Blessings Serene Horizons

Dignified Farewell. Gentle Support.

Join our community-based funeral support program. We provide dignified and compassionate assistance during life's most difficult moments.

A. Principal Member Details

Full Name *

National ID Number *

Phone Number *

Alternative Phone

Age *

Physical Location (Village/Area)

County

B. Family Covered (Spouse & Children)

Spouse Name

Spouse ID Number

Children (up to 4) - attach birth certificates

Child 1 Name

Age

Birth Cert. Number

Child 2 Name

Age

Birth Cert. Number

Child 3 Name

Age

Birth Cert. Number

Child 4 Name

Age

Birth Cert. Number

Extra Members/Dependents

Additional KES 100 per month for children under 25, KES 200 per month for adults (beyond the 4 standard children)

C. Next of Kin

Name *

Relationship *

ID Number

Phone Number *

D. Membership Plan Selected

Select Plan *

Essential funeral support coverage

Payment Information

• Registration Fee: KES 300 (one-time, non-refundable)
• Base Monthly Contribution: KES 350
• Payment methods: M-Pesa, Bank Transfer, or Cash

E. Food Basket Support (Optional Add-On)

Annual subscription - Cash benefit delivered during funeral support period

Basic Package

Annual Premium

KES 696/year

Cash Benefit

KES 25,000

KES 25,000 cash benefit delivered during funeral support

Standard Package

Annual Premium

KES 1,396/year

Cash Benefit

KES 50,000

KES 50,000 cash benefit delivered during funeral support

Premium Package

Annual Premium

KES 2,478/year

Cash Benefit

KES 100,000

KES 100,000 cash benefit delivered during funeral support

I confirm that I have read and understood the Terms and Conditions, including rules on extra membership. I acknowledge that no promises outside this document have been made to me. I confirm that all information provided is accurate. *

Located in Homa Bay County, Kenya