psgtp016266_sch_20110920_14_48_12

20/09/2011 (1 / 24)

Administrated by Topexec Management Bureau (Pty) Ltd. (2000/003839/07) FSP4520, an affiliate of PSG Konsult Ltd, on behalf of the insurer.

SHORT TERM INSURANCE POLICY SCHEDULEBROKER DETAILS

Broker PSG Konsult ST TygerbergAgent PSG Client Care Centre

Contact Details Tel: 0860 774 566 Address Details PO Box 68277Fax: 0866 156 172 Highveld ParkEmail: [email protected] 0067

VAT Registration no. 4050194820FSP License no. 728

POLICY DETAILS

Policy Number PSGTP016266 (Old policy number: AGIB94330)

Inception Date 21 March 1989Payment Frequency MonthlyPeriod of Insurance (a) From 01 September 2011 to 30 September 2011 (both dates inclusive)

(b) and any subsequent period for which the Insurer agrees to renew this policy or any section thereof.

Review Date 01 March 2012Insurer Santam Limited

DETAILS OF INSURED

The Insured Mr AH GIBBONS & MRS S GIBBONS ID / Passport no. : 8208295084082

Co Insured None

Occupation Unknown

Contact Details Cell : +2783-725-8791 Postal Address 46 F KLEINBOSCH CRESCENTWork : KLEINBOSCH(PAROW)Home : 7500Fax : Email : [email protected]

TRANSACTION DETAILS

Effective Date 20 September 2011

Date Processed 20 September 2011

Transaction Reason ADJUSTED VEHICLE RETAIL VALUES

The Broker must be informed of any discrepancies within 30 days after print date, after which the broker will not be liable for errors or ommissions.�This Schedule forms part of the Insurer's policy wording and must be read in conjunction with the applicable policy wording and excess structure.

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Administrated by Topexec Management Bureau (Pty) Ltd. (2000/003839/07) FSP4520, an affiliate of PSG Konsult Ltd, on behalf of the insurer.

Insured Mr AH GIBBONS & MRS S GIBBONS

Policy No PSGTP016266Effective Date 20 September 2011Payment Frequency MonthlyCollection Day 1st Day Of Month

Please note that this is only a summary of the elements of the policy. Make sure that this information is correct as it can affectyour cover and premium. For a complete description of the cover and conditions the policy wording should be read.Particular attention should be paid to first amounts payable (excesses) and the restrictions or exceptions.

Sections Cover Sum Insured Pro-Rata Premium Premium

House Contents Yes 380,932.00 128.25Buildings NoAll Risks Yes 25,400.00 70.22Motor Yes 121,370.00 -6.34 629.15Motorcycle NoCaravan & Trailer NoWatercraft NoPersonal Accident Yes 20,000.00 9.28Personal Legal Liability Yes 2,500,000.00 3.25Death Benefit Plan No

Optional CoverExtended Legal Liability (PLIP) NoPSG Assist (Tel: 0860 522 522 ) Yes 29.00EFS Comprehensive Car Hire NoCredit Life Yes 6.25Domestic Employee Compensation Plan Yes 15,000.00 5.00Funeral Benefit Plan NoWindscreen - Excess Buy-back NoTyreSure NoX'S Sure NoX'S Sure - 2010 No

Legal Costs and Expenses Yes 30,000.00 6.00

Sub Total -6.34 886.40Sasria 2.00 9.00

EDS – Electronic Debit Order and System Fee - 10.00Administration Fee - 8.60

Insurer Policy Fee - -Broker Fee - 19.37

Total R -4.34 R 933.37

We have arranged SASRIA cover on your behalf in respect of property insured under this policy unless otherwise stated on the schedule. SASRIA terms and conditions are available on request.

Total commission component included in the premium: R 128.43This schedule becomes a VAT invoice after inception of the cover when payment due has been made. VAT is included at 14%.Santam VAT Number: 4440102095

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EXCESS DEFINITIONSHOUSE CONTENTS

Lightning damageAny occurrence which leads to a claim due to lightening damage

BUILDINGS

Each and every occurrenceAny occurrence which leads to a claim.

