Broker Recon System

Confirm

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Generate Certificate

PRINCIPAL MEMBER DETAILS

MAXIMUM of R30 000.00 cover per person

Policy Number :

ID Number :

Surname :

Name :

Date of Birth :

Cell Number :

Email :

Product Type :

Premium :

DECLARATION ONE:

DECLARATION TWO:

Commencement Day :

Residential Address :

Status

GROUP :

PERSONAL DETAILS OF SPOUSE:

@if( $sp != null)

Surname :

First Name :

ID Number :

@else

Surname :

First Name :

ID Number :

@endif

DEPENDANTS:

@if( $dp != null) @foreach($dp as $data) @endforeach @else @endif

NAME:	SURNAME:	ID NUMBER:	RELATION:	BENEFIT:

BENEFICIARY NOMINATION

I hereby nominate the following person for any benefits due to be paid from the scheme in the event of my death

@if($bn != null)

NAME:

SURNAME:

CELL NUMBER:

AMOUNT:

@else

NAME:

SURNAME:

CELL NUMBER:

AMOUNT:

@endif

BANKING DETAILS

@if($do != null)

ACCOUNT HOLDER :

BANK NAME :

BRANCH NAME :

ACCOUNT NUMBER :

BRANCH CODE :

ACCOUNT TYPE : {{-- --}}

@else

ACCOUNT HOLDER :

BANK NAME :

BRANCH NAME :

ACCOUNT NUMBER :

BRANCH CODE :

ACCOUNT TYPE : {{-- --}}

@endif

Add New Note

Notes

@foreach($nt as $note) @endforeach

NOTE NAME	NOTE	ADDED BY	DATE
{{$note->note_name}}	{{$note->note}}	{{$note->added_by}}	{{$note->created_at}}

Add New SMS

Add New Email

Communication

@foreach($co as $com) @endforeach

ACTION	EMAIL SUBJECT	ASSIGNED TO	DATE
{{$com->com_name}}	{{$com->sent_by}}	{{$com->email_sub}}	{{$com->created_at}}