Terms and Conditions

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NOTICE TO LONG-TERM INSURANCE POLICYHOLDERS

IMPORTANT - PLEASE READ CAREFULLY

DISCLOSURE AND OTHER LEGAL REQUIREMENTS

(This notice does not form part of the Insurance Contract or any other document)

As a long-term insurance policy holder, or prospective policyholder, you have the right to the following information:

LEGAL STATUS OF PROVIDERS

Guardrisk Life Limited (1999/013922/06), hereinafter referred to as “Guardrisk Life”, is a public company established in 1999 and registered as the long-term insurer in terms of the Long-Term Insurance Act. As an authorised Financial Services Provider in terms of the Financial Advisory and Intermediary Services Act, Guardrisk accepts responsibility for the activities of its representatives performed within the scope of, or in the course of, their duties as mandated by Guardrisk in the rendering of financial services as defined by FAIS. Our representatives meet the fit and proper requirements as prescribed by FAIS, to assist you in a professional manner with your financial requirements.

YOUR FINANCIAL SERVICES PROVIDER

Smartcall Insurance Administrators Pty (Ltd), FSP Licence no. 32590, hereinafter referred to as “SIA”, has been licensed by the Financial Services Board in terms of the FAIS Act, to render advice and intermediary services in respect of Long-Term Category A. A copy of our FSP licence and the conditions of the licence are available on request.

LEGAL STATUS OF REPRESENTATIVES

SIA confirms that it representatives are mandated and entitled to render financial advice and/or intermediary services to you in terms of the FAIS Act. As full time representatives of SIA, representatives receive more than 30% of their remuneration from Smartcall. SIA does not hold professional indemnity and fidelity insurance

YOUR RIGHT WHEN BEING ADVISED TO REPLACE AN EXISTING POLICY

You may not be advised to cancel a policy to enable you to purchase a new policy or amend an existing policy, unless:

a) The intermediary identifies the policy as a replacement policy.

b) The implications of cancellation of the policy are disclosed to you such as:

* The influence of your benefits under the old policy.

* The additional costs incurred with the replacement.

c) The insurer which issued the original policy will contact you, you are advised to discuss the matter with its representative.

YOUR RIGHT TO CANCEL THE TRANSACTION

In most cases, you have the right to cancel a policy in writing within 30 days after receipt of the summary from the insurer as contemplated in section 48 of the Long-Term Insurance Act. The same applies to certain changes you may make to the policy. The insurer is obliged to confirm to you whether you have this right and to explain how to exercise it. Please bear in mind that you may not exercise if you have already claimed under the policy or if the event, which the policy insures you against, has already happened. If the policy has an investment component, you will carry any investment loss.

IMPORTANT WARNING

Please read the contract terms of your policy carefully, and should you have any query please contact our call centre on 082 241 4949 or 011 507 4779.

It is very important that you are quite sure that the product or transaction meets your needs and that you feel you have all the information you need before making a decision. It is recommended that you discuss with the intermediary or insurer the possible impact of the proposed transaction on your finances, your other policies or your broader investment portfolio. You should also ask for information about the flexibility of any proposed policy.

Where paper forms are required, it is advisable to sign them only once they are fully completed. Feel free to make notes regarding verbal information, and to ask for written confirmation or copies of documents.

Remember that you may contact either the Long-Term Insurance Ombudsman or the Registrar of Long-Term Insurance, whose details are set out below, if you have any concerns regarding a product sold to you or advice given to you.

DETAILS OF COMPLIANCE, COMPLAINT and FAIS OMBUD

a) The life insured has the right to write to the insurer’s COMPLIANCE OFFICER should they encounter any problem with regards to the policy issued.

b) The complaint may include any dissatisfaction the life insured experienced in dealings with the intermediary with regards to this policy.

c) Contact Details of Insurer:

         Name: Guardrisk Life Limited (1999/013922/06)

         Postal Address: P.O. Box 786015, Sandton, 2146

         E-mail Address: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

         Fax: +27 11 669 1931

         Tel: +27 11 669 1000

 d) Should a complaint not be resolved to your satisfaction, you may forward such complaint to the Office of the Ombud for Financial Service Providers:

Name: FAIS Ombud (www.faisombud.co.za)

Postal Address: P.O.Box 74571, Lynnwood Ridge, 0040

E-mail Address: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Fax: +27 12 348 3447

Toll free: 0860 324 766

Please note that if you wish to lodge a complaint with the FAIS Ombud against SIA or our representative, you will need to show that you have already attempted to resolve the matter directly with SIA.