VEHICLES

CompulsoryAny occurrence, excluding theft/hi-jacking which leads to a claim. This excess does not apply if an excess for "other" applies

OtherAny occurrence, excluding theft/hi-jacking which leads to a claim due to the driving of the car or light delivery vehicle by a person other than yourself, or your spouse (if you are 55 years or older), under thevehicle in the schedule, and the damage result form driving.

Under 25Any occurrence which leads to a claim due to the driving of the car or light delivery vehicle by a personunder the age of 25 years. Add this excess to the "compulsory" or, if applicable, the "other" excess. Thisexcess does not apply if the excess for license less than 2 years applies.

Theft/Hi-jackingAny occurrence which leads to a claim for theft/hi-jacking. If the stolen/hi-jacked car or light deliveryvehicle is found and delivered to us after we have paid the claim for theft/hi-jacking to you, the excesswhich you have paid, excluding any voluntary excess, will be paid back to you. If the car or lightdelivery vehicle is found before we have paid the claim for theft/hi-jacking to you and there is damageto the car or light delivery vehicle, the "compulsory" excess will be applicable.

WindowAny occurrence which leads to a claim for glass of the windows of the car or light delivery vehicle. Thisexcess is applicable on its own unless an excess for "window glass additional compulsory" is alsoapplicable.

Window glass additional compulsoryAny occurrence which leads to a claim for the glass of the windows of the car or light delivery vehicle. Add this excess to the excess for "window glass".

Drivers license less than 2 yearsAny occurrence which leads to a claim due to the driving of a car or light delivery vehicle by a person who has a driver's license less than 2 years. Add this excess to the "compulsory" excess or, if applicable, to the "other" excess.

Tools and partsAny occurrence which leads to a claim. This excess is applicable on its own.

Loss of keysExcess for loss of keys.

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HOUSE CONTENTS SECTIONInsured : Mr AH GIBBONS & MRS S GIBBONS

Policy No : PSGTP016266Effective Date : 20 September 2011Insurer: Santam Ltd

INSURANCE COVER DETAILS

Risk Address: 46 F Kleinbosch Crescent, Kleinbosch(Parow), Kleinbosch(Parow), 7500 Insured AmountR380,932.00

PremiumR129.62

Construction - Walls Standard `Construction - Roof Standard

Type of Dwelling Main ResidenceApproved alarm system linked to 24 hour control room Yes

Occupancy Private ResidencePremises Occupied During the Day No

No Claim Bonus 7

Optional CoverSubsidence or Landslip (Comprehensive cover) No

First Amounts PayableDamage by wild baboons or wild monkeys R 500Lightning damage R 500Accidental damage - household goods R 500

Additional First Amounts PayableNone

Security Requirements

Linked Alarm

Special Conditions, Clauses & Warranties Applicable 0None

Additional ClausesNone

Additional Notes

OPEN FIELDS, PARKS OR STANDS

It is hereby declared and agreed that :-�If access to the insured residence is gained through any open stand, fields or parks which directly border the insured risk address, an additional excess payment of 10% of the claim, minimum R1000.00 will be applicable.

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HOUSE CONTENTS SECTIONInsured : Mr AH GIBBONS & MRS S GIBBONS


INSURANCE COVER DETAILSSECURITY MEASURES

Unless stated otherwise in the schedule, the following security measures are applicable.-All opening windows, including louver windows, must be fitted with steel burglar bars.-All outside doors, including doors granted entrance/exit to the main residence / residences, excluding solid wooden pivot doors, must be fitted with lockable steel security gates. These steel security gates must be locked when the main residence / residences is left unattended and also at night.

The residence must meet with all the above requirements, or -Must be equipped with an alarm system linked to a twenty-four (24) hour reliable reaction unit / control room.-The alarm system must be installed under contract and maintained by a contractor approved by us.-There must be a radio link between the system and a fully manned control room with 24-hour immediate armed response.-If the residence is left unattended, the alarm system must be fully activated.

