Dei-Sta Carry Me Home Registration Form

Application Form

We at Dei-sta Funeral Services understand the importance of compassionate support during difficult times. Our dedicated team is here to assist you with any questions or concerns you may have. Please reach out to us through any of the following methods.

Chat to us

Request a call

Personal Details

Name

Surname

Date of Birth

Nationality

Gender

Package Selection

Cell Number

Address

Your email

Cell No. 2

Spouse Details (Optional)

Name

Surname

Gender

Relationship

Date of Birth

ID Number

Children Details

Dependent Full Name

Gender

Relationship

Date of Birth

Extended or Family Member

Full Name

Gender

Relationship

Date of Birth

Payment Details

Payment Option

Name of Bank

Branch Code

Account Type

Account Holder

Account Number

Date of Deduction

010 157 2422

info@dei-sta.co.za

Application Form

From as Little as R145 pm. You get SADC Repatriation and Burial Cover