COMPLIANCE OFFICER DETAILS

Name: National Compliance Company (Pty) Ltd Practice Number 1307

Address: 3 Brabham House, Garlicke Crescent Crowthorne Corner, Ballito

Tel:  032 946 2921 / 2949

Fax:  032 946 2225

REPUDIATION OF CLAIMS PROCEDURE

a) The life insured/beneficiary will be notified, in writing, as to the reasons for the repudiation.

b) The life insured/beneficiary has the right to approach Guardrisk life directly at the “insurer’s” address, in writing, should they wish to make further representations. The dispute must reach Guardrisk life within 90 days of the date of the repudiation letter per point a) above.

OTHER MATTERS OF IMPORTANCE

a) Keep all documents handed to you.

b) In the event that there is a potential conflict of interest in any financial advice offered, Guardrisk Life shall at all times place the interest of its clients before its own

POLICY WORDING

GENERAL CONDITIONS

Reference throughout this document to the masculine shall include the feminine and the singular shall include the plural where appropriate and vice versa.

1. DEFINITIONS

2. ELIGIBILITY

2.1 The Principal Insured, in respect of whom benefits are to be insured under this policy, shall be a person who at the Commencement Date is at least eighteen years of age but not yet seventy six years of age.

2.2 There may only be one Spouse insured under this policy at any point in time (if applicable Family Policy is opted for).

2.3 Where Extended Family Members are included in this policy, the number of lives for this group is limited to a maximum of: 2.3.1 For parents and parents-in-law, a total of four Insureds; 2.3.2 For any other extended family as per the definition (of either the Principal Insured or the Spouse), a total of four Insureds.

2.4 Only the lives stated on the Application Form are insured under this Policy. These lives may be changed subject to clauses 3 and 4 below. 2.5 No individual may be covered, in any capacity, by more than 2 policies held with SIA at one time.

3. CHANGES TO INSUREDS

3.1 The Principal Insured may add a Spouse, Child and/or an Extended Family Member under the following conditions:

3.1.1 A Spouse may be added within 6 months of marriage or within 6 months of the Principal Insured’s first premium being processed on the SIA system. The Spouse added will replace the insurance cover for the Spouse, if any, named on the Application Form. Waiting periods as per paragraph 9 will apply;

3.1.2 Children may be added within 6 months after birth, legal adoption, legal fostering or, in the case of stepchildren, marriage or within 6 months of the Principal Insured’s first premium being processed on the SIA system. Natural children may be added at any stage of the policy Waiting periods as per paragraph 9 will apply;

3.1.3 An Extended Family Member of the new spouse may be added at the same time as the new Spouse per 3.1.1 above but limited to the natural relations as mentioned in the extended family definition above, or within 6 months of the Principal Insured’s first premium being processed on the SIA system. Any additional Extended Family Member is subject to the maximum stated in clauses 2.3 and 2.4 above. Waiting periods as per paragraph 10 will apply;

3.1.4 The Insurer reserves the right to accept or decline any new Insured. In the case of 3.1.1, 3.1.2 and 3.1.3, the Insurer reserves the right to request evidence of such changes.

3.2 Any additions or changes to the insureds will be subject to the full waiting periods as per paragraph 9 below.

3.3 Apart from clause 4 below, the Principal Insured may request the Insurer to remove an Insured subject to one month’s written notice.

4. CESSATION OF BENEFITS

4.1 The Policy shall terminate on the earliest of:

4.1.1 The death of the Principal Insured except in the following instances:

a) If the policy is a Family Policy and there is a surviving Spouse on the policy, the surviving Spouse will automatically be converted to the new Principal Insured. From this point, if further monthly premiums are received after the death of the Principal Insured, then the policy will continue, if no further premiums are received within a period of 2 months of the previously paid premium, the policy will lapse.

b) If there is no surviving Spouse or the policy is an Individual policy and the Principal Insured dies, the policy shall terminate, and the remaining members on the policy, including children and extended family members will no longer be covered.