SASRIA Cover Included

Your Cover Information (Subject to Policy Terms and Conditions) Insured Amount

Basic coverYour property inside your private residence & outbuildings Contents Insured AmountTheft or attempted theft from your outbuildings 2% of Contents Insured Amount Minimum R5,000Loss or damage to money (excluding theft) R2,500Property not inside private residence, but on the premises 2% of Contents Insured Amount Minimum R5,000Property on the premises where you are employed 2% of Contents Insured Amount Minimum R5,000Theft from any vehicle not left unattended and unlocked R 5,000

Extended Basic coverTemporary increase of the insured amount 10%Debris Removal R5,000Rent Limited to Percentage of Contents Insured Amount 25%Extinguishing charges Reasonable costMirrors and certain glass Replacement costDeath R10,000Veterinary expenses 2% of Contents Insured Amount Minimum R5,000Damage by wild baboons or wild monkeys 2% of Contents Insured Amount Minimum R10,000

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Convenience BenefitsMedical expenses of guests or visitors R5,000Medical expenses of domestic employees R5,000Personal effects of guests 2% of Contents Insured Amount Minimum R5,000Personal effects of domestic employees 2% of Contents Insured Amount Minimum R5,000Contents of refrigerators and freezers 2% of Contents Insured Amount Minimum R5,000Storage costs for contents after damage 2% of Contents Insured Amount Minimum R5,000Trauma treatment R5,000Guards R5,000

IF BED AND BREAKFAST COVER SELECTEDBed and Breakfast Cover- (Only applicable to premises risk where Limited Bed and Breakfast Cover is selected).

Stock in trade If the House Contents insured amount is adequateIncluded Increase in peak period Increase by percentage 10%Theft of personal effects- paying guests per event R10,000Trauma compensation- paying guests per event R10,000External signs, blinds and canopies R2,000Cleaning and dry cleaning of guests property per event R5,000

SPECIAL CLAUSES, WARRANTIES AND ENDORSEMENTS

The following Special Clauses, Warranties and Endorsements apply to the House Contents section of your policy:

261 VALUATION CERTIFICATE FOR ARTICLES WITH VALUE OF MORE THAN R 25 000.

You must give us a valuation certificate (dated before the occurrence) for each of your furs, jewels, jewellery, gemstones, watches, articles of platinum, gold or silver (pairs and sets included) with a value of more than R 25 000.

If we do not receive the certificate after the event that leads to a claim, we shall not pay more than R 25 000 per article.

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ALL RISKS SECTIONInsured : Mr AH GIBBONS & MRS S GIBBONS


INSURANCE COVER DETAILSSum Insured

Item Insured BICYCLES R400.00Premium

R2.91Bank Safe Deposit Box No

First Amount Payable 0None

Applicable Clauses & Warranties 0None


Additional Notes


Sum InsuredItem Insured CLOTHING AND PERSONAL EFFECTS R5,000.00

PremiumR24.80

Bank Safe Deposit Box No




Additional Notes


Sum InsuredItem Insured 1X MUSICAL TRUMPERT R20,000.00

PremiumR44.14

Bank Safe Deposit Box No


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ALL RISKS SECTIONInsured : Mr AH GIBBONS & MRS S GIBBONS





Additional Notes

MUSIC INSTRUMENTS

It is hereby declared and agreed that :-�The standard payment with regard to musical instruments with an insured value exceeding R5 000-00, is amended to 10% of the claim, minimum R500.00.


SPECIAL CLAUSES, WARRANTIES AND ENDORSEMENTSThe following Special Clauses, Warranties and Endorsements apply to the All Risks section of your policy:

261 VALUATION CERTIFICATE FOR ARTICLES WITH VALUE OF MORE THAN R 25 000.

You must give us a valuation certificate (dated before the occurrence) for each of your furs, jewels, jewellery, gemstones, watches, articles of platinum, gold or silver (pairs and sets included) with a value of more than R 25 000.

