MALAWI POLICE SAVINGS AND CREDIT COOPERATIVE SOCIETY LIMITED

National Police Headquarters, Private Bag 305 Capital City Lilongwe 3

Cell: 0992308090 | 09937388858 | www.malawipolicesacco.com

MTHANDIZI FUNERAL COVER REGISTRATION FORM

Note: Fields marked with * are required. Spouse information is required for married members. Children must be below 18 years.

PART 1 – MEMBER INFORMATION

First Name *

Middle Name

Surname *

Employment Number *

Service Number

National ID Number *

Date of Birth *

Form Type *

Initial RegistrationUpdateAmend

Upload National ID *

Accepted: Images and PDFs

PART 2 – CONTACT INFORMATION

Current Address *

Employer's Address

Home Village

Traditional Authority (T/A)

District

Phone Number(s)

Email Address

PART 3 – FUNERAL COVER BENEFICIARIES

Registered spouse and 4 children below 18 years of age

Relationship	Full Names	Gender	Date of Birth	National ID No.	Home/Work Address	Phone No.
SPOUSE
CHILD 1
CHILD 2
CHILD 3
CHILD 4

Upload Children's ID Documents

Accepted: Images and PDFs • Optional - You can select multiple files

DECLARATION

Declaration Statement *

I declare that the information given on this form is true and correct to the best of my knowledge.

Member Signature *

Accepted: Images only

Spouse Signature

Optional - Required if married

Date *

I confirm that the information provided is true and correct to the best of my knowledge *

OFFICIAL USE ONLY

Captured by

Data Verified by

Checked by

Approved by

Capture Date

Approval Date

Official Date Stamp Area

(For official stamp/date)

By submitting this registration, I confirm that all information provided is accurate and complete.

I understand that false information may result in registration rejection.

Registration submission is secure and encrypted. You will receive a confirmation email.