4.1.2 The written request for cancellation by the Principal Insured giving thirty days notice from the date of the request;

4.1.3 The lapse of the Policy in terms of clause 7.2.4 below.

4.2 Apart from 4.1 above, insurance cover for Insureds other than the Principal Insured shall cease for:

4.2.1 The Spouse – upon the divorce or the permanent separation of the Spouse from the Principal Insured;

4.2.2 The Child - natural or legally adopted by the Spouse in the event of clause 4.2.1 arising;

4.2.3 The Extended Family Member – the natural grandparents, natural parents, natural aunts, natural uncle’s, natural cousins, natural brother and natural sister of the Spouse in the event of clause 4.2.1 arising.

4.3 This policy is only valid if it is accompanied by a fully completed application form and premiums are fully paid up to date.

5. CONVERSION OF BENEFITS

Upon the Child no longer meeting the criteria of being a Child as defined in terms of this Policy, the Child will automatically be converted to an extended family member on the same policy with the highest cover. The Principal Insured may then cancel the extended family member and the Child may apply for his/her own policy if they wish, or the Principal Insured may change the cover value, if the conversion is not acceptable to either party. For the Child to remain on the Family Policy due to the Child being a full time student (as per the definition of a Child above), a request in writing containing proof from the students registered educational institution, must be received and accepted by SIA. No additional waiting periods will be applicable upon conversion.

6. PROOF OF AGE

Should a certificate of birth not be available in respect of an Insured, the Insurer may accept such other evidence of age as at its sole discretion, it considers satisfactory.

7. PREMIUMS

7.1 Amount of Premiums The amount of premiums payable to secure the benefits under this Policy is stated in the Schedule corresponding with the option selected on the Application Form. The Insurer reserves the right to review the premium rate annually. Any amendment to the premium will be advised to the Principal Insured, in writing, giving ninety days notice to this effect.

7.2 Payment of Premiums

7.2.1 The premiums required to secure an Insured’s benefit shall be payable from the Commencement Date.

7.2.2 All premiums and benefits due to or payable by the Insurer shall be paid in the lawful currency of the Republic of South Africa.

7.2.3 No latitude, extension of time or other indulgence which may be given or allowed, whether by agreement or inadvertently by the Insurer to the Principal Insured in respect of the performance of any obligation in terms of this contract, shall under any circumstances be construed to be implied consent or operate as a waiver or a novation of, or otherwise affect any of the rights of the Insurer or stop the Insurer from enforcing, at any time and without notice, strict and punctual compliance with each and every obligation of the Principal Insured.

7.2.4 All premiums are payable monthly in advance. The period of grace allowed for payment of the premiums is one calendar month commencing on the first day of the month in which the premium is due. If the premiums are not paid within the period of grace, the policy will lapse. If a policy has, more than three times, fallen into the grace period, and then subsequently moved out of grace and back into an active policy due to a premium being paid, without the policy lapsing during that period, the policy may be cancelled by SIA.

7.2.5 If premiums, in whole or in part, are in arrears, then no claim shall be payable. For this purpose payment by the Principal Insured to an intermediary, but not to the Insurer, shall not suffice to validate any claim.

8. REINSTATEMENT OF LAPSED BENEFITS

8.1 Where the Policy has lapsed, and within 2 months of the policy lapsing, if a further premium is paid by the Principal Insured, the policy will be reinstated subject to point 8.3 below. After a period of 2 months of the policy lapsing, the policy will be cancelled, and the Principal Insured will need to re apply for a new policy. The Insurer reserves the right to either accept or decline reinstatement of the Principal Insured or any other Insured previously admitted for insurance benefits.

8.2 Reinstatements will at all times be subject to such further conditions as the Insurer may determine at that time. 8.3 Any waiting period mentioned under clause 10 below shall be reapplied with effect from the reinstatement date at the discretion of SIA.