If we do not receive the certificate after the event that leads to a claim, we shall not pay more than R 25 000 per article.

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MOTOR SECTIONInsured : Mr AH GIBBONS & MRS S GIBBONS



Make and Model OPEL CORSA UTILITY 1.4i P/U S/C Premium R210.70Limit of Indemnity R 36,700.00 Cover Type ComprehensiveYear of Manufacture 2003 Class of use PrivateRegistration Number CY115138 Registered Owner INSUREDVin Number ADMRC80AM3H161220 Regular Driver AH GIBBONS & MRS S GIBBONSEngine Number 2K0006577 Regular Driver Date of Birth 29 August 1982Meadnet code 480|21101|2003|2|2|0|| Claim Free Group 5Risk Address 46 F Kleinbosch Crescent, Kleinbosch(Parow), 7500

Canopy fitted R 5,000.00

Security DetailVehicle parked at night Locked GarageApproved Tracking device NoApproved Immobilizer VSSGear-Lever Lock NoAlarm System YesData Dot No

Optional Cover Applicable Limit of IndemnityCare Assist Breakdown No

First Amounts PayableIf you are not a pensioner (*) / If you are a pensioner (**) (55 years or older)Any occurrence which leads to a claim:(*)Compulsory 5% of claim, minimum R 2,000(*)(**)Loss of keys R 100(*)Repatriation R 2,500(*)Loss of keys (4X4) R 100(*)Loss of keys (Luxury) R 100(*)Other driver 5% of claim, minimum R 2,000(*)Under 25 R 1,000(*)Theft / Hi-Jacking 10% of claim, minimum R 3,000(*)Specified articles R 100(*)Drivers licence less than 2 years R 2,000(*)Excess Waiver No(*)Window 20% of claim, minimum R 350

First Amounts Payable do not apply to Extended Basic cover or Convenience Benefits, unless otherwise stated.Security Requirements

ImmobiliserApplicable Clauses & Warranties 0

NoneAdditional Clauses

None

Additional NotesNone


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Make and Model BMW 318I (E46) Premium R215.08Limit of Indemnity R 49,770.00 Cover Type ComprehensiveYear of Manufacture 2000 Class of use PrivateRegistration Number CA313873 Registered Owner AH GIBBONSVin Number WBAAN92020NB11983 Regular Driver GIBBONS & MRS S GIBBONSEngine Number 02149413 Regular Driver Date of Birth 29 August 1982Meadnet code 050|34050|2000|2|0|0|| Claim Free Group 6Risk Address 46 F Kleinbosch Crescent, Kleinbosch(Parow), 7500

Security DetailVehicle parked at night UnknownApproved Tracking device NoApproved Immobilizer VSSGear-Lever Lock NoAlarm System NoData Dot No

Vehicle Financed Yes Finance Details CASHOptional Cover Applicable Limit of Indemnity

Care Assist Breakdown No


First Amounts Payable do not apply to Extended Basic cover or Convenience Benefits, unless otherwise stated.Security RequirementsApplicable Clauses & Warranties 0


None

Additional Notes

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INSURANCE COVER DETAILSSECURITY

Unless otherwise stated above, the following will apply:

It is hereby declared and agreed that the following minimum security is required:

R0 - R249 999 Vesa3/Vesa4/VSS approved device. -�If the vehicle is fitted with a Vesa3/4 immobiliser, the certificate must be provided to the broker. The normal excess is applicable in case of theft/ hi-jack.-�If the above mentioned vehicle does not comply with the minimum security requirements (Vesa 3/ Vesa 4/VSS or tracking device) or if no installation certificates have been received, the following will apply: The standard excess payment with regard to theft/hijacking is amended to 25% of the claim, minimum R3000

Above R250 000 Approved tracking device.-�In the event of damage following Theft/Hi-jacking, no excess will be applicable if vehicle is fitted with an approved tracking device.-�If the above mentioned vehicle is not fitted with a approved tracking device), there is no cover with regards to theft/hijacking


