SOS Helpme

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The SOS-HelpMe Panic Assist is available to persons who wish to use the service and benefits from the Panic Button?

The costs are:

R40.00 Once-Off Registration fee, plus R160.00 Monthly Service & Benefits fee
(Total R200 for the 1st month – thereafter R160 only for the monthly service & benefits membership fee).

SUBSCRIBE HERE

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[SSL (Secure Sockets Layer) is the standard security technology for stablishing an encrypted link between a web server and a browser. This link ensures that all data passed between the web server and browsers remain private and integral.]

Date of registration: *
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Principal Member

Name:*
ID Number*
Your E-mail:*
Cellphone Number:

PLEASE NOTIFY US IMMEDIATELY IF YOUR CELL PHONE NUMBER CHANGES

Address:*

Vehicle Details

Vehicle Make:
Vehicle Model:
Vehicle Colour:
Vehicle Registration Number:

Who to contact if you are unable to answer?
ICE = In Case of Emergency

ICE Contact:
ICE cellphone

2nd Person to contact if you are unable to answer?
ICE = In Case of Emergency

ICE 2 Contact:
ICE 2 cellphone

Spouse Details

Spous Name:
Spouse cellphone
Spouse ID Number:
Spouse E-mail:

Spouse Vehicle Details

Spouse Vehicle Colour:
Spouse Vehicle Make:
Spouse Vehicle Model:
Spouse Vehicle Reg Number:

Child 1 Detail

Child1 Name:
Child1 ID:
Child 1 cellphone
Child1 E-mail:

Child 2 Detail

Child2 Name:
Child2 ID:
Child2 E-mail:
Child 2 cellphone

Child 3 Detail

Child3 Name:
Child3 ID:
Child 3 cellphone
Child3 E-mail:

PLEASE NOTIFY US IMMEDIATELY IF YOUR CELL PHONE NUMBER CHANGES

Select Membership Option - excluding the once off fee of R 40

Do you have Medical Aid?
If YES, Which Scheme (Name):
Please state any serious medical conditions:
Do you have ARMED RESPONSE Service?

If YES, please complete the following fields


Name of Armed Response Company (that we can contact if you can not)
Armed Response Control Room Contact Number
Customer / Account Number with Armed Response Company
Monthly Payment Dates*

Monthly Payments by EFT / Recurring EFT Only. A Monthly Invoice will be sent to you via email containing the SOS HelpMe Banking Details

Dependant R 20 each:*

Remember the Principal Member only pays R160 and that spouses & children can also have the panic on their cellphones at an additional cost of R15 per cellphone.

Monthly subscription :
Registration fee:
Payable Amount
R
Referring Agent :*
If referring agent selected, plase state name:
Complete to continue: