SHC FUNERAL AND AFTER DEATH ASSISTANCE MEMBERSHIP FORM
Next of Kin
Emergency Contact 1
Emergency Contact 2
Pre-Authorized Debit (PAD)
Visa / Master Card
I, the Principal Applicant, do hereby authorized SacredHand Canada to withdraw the reimbursement share amount to cover funeral cost of deceased member of the organization as and when needed from my under mentioned account up to the limit of $50.00 per funeral. I further authorize SacredHand Canada to withdraw any past due payment along with penalty (NSF Fee or Bank Charges) from my valid account.
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