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Make and Model VOLKSWAGEN CITI CHICO 1.4I Premium R209.37Limit of Indemnity R 34,900.00 Cover Type ComprehensiveYear of Manufacture 2002 Class of use PrivateRegistration Number CY 170519 Registered Owner SIMONE GIBBONS (WIFE)Vin Number AAVZZZ17Z3U005696 Regular Driver Mr PJ GibbonsEngine Number AGY045516 Regular Driver Date of Birth 12 August 1948Meadnet code 640|33050|2002|2|2|0|| Claim Free Group 6Risk Address 46 F Kleinbosch Crescent, Kleinbosch(Parow), 7500

Security DetailVehicle parked at night UnknownApproved Tracking device NoApproved Immobilizer VSSGear-Lever Lock NoAlarm System NoData Dot No

Optional Cover Applicable Limit of IndemnityCare Assist Breakdown No

Driver 1: Name Mr PJ GibbonsDriver 1: Date Of Birth 12 August 1948Driver 1: Gender Male


First Amounts Payable do not apply to Extended Basic cover or Convenience Benefits, unless otherwise stated.Security RequirementsApplicable Clauses & Warranties 0


None

Additional Notes

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INSURANCE COVER DETAILSSECURITY

Unless otherwise stated above, the following will apply:

It is hereby declared and agreed that the following minimum security is required:

R0 - R249 999 Vesa3/Vesa4/VSS approved device. -�If the vehicle is fitted with a Vesa3/4 immobiliser, the certificate must be provided to the broker. The normal excess is applicable in case of theft/ hi-jack.-�If the above mentioned vehicle does not comply with the minimum security requirements (Vesa 3/ Vesa 4/VSS or tracking device) or if no installation certificates have been received, the following will apply: The standard excess payment with regard to theft/hijacking is amended to 25% of the claim, minimum R3000

Above R250 000 Approved tracking device.-�In the event of damage following Theft/Hi-jacking, no excess will be applicable if vehicle is fitted with an approved tracking device.-�If the above mentioned vehicle is not fitted with a approved tracking device), there is no cover with regards to theft/hijacking


Your Cover Information (Subject to Policy Terms and Conditions)

Basic Cover Insured amount The vehicle insured

Indemnity is limited to the insured amount of the vehicle or its reasonable market value whichever is the lesser. Liability to Third Parties R 5,000,000.00 Passenger Liability- person in or on load body of LDV Limited to R 400,000.00

Extended Basic Cover Tow in costs and safeguarding after valid claim Reasonable cost Emergency repairs R 5,000.00 Delivery after repairs Reasonable cost Tow in cost and safeguarding after mechanical breakdown R 1,000.00 Vehicle Transfer Cover for any vehicle you buy Included Difference in excess cover for a rented vehicle- Comprehensive Cover only R 1,500.00 Loss of keys R 2,500.00

Convenience Benefits - Applicable to vehicles insured on a Comprehensive basis only unless otherwise stated Medical expenses for passengers- excluding family per person R 3,000.00 Emergency accommodation per event R 5,000.00

(This benefit does not apply if you claim under Extended Basic Cover- Tow-in cost and safeguarding after mechanical breakdown.) Medical expenses for passengers- family members only per person R 5,000.00

per event R 20,000.00 Emergency Costs R 5,000.00 Recovery Costs Includes vehicles insured on a Limited basis R 5,000.00 Trauma treatment Includes vehicles insured on a Limited basis R 5,000.00

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Extended Basic Cover and Convenience Benefits do not apply to any vehicle insured on a Third Party Only basis.If vehicle is insured on Comprehensive excluding Theft and Hijack basis, no benefits apply if loss is as a result of Theft or Hijack.

