Buy the The Palmerita Plan – Mainland Spain

Applicant

Your Name (required)

Date of Birth (required)

Passport number (required)

Address (required)

Phone Number (required)

e-mail address (required)

Next of kin (required)

Next of kin telephone number (required)

How did you hear about us? (required)

Emergency Contact

Emergency Contact Name (required)

Emergency Contact Relationship (required)

Emergency Contact Phone Number (required)

Mother's Christian name (required)

Father's Christian name (required)

YOUR DECLARATION

YOUR DECLARATION. I hereby agree to purchase a funeral plan from Funeral Plans Europe (SL) NIF B42671487 as specified above. I confirm that I have received and read the key facts which describe the benefits and terms of the plan. On purchasing plan, I accept that my personal details will be held for the purpose of administering the plan and will be shared with relevant individuals and funeral directors in order that the plan can be enacted.

Applicant 1

I have read the key facts.