Please click choose file to add your upload.

Contact us

Send through a form, we endeavor
to answer all inquiries within 24 hours on weekdays.

Application Form

True Professionals

Step One: Main Member Details

Step two: Dependent Details

Step Three: Signatures and consent

Step One: Download form

Step Two: Upload form

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Name	Surname	ID Number	Relationship

Name	Surname	ID Number	Relationship	Sum Assured

Title	Initials	First Name	Surname	ID Number	Relationship	Benefits