Thank you for your interest in joining the Dis-Chem Benefit Programme. Please complete the form to apply and collect your card in-store. Alternatively register an online account and apply for a digital card.

Personal Details

Contact Details

Are you currently pregnant?

Details of Dependants Under 36 Months

Dependant #1

Dependant #2

Dependant #3


Feel free to reach out to our friendly Customer Care team:

Monday - Friday: 08:00am to 16:30pm

Saturday, Sunday and Public Holidays: Closed

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