Funeral Group Membership Application Form
Name:
Address:
Date of Birth:
Email:
Phone
Number:
PWA
Membership
Number:
Members of Family (living under same address)
Name (in order of preference - ie who the
cash sum is to be paid to)
Date of Birth
Relationship to member
1)
2)
3)
4)
5)
6)
I herby declare that all the information provided above is correct and up to date. I have read and agree to the rules
outlined below. I also declare that no one named on this form is suffering from a serious or terminal illness and
give permission to my GP to release any relevant information as requested.
(Tick)
Name and
Address of
GP:
Signature:
...................................................
Date:
Full Rules are available on request:
1.1
The Service is available to all paid up members of Pakistan Welfare Association-Hounslow
2.1-.3
A joining fee of Ten pounds is payable at joining, Monthly subscription fee will be Ten pounds payable by a Standing
Order. Membership may be terminated if more than two monthly payments are missed, however if the member
wishes to resume membership, re-joining fee (£10) and all arrears in lieu of months missed will be payable.
3.1
A single monthly subscription covers member and the following providing living at the same address as the member,
spouse, all single children, parents of either member and/or spouse providing they are retired and aged over 60
years.
3.2
Burial expenses as per charges made by the London Borough of Hounslow for residents in Hounslow only will be
paid by the group.
3.2.1
Expenses in relation to the undertaker's fees and transport of the deceased (Body Only) overseas will be paid for by
the group up to the level of burial expenses in the London Borough of Hounslow.
3.3
A Cash-In-Hand payment of £200 Two Hundred Pounds only will be payable to the nominated person in the family of
the member in case of a death of amember or family covered under Article 3.1 described above. This will also be
payable in case of an overseas death as described above.
4.1
In case of a death it will be the responsibility of the family to inform the management of the Funeral Group. The
Group will provide for the undertaking facilities. Only the Contracted Undertaker will be used for such facilities. All
expenses including the Undertaker etc. will be paid directly by the Group.
4.2
Any Changes in circumstances of the member/family should be notified to the Management of the Funeral Group in
writing within six weeks, failure to comply with this rule might affect the benefits.
Membership is only granted on acceptance and confirmation by the Executive. Not by virtue of application.