SOS-Help Me Sign Up
 
  * Fields are mandatory
  * Principal Member:
     
  Full Names
  Surname
  ID Number
  Cell Phone Number
  Age
  Email address
  Name of Introductory Agent (Website if found online)
  Address Line 1
  Address Line 2
  Address Line 3 (City / Town)
  State / Province / Region
  Postal Code
     
  Vehicle Details:
     
  Vehicle Make
  Vehicle Model
  Vehicle Colour
  Vehicle Registration N
     
   
 

PLEASE NOTIFY US IMMEDIATELY IF YOUR CELL PHONE NUMBER CHANGES

   
  * Who can we contact if you are unable to answer:
     
  Title
  First Name
  Last Name
  Cell Phone number
     
  * Who can we contact if you are unable to answer:
     
  Title
  First Name
  Last Name
  Cell Phone number
     
  Spouse Details:
     
  Full Names
  Surname
  ID Number
  Age
  Cellphone Number
  Email address
     
  Vehicle Details
     
  Vehicle Make
  Vehicle Model
  Vehicle Colour
  Vehicle Registration Number
     
  Do you have Medical Aid:
     
  Yes or No
  If Yes, Which Scheme (Name)
  Any known serious medical conditions
     
  * Do You Have An Armed Response Service:
     
  Yes
  No
   
  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
     
   
 

Payment Details

   
  * Monthly Payment Date:
     
  25th
  1st
  7th
   
  * Monthly Payments by EFT / Recurring EFT Only. A Monthly Invoice will be sent to you via email containing the SOS HelpMe Banking Details:
     
  Recurring Monthly EFT
  EFT
   
   
 

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.

   
  * Select Membership Option - With Once Off Registration Fee Of R40:
     
  Panic & Gold Loyalty Plan R160 p/m - Principal Member Only
  Panic & Gold Loyalty Plan R175 p/m - Principal Member + 1 Family Member
  Panic & Gold Loyalty Plan R190 p/m - Principal Member + 2 Family Members
  Panic & Gold Loyalty Plan R205 p/m - Principal Member + 3 Family Members
  Panic & Gold Loyalty Plan R220 p/m - Principal Member + 4 Family Members
   
  Child 1:
     
  Name
  Surname
  ID Number
  Cell Phone Number
     
  Child 2:
     
  Name
  Surname
  ID Number
  Cell Phone Number
     
  Child 3:
     
  Name
  Surname
  ID Number
  Cell Phone Number
     
  * Preferred Language:
     
  English
  Afrikaans
   
   
 

Click here to read the Terms and Conditions

   
  * I have read and understand the Terms, Conditions & Standard Operating Procedures:
     
  I Agree
     
 
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