Optional Cover Information- Luxury VehiclesIf you have selected the Luxury vehicle option, then the following Limits of Indemnity are increased to the amounts stated below and apply to the vehicle(s) in question:

Extended Basic Cover Emergency repairs R 15,000.00 Tow in cost and safeguarding after mechanical breakdown R 3,500.00 Loss of keys R 15,000.00 Wreckage removal R 1,000.00

Convenience Benefits Emergency accommodation per person R 500.00

per event R 10,000.00In addition, the following benefits apply:

Extinguishing costs R 5,000.00 Head, tail or spot lights Included

Optional Cover Information- 4 X 4 Vehicles If you have selected the 4 x 4 cover option, then the following Limits of Indemnity are increased to the amounts stated below and apply to the vehicle(s) in question:

Extended Basic Cover Emergency repairs R 15,000.00 Tow in cost and safeguarding after mechanical breakdown R 2,500.00 Loss of keys R 10,000.00

Convenience Benefits Emergency accommodation per person R 500.00

per event R 6,000.00 Medical expenses for passengers- family members only per person R 5,000.00

per event R 25,000.00 Trauma treatment R 10,000.00

In addition, the following benefits apply: Winching equipment R 15,000.00 Repatriation costs R 25,000.00 Extinguishing costs R 5,000.00 Personal Documents R 5,000.00 Wreckage removal R 1,000.00 Head, tail or spotlights Included Compensation for car hiremaximum period 30 consecutive days per day R 500.00

SPECIAL CLAUSES, WARRANTIES AND ENDORSEMENTSThe following Special Clauses, Warranties and Endorsements apply to the Motor section of your policy:

20/09/2011 (15 / 24)

PERSONAL LEGAL LIABILITY SECTION

Insured : Mr AH GIBBONS & MRS S GIBBONS



Details of Cover: Basic Cover Limit of IndemnityPersonal Legal Liability R2,500,000.00

PremiumR3.25

Additional Cover Provided

Personal Legal Liabilty to domestic employees R2,500,000.00Property Owners Liability (only applicable if building or its contents are covered by this policy) R2,500,000.00Tenants Liability R2,500,000.00Wrongful arrest R 100,000.00Credit, purchase and SIM cards R 5,000.00Hole in One R 2,000.00Full House R 2,000.00



20/09/2011 (16 / 24)

PERSONAL ACCIDENT SECTIONInsured : Mr AH GIBBONS & MRS S GIBBONS



Name of Insured Occupation Date of Birthmr AH GIBBONS & MRS S GIBBONS Unknown 29 August 1982

Basic CoverBenefit Limit of Compensation Death R10,000.00

PremiumExtended Basic Cover R7.52Benefit Medical Expenses R 5,000.00

Repatriation Costs R 10,000.00 Trauma Treatment R 10,000.00 Mobility Cover R 10,000.00 Life Support Machinery R 10,000.00

Optional Cover Included Temporary Total Disablement Yes R50,000.00 (Must be more than 7 days and not longer than 104 weeks)



Name of Insured Occupation Date of Birthmr AH GIBBONS & MRS S GIBBONS Unknown 29 August 1982

Basic CoverBenefit Limit of Compensation Death R10,000.00

PremiumExtended Basic Cover R1.76Benefit Medical Expenses R 5,000.00

Repatriation Costs R 10,000.00 Trauma Treatment R 10,000.00 Mobility Cover R 10,000.00 Life Support Machinery R 10,000.00

Optional Cover Included Temporary Total Disablement Yes R50,000.00 (Must be more than 7 days and not longer than 104 weeks)



20/09/2011 (17 / 24)

DOMESTIC EMPLOYEE COMPENSATION PLAN SECTIONInsured : Mr AH GIBBONS & MRS S GIBBONS

Policy No : PSGTP016266Effective Date : 20 September 2011Insurer: Risk Solutions International (Pty) Ltd

Cover DetailsDOMESTIC EMPLOYEE COMPENSATION PLAN Premium

R5.00

INSURED PERSON : IDENTITY NUMBER :

Benefits- Domestic WorkerDeathPermanent Disablement Percentage of R0 in accordance with the Table of Permanent DisablementMedical Expenses

In Hospital A day is defined as a 24 hour period encompassing midnight spent in hospital

R0 per day (max.0 days)

Out of HospitalEmergency Medical Transportation

(All reasonable costs of an ambulance to transport injured party to nearest medical facility in the case of emergency following accident).

