Membership Application

Get covered in under 5 minutes.

Pick your plan, complete your details and pay securely with PayFast. You'll receive your policy number and welcome pack immediately after payment.

Your details

All information is protected under POPIA. Fields marked * are required.

Full name *SA ID number *Email address *Mobile number *Dependants (spouse + children)

Physical address *

City / TownProvincePostal code

Payment schedule

Choose when your first premium is charged and which day of the month future debits should run.

Pay first premium now (R399.00)You'll be charged today. Monthly debits then run on the date you pick below.Start on my chosen date (no charge today)Nothing is charged today. Your first premium will be debited on the date below, and every month thereafter.

Monthly debit date *

Debits will recur monthly on this date via PayFast. Tip: choose a date shortly after your salary lands.

I confirm the information above is accurate, I accept Premium Legal's terms of cover, and I consent to the processing of my personal information in line with POPIA.

You'll pay R399.00 today on PayFast. Monthly debits of R399.00 then run on 2026-09-01 each month.