Overview
About Us
Packages
Claims
Resources
Signup Now
Get In Touch
DIMAMO Membership Application
Join South Africa's trusted funeral cover provider
Thank you for your membership application! We'll contact you shortly.
Please complete all required fields.
Personal Details
Full Name (Principal Member)
ID/Passport No.
Date of Birth
Gender
Select Gender
Male
Female
Other
Marital Status
Select Status
Single
Married
Divorced
Widowed
Contact Number
Email Address
Referral Information (if applicable)
Agent Name
Agent Code
Residential Address
Street Address
Suburb
City/Town
Province
Select Province
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
North West
Northern Cape
Western Cape
Postal Code
Cover Type Selection
Select Plan Type
Select Plan
Full Family Cover
Single Parent
Member and Spouse
Individual Cover
Member Plus 5
Member Plus 9
Member Plus 13
Extended Family Members
Repatriation
Spouse Details (if covered)
Full Name
ID/Passport No.
Date of Birth
Children/Dependents
Dependent Name
ID/Passport No.
Date of Birth
Covered?
Select
Yes
No
+ Add Another Dependent
Payment Details
Payment Method
Select Payment Method
Debit Order
Cash
Bank Transfer
Bank Name
Account Holder Name
Account Number
Branch Code
I confirm that all information provided is accurate and consent to DIMAMO processing my data in accordance with POPIA.
Submit Membership Application
© Copyright 2025 Dimamo (Pty) Ltd. - All Rights Reserved | Designed by
Lamasco Graphics