Kganya Botswana Pukwana ya Kganya Payment Book

7 DETAILS OF DEPENDANT CHILDREN Important: See page 19 for the definition of a Dependant First Names Date of Birth Male/ Female Date Entered DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY DD/MM/YYYY Signature of Church Official 1 2 3 4 5 6 7 8 9 10 Where the Policyholder is the father, please tick the applicable options below. Please note that relevant proof will be required at claims stage: • the natural mother is deceased • the Policyholder is the legal guardian • the natural mother is not a member of ZCC POLICYHOLDER DEPENDANTS