9. CLAIM PROCEDURE FOR PAYMENT OF DEATH BENEFIT

In consideration of the payment of the premiums and subject to the conditions of the policy, the Insurer agrees that it shall pay the benefit per clause 10 below upon receipt at its head office of:

9.1 The signed original policy document/application;

9.2 The original death certificate or a certified copy thereof;

9.3 The original identity document or certified copy thereof of the deceased;

9.4 The original identity document or certified copy thereof of the claimant (if not a company);

9.5 A copy of the form BI 1663;

9.6 If a stillborn child, a letter from the doctor confirming the length of pregnancy;

9.7 Every accidental death claim will require a police report;

9.8 In the case of a Spouse, marriage certificate or an affidavit satisfactory to Insurer;

9.9 In the case of a legitimate biological child, a certified copy of the Principal Insured’s or Spouses Identity Document and marriage certificate and Child’s birth certificate;

9.10 In the case of a stepchild, a certified copy of the relevant marriage certificate and the Child’s birth certificate;

9.11 In the case of an illegitimate or adopted Child, a copy of the adoption certificate, and affidavit or any other documentary proof satisfactory to the Insurer;

9.12 All copies shall be certified by a Commissioner of Oaths and originally certified copies to be sent to the Insurer;

9.13 Any documentation required by the Insurer as proof of the deceased’s relationship to the Principal Insured;

9.14 Where the deceased is a Child over age 21 and was incapacitated by mental or physical infirmity from maintaining him/herself, a declaration signed by a Medical Practitioner setting out the nature of the infirmity of the Child from his 21st birthday until date of death;

9.15 In the case of the Principal Insured using a passport or refugee number instead of a South African ID number on the system, the claim will only be processed if the identical Passport or Refugee number appears on the certified death certificate of the deceased, and a Residence permit for the main member will be requested.

9.16 Any other evidence the Insurer may require.

Please refer to SIA's Claim Call Centre details on the front page for contact information upon claim.

10. WAITING PERIODS FOR BENEFITS

The benefits provided under this policy shall commence as follows:

10.1 Accidental Death: Upon accidental death of the Insured, benefits will be payable from the Commencement date of the policy, with no waiting period applicable. This shall be defined as an unforeseen event, which could not reasonable have been expected to occur. The event must result in death caused directly and independently of all other causes by some external and visible means arising from this event, and excludes death by natural causes.

10.2 Other Causes: For all Extended Family Policy members, as well as any members, who upon joining, as a main member, or as an extended family member, or as a spouse on a Family plan, are over the age of 65, the following will be applicable:

On the death of the life Insured within six months of either the commencement date stated in the schedule, or the reinstatement date in the event of a policy lapsing due to the non-payment of premiums, no benefit will be paid.

For all remaining Core Policies, being all Individual and Family policies (except as mentioned above) as well as members on the 66-75 years old policies who are under the age of 65, the following will be applicable: On the death of the life Insured within three months of either the commencement date stated in the schedule, or the reinstatement date in the event of a policy lapsing due to the non-payment of premiums, no benefit will be paid.

 All Core Policies with a cover value of R 15 000 or R 18 000 (Individual and Family policies), which have a Commencement date, or are re-activated, or an upgrade in cover value takes place, on or after the 1st November 2009 the following will be applicable:
On the death of the life Insured within six months of either the commencement date stated in the schedule, or the reinstatement date in the event of a policy lapsing due to the non-payment of premiums, no benefit will be paid.

11. PAYMENT OF BENEFITS

11.1 On the death of the Principal Insured:

11.1.1 The amount of the benefit is that per the Schedule corresponding with the amount for the “Principal Member”;

11.1.2 The beneficiary nominated must notify the Insurer or their appointed administrator as contemplated in clause 15 below, within six months of the occurrence of any claim, otherwise no claim will be admitted;

11.1.3 Payment of the benefit shall be made to the beneficiary nominated and the receipt of the benefit by the beneficiary shall be a good and sufficient discharge to the Insurer.

11.2 On the death of any other Insured:

11.2.1 The amount of the benefit is that per the Schedule corresponding with the amount for the deceased Insured and option selected per the Application Form;

11.2.2 The Principal Insured must notify the Insurer or their appointed administrator as contemplated in clause 14 below, within six months of the occurrence of any claim, otherwise no claim will be admitted;

11.2.3 Payment of the benefit shall be made to the Principal Insured and the receipt of a benefit by the Principal Insured shall be a good and sufficient discharge to the Insurer.

