e-FML Alteration Form Please enable JavaScript in your browser to complete this form. – Step 1 of 2Policy Number or Card Reference NumberFirst Name *Surname *Address Email *Mobile NumberNational I.D Number *Date Of Birth Alteration TypeUpgrade or add dependents on my existing e – FMLConvert and upgrade my group funeral cash plan to e – FMLNew Sum Assured/ Cover (For all lives covered)Grocery Rider Tombstone Rider NextDependants 1Dependents 2Dependents 3Dependents 4Dependents 5Total Contract PremiumPayment OptionEcocash: Biller Code 17123 e.g *151*2*1*17123*amount#One money: Biller Code 22085Telecash select option to pay insuranceTransfer – Standard Chartered Bank Account NO. 0100203178680Stop orders (Please get in touch with FML on email FMLILB@firstmutual.co.zwPayment Reference NumberSignature of Main Life Assured or Premium Payer (name and surname)MessageSubmit