First Amount Payable

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LEGAL COSTS SECTIONInsured : Mr AH GIBBONS & MRS S GIBBONS



Details of Cover: Limit of IndemnityLegal Costs R30,000.00

First Amount PayableFamily Matters R250.00

Premium R6.00

Applicable Clauses & Warranties

Additional Clauses

Additional Notes

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PSG ASSIST SECTION

Insured : Mr AH GIBBONS & MRS S GIBBONS

Policy No : PSGTP016266Effective Date : 20 September 2011Insurer: CLC (Lifestyle Assist)

INSURANCE COVER DETAILSPremium

Contact PSG Call Centre Tel : 0860 522 522 R29.00

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PremiumR6.25

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FINANCIAL ADVISORY AND INTERMEDIARY SERVICES ACT (NO. 37 OF 2002)Important information that must be read carefully

Client Name: Mr AH GIBBONS & MRS S GIBBONS

Policy Number: PSGTP016266

General Information

The Financial Advisory and Intermediary Services Act (FAIS) requires compliance by Product Suppliers (insurers) and Financial Services

Providers (intermediaries or brokers) with a General Code of Conduct and was introduced to assist you in making informed decisions about the

insurance products that you purchase. It also aims to ensure that your Product Supplier and Financial Services Provider render financial services

honestly, fairly, with due skill, care and diligence and in your interests and the integrity of the financial services industry.

You will receive a Disclosure Notice at the inception of your policy and at each subsequent Renewal or Anniversary date. The Disclosure

Notice relates to details about your Financial Services Provider and Product Supplier, additional general information and details about the

Ombuds and the Registrar. You are entitled to this information and should you experience any difficulties in obtaining required details, please

contact your Financial Services Provider or nearest Product Supplier office for further assistance.

Procedures for registering claims or complaints

Procedures for the submission of claims are detailed in your policy document and are important. If you have difficulties in determining the

correct procedures, please contact your Financial Services Provider or Product Supplier for assistance. Generally, you are required to advise

the Product Supplier within a prescribed number of days of a loss, provide written details of the loss, provide proof in support of a claim, report

theft to the police and provide any other details that may be required by the Product Supplier.

If you are not satisfied with the information that you are provided with upon your request, you may choose to contact your nearest Product

Supplier office, lodge a complaint with the Product Supplier or Financial Services Provider for assistance. Should you remain dissatisfied with

the assistance provided, then you may contact any of the Compliance Officers at the addresses provided on the Disclosure Notice. In addition,

the address of the Registrar of Short-Term Insurance is provided should your complaint still not be satisfactorily resolved.

Name, Class or Type of Policy

Full details about the name, class and type of policy involved are reflected on your policy schedules and are also contained in the policy wording.

Policy schedules should always be read in conjunction with the policy wording. Should you require any explanation about the terms, conditions,

provisions, premiums, excesses (or deductibles) or any other information, please contact your Financial Services Provider or Product Supplier

for assistance as failure to comply with terms, conditions and provisions influence the insurance contract.

Extent and nature of premium obligations

Your policy document reflects the premiums payable, the due date of payment and the frequency of payment (e.g. monthly or annually). When

amendments are made to the policy, an additional or refund premium may become due and such amounts are also reflected on the policy

schedules or endorsements. All premiums are inclusive of Value Added Tax at the prescribed rate.

Some Financial Services Providers are authorised to accept premium payment on behalf of Product Suppliers and should your Financial

Services Provider be authorised to do so, then you may make payment to such Financial Services Provider. Where a Financial Services

Provider is not authorised to receive payment on behalf of the Product Supplier, your payment should be made in favour of the Product Supplier.

