Register for Eezi Assist

Please complete the following registration form for the Eezi Assist Button

Policyholders Details

Title
First Name
Surname
ID Number
Policy Number
Mobile Number
eg 27821234000 
Email
 

Security Company (optional)

 
Name of Security Co
Telephone Number
   
Home Address
 
 
   

Medical Aids Details (Optional)

 
Name of Medical Aid
Medical Aid Number
   

Additional 1

 
Title
First Name
Surname
Relation to Member
Mobile Number
 eg 27821234000
ID Number
   

Additional 2

 
Title
First Name
Surname
Relation to Member
Mobile Number
eg 27821234000
ID Number
   

Additional 3

 
Title
First Name
Surname
Relation to Member
Mobile Number
 eg 27821234000
ID Number
   
 

 

By ticking the “I Agree” box you consent to being located by Eezi Assist using an assist system from cellfind for personal safety.
  I Agree
  Read Terms and Conditions