Join NZ Firefighters Welfare Society - New Zealand Firefighters Welfare Society

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Contact NZFFWS

Phone: 0800 65 34 73
Email: office@firefighters.org.nz

New Membership Form

"*" indicates required fields

Title (e.g. Mr/Miss/Ms/Mrs)*

Your Name*

Your Date of Birth*

Occupation

Payroll Number

Station*

Home Phone (please include area code)*

Cellphone*

Your Email*

Address*

Street Address Address Line 2 City Post code

Nominated Next of Kin

Name*

Relationship to You*

Address*

Street Address Address Line 2 City Postcode

Contact Number*

Funeral Benefit Payment Instructions

Persons to whom you instruct us to pay the Funeral Assistance Benefit in the event of your death

Funeral Benefit Person 1

Name*

Percentage of Benefit to Receive*

Please enter a number from 0 to 100.

Contact Number*

Contact Email*

Funeral Benefit Person 2

Name

Percentage of Benefit to Receive

Please enter a number from 0 to 100.

Contact Number

Contact Email

Funeral Benefit Person 3

Name

Percentage of Benefit to Receive

Please enter a number from 0 to 100.

Contact Number

Contact Email

How did you hear about us?*

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