I, the undersigned, hereby apply for membership with Bophelo Medical Stokvel. I agree to:

1. Contribute R250 per month towards the stokvel fund.

2. Abide by the rules and constitution of the stokvel.

3. Allow my personal details to be used solely for the purpose of managing my membership and processing claims.

I understand that:

• The stokvel only covers general practitioner visits and prescribed medicines.

• Hospital bills, specialist fees, dental, and optical care are not covered.

• Failure to pay contributions may result in suspension or cancellation of my membership

Yes, I agree with the privacy policy and terms and conditions.