12. THE CORRECTNESS OF STATEMENTS MADE TO THE INSURER

12.1 The Insurer relies on the truth, completeness and correctness of all statements submitted. If the benefits granted have been obtained through any misrepresentation or concealment, the policy shall be void and monies paid in respect thereof shall be forfeited. This shall apply to the original application, as well as to any reinstatements. 12.2 Should any benefits have been paid out on the basis of the information provided by the Principal Insured to the Insurer, and such information subsequently proves to be incorrect in any material respect, the Insurer shall have the right to take such steps as may be required to put it in the position it would have been in if the correct information had been provided in the first instance.

13. ALTERATION OF THE POLICY

Any alteration to any of the conditions, definitions, benefits, and privileges of this Policy by either the Insurer or the Principal Insured, must be given to/by the Insurer to/by the Principal Insured, in writing, with one calendar month's notice of any such alteration.

14. ADMINISTRATORS

The Insurer shall appoint Administrators of the policy. The Administrators shall collect premiums, attend to inquiries and pay claims on behalf of the Insurer.

15. INTERPRETATION

15.1 The decision of the Insurer as to the meaning of or interpretation of the Policy shall be final and binding on the Principal Insureds and every person claiming to be entitled to a benefit in terms of this Policy.

15.2 If any person affected by a decision of the Insurer in terms of clause 15.1 above is dissatisfied with the decision, such person shall have the right to refer the matter to arbitration in accordance with the provisions of the Arbitration Act, 1965. Notice of intention to exercise this right shall be given by the person concerned to the Insurer within ninety days of the Insurer’s decision. Before the arbitration commences, the person concerned shall furnish such security for the costs of arbitration as the Insurer may reasonably require. The costs of the arbitration shall follow the award of the Arbitrator.

15.3 Should any difference arise between the Insurer and the Principal Insured, or any other claimant, as to a claim under this Policy, the same shall be referred to arbitration in accordance with the statutory provisions in force at the time, and the obtaining of any award shall be a condition precedent to any right of action against the Insurer.

16. FRAUD

This Policy shall be void as from the Commencement Date if:

16.1 Any claim under this Policy is in any respect fraudulent; or

16.2 Any fraudulent means or devices are used or employed by the Principal Insured or anyone acting on the Principal Insured’s behalf, to obtain any benefit under this Policy; or

16.3 Any event is occasioned by the wilful act of, or with the Principal Insured’s connivance.

17. EXCLUSIONS

No claim will be admitted in terms of this Policy if the event giving rise to the claim is caused directly or indirectly by or is in any way attributable to any of the following:

17.1 If the cause of death was suicide within the first two years from the Commencement Date, or reinstatement date, or the date any Insured was added after the Commencement Date;

17.2 The Insured committing any act or deed in violation of criminal law;

17.3 Active participation in any riot, insurrection, civil commotion, war (declared or not), terrorism, hostility, civil war, rebellion, revolution, usurpation of power, martial law, kidnapping, hijacking or military action;

17.4 Atomic energy, nuclear fission or reaction, or the release of chemical weapons;

17.5 Intentional self-inflicted injury;

17.6 Any material misrepresentation or non-disclosure;

17.7 If the life insured or anyone acting on his behalf wilfully connives to obtain a claim by fraudulent means or devices, all benefits under this policy in respect of that claim will be forfeited;

17.8 Participation in speed tests or races, hand-gliding, bungee-jumping, parachute jumping, mountaineering (without ropes), or any other activity Guardrisk Life regards as an excessive exposure to risk;

17.9 Participation or attempted participation in aviation in any capacity other than as a passenger in a passenger aircraft. This aircraft must have a valid certificate of airworthiness and must be piloted by a duly licensed pilot (and navigator where required by law).

18. FEE DISCLOSURES

* - This fee is quoted per R 1 000 in cover value, which differs depending on the age of the child. The maximum payout for a child as defined would be R 12 000.

19. SURRENDER VALUE

This Policy has no surrender value.

20. ASSIGNMENT OF POLICY

The Principal Insured may not cede, pledge or otherwise alienate the benefits or the rights to benefits in terms of this Policy and such benefits shall not be subject to any form of execution or judgment and shall not, on insolvency, or on surrender form part of the estate of any Insured.

21. LAW

This Policy shall be subject to the laws of the Republic of South Africa.