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2011- STATUTORY NOTICE TO SHORT TERM INSURANCE POLICY HOLDERSName of the Client
IMPORTANT – PLEASE READ CAREFULLYDISCLOSURE AND OTHER LEGAL REQUIREMENTS
(This Notice does not form part of the Insurance Contract nor any other document)As a short-term insurance policyholder, or prospective policyholder, you have the right to the following information:
1. YOUR INTERMEDIARY (BROKER THAT IS SELLING YOU THE PRODUCT)
iCompany name: Alexander Forbes Health (Pty) Ltd (“AFH”), Registration Number 2007/015447/07Physical Address: Alexander Forbes Place, 61 Katherine Street, Sandown Postal Address: PO Box 61703, Marshalltown, 2107Telephone Number: +27-11-269-0000 Facsimile Number: +27-11-263 1111
ii Legal status of the intermediary and interest in the Insurer(s):(a) AFH and Guardrisk Insurance Company Limited are subsidiaries of Alexander Forbes SA Holdings (Pty) Ltd(b) AFH is an intermediary of Guardrisk Insurance Company Limited(c) AFH does not receive more than 30% of its total commission and remuneration from Guardrisk Insurance Company Limited
iii AFH has Professional Indemnity Insurance Cover in forceiv AFH is in possession of the required written agreement to act as an intermediary of Guardrisk Insurance Company Limitedv Statutory commission is paid by Guardrisk Insurance Company Limited to AFHvi Financial Advisory and Intermediary Services (FAIS) Registration Number is 33471
vii Without in any way limiting and subject to the other provisions of the Services Agreement/Mandate, AFH accepts responsibility for the lawful actions of their Representatives (as defined in the Financial Advisory and Intermediary Services Act) in rendering financial services within the course and scope of their employment.
viii Claims Procedure: Completed claims forms and all required documents to be submitted to Guardrisk Insurance Company Limited, PO Box 786015, Sandton, 2146
ix Complaints Procedure: Complaints relating to any advice given to you by your broker may be notified in writing to: Customer Care Alexander Forbes Financial Services, PO Box 787240, Sandton, 2146
x Compliance Officer: Margaret Van Den Berg Tel.+27-11-269 1727, Fax +27-11 263 1731, e-mail : [email protected] Policy Wording: A copy of the policy wording can be obtained from Guardrisk Insurance Limited or from the insurer, Guardrisk Insurance Company Limited.
2. YOUR INSURER (REGISTERED SHORT TERM INSURER UNDERWRITING THE ADMED PRODUCT)
a. ABOUT THE INSURER(INSURER’S CONTACT DETAILS)
Name: Guardrisk Insurance Company Limited, Registration Number 1992/001639/06Physical Address: 4th Floor 90 Rivonia Road, Sandton Postal Address: PO Box 786015, Sandton, 2146Telephone Number: +27-11-669-1000 Facsimile Number: +27-11-669-1931/2FAIS Registration: Guardrisk Insurance Company is an Authorised Financial Services Provider in terms of FAIS. FAIS registration number is 26/10/75Compliance Officer: The Compliance Manager, Nicky Maseko Tel: +27-11-669-1039, Fax: +27-11-669-2792, e-mail : [email protected] of Policy Health and Accident
b. CONTACT DETAILS FOR ADMINISTRATION QUERIES(FOR ALL ADMINISTRATIVE QUERIES INCLUDING PREMIUM AND CLAIMS QUERIES)
Administrators Guardrisk Allied Products and Services (Pty) Ltd, Registration Number 2007/016202/07Telephone Number: 0860 102 936Facsimile Number +27-11-263-2793E-mail Address e-mail: [email protected]
c. PREMIUMS(DETAILS OF THE PREMIUMS PAYABLE)
Product: TOTAL PAYABLE : Net Premium : Commission : Administration Fee :
AdmedGap R0.00 per family per month (VAT Inclusive).
R0.00 per family per month (VAT Inclusive).
R0.00 per family per month paid to AFH R0.00 per family per month (VAT Inclusive) (included in the monthly premium) paid to Guardrisk
Due Date of Payment: The premium is payable monthly and is due on the 1st first day of each calendar month (Due Date)Consequence of Non-Payment: If the premium is not received by the 7th of the following calendar month then the policy shall be deemed to have been cancelled
by midnight of the Due Date.Method of Payment: Premiums may be paid by debit order, EFT or by cheque on or before the Due Date.
4. OTHER MATTERS OF IMPORTANCEi You will be informed of any material changes to the information about the intermediary and or insurer provided above.ii If any of the information reflected above was given to you orally, this disclosure notice serves to provide you with the information in writing. Should you not be satisfied with the policy, you
are entitled a period up to 30 days within which you may cancel your policy in writing at no cost. Cover will cease upon cancellation of the policy.iii If we fail to resolve your complaint satisfactorily, you may submit your complaint to the Registrar of Short-Term Insurance.iv You will always be given a reason for the repudiation of your claim.v If the insurer wishes to cancel your policy, this will be done in writing, to your last known address.vi You will always be entitled to a copy of your policy at no extra charge.
5. WARNINGi Do not sign any blank or partially completed application form.ii Complete all forms in ink.iii Keep notes of what is said to you and all documents handed to you.iv Don’t be pressurised to buy the product.v If you fail to disclose facts relevant to your insurance, this may influence the assessment of a claim by the insurer.
6. PARTICULARS OF THE SHORT-TERM INSURANCE OMBUDSMAN 7. PARTICULARS OF THE OMBUDSMAN FOR FINANCIAL SERVICES PROVIDERS
Postal Address: PO Box 32334 Postal Address: PO Box 74571Braamfontein, 2017 Lynwood Ridge, 0040
Telephone Number: +27-11-726-8900 Telephone Number: +27-12-470-9080Facsimile Number: +27-11-726-5501 Facsimile Number: +27-12-348-3447The Ombudsman is available to advise you in the event of claims problems which are not satisfactorily resolved by the Intermediary and Insurer.
If any complaint to the Intermediary or Insurer is not resolved to your satisfaction, you may submit the complaint to the Register of Short-Term Insurance.