Should you not operate through a Financial Services Provider, then your payment should be made directly to your Product Supplier. In the

case of monthly premiums by debit order, payment is usually made to the Product Supplier directly, unless you have authorised such payment

via your Financial Services Provider or other third party, who have authority to collect premium on behalf of the Product Supplier.

Consequences of non-payment of premiums

The due date for the payment is reflected on your policy schedule, renewal notice or premium advice as the case may be. Your payment

should be made on or before the due date reflected to avoid the cancellation of the policy at midnight on the day before the due date.

First Amounts Payable (also known as Excesses or Deductibles)

It is important that you are aware of any amounts that you will be required to pay in the unfortunate event of a claim. Your policy schedules or

wording contain the amounts that you pay as a portion of a claim amount and your Financial Services Provider or Product Supplier can assist

you with any queries you have in this regard.

20/09/2011 (22 / 24)

DISCLOSURE NOTICE TO SHORT-TERM INSURANCE POLICY HOLDERSIMPORTANT – PLEASE READ CAREFULLY – DISCLOSURE AND OTHER LEGAL REQUIREMENTS

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

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

Your insurance broker should provide this information to you within a reasonable time from the time you are provided with a quotation, take out a policy

or amend your policy. If your broker does not do so after you have requested it, please contact the Financial Services Board. This information must

make it clear which entity accepts responsibility for the actions of the broker or representative who has advised you. The broker or representative must

disclose whether his service to you is rendered under supervision of another person.

ABOUT YOUR FINANCIAL SERVICES PROVIDER

(THE BROKER)

a) Name, address, contact details of your broker PSG Konsult ST Tygerberg

Belvedere Office Park, Block D, Bella Rosa street

Rosenpark

BELLVILLE Tel: 021-970 7000

7530 Fax: 021-914 0554 / 086 6

FSP License no. 728

VAT Registration no. 4050194820

b) Interest held by the Broker in the Insurer Your broker has no direct interest in the insurer.

c) Whether professional indemnity insurance is held Your broker is in possession of professional indemnity insurance.

d) Details for claiming against the broker in terms of In the event that you wish to institute a claim against the broker in terms of professional

the professional indemnity insurance indemnity insurance, details of your claim should be delivered in writing to the offices

of the broker.

e) Rand amount of fees, commissions payable Rand amount of commission payable: R 128.43

A monthly or annual fee is payable depending on the term of your policy. This is

disclosed on the Schedule of Insurance.

f) Procedure to institute a claim The procedure for the submission of claims are detailed under GENERAL CONDITIONS

of the policy wording. In the event of a claim or the happening of any event which may

result in a claim, you must notify your broker as soon as possible and within 30 days.

Notify the police within 24 hours of loss or theft of property or accident involving your

vehicle. In the event of a vehicle accident with injuries, the police must be notified

immediately. You will be requested to furnish the following:

(i) Details of other insurance covering the same event

(ii) Written details of the event unless otherwise notified

(iii) Information and proof in support of your claim

(iv) Document or details of any communication in connection with the claim.

No Admission, statement, offer, promise, payment or indemnity shall be made without

the written consent of the insurer.

You must notify your broker immediately if you become aware of any legal process

against you. In the event of a claim you may become responsible for the first amount

payable in respect of such claim. Details of the first amount payable are stipulated in the

policy and the amount is shown in the Schedule of Insurance.

g) How to institute a complaint Your broker is committed to handle all complaints promptly, seeking an outcome that is

fair and equitable. All telephonic complaints must be directed to the broker as per above

details. All written complaints must be directed to the broker as per above details.

Complaints are being registered in a complaints register. The person that has lodged

such complaint will be notified within 48 hours of the outcome of the complaint.

20/09/2011 (23 / 24)

ABOUT THE PRODUCT SUPPLIER (INSURER)

a) Name, address, contact details of Santam Limited

product supplier 1 Sportica Crescent, Tyger Valley, Bellville, 7530

PO Box 3881, Tyger Valley, 7536

Telephone: 021 915 7000 / Fax: 021 914 0700

E-mail: [email protected] / Web: www.santam.co.za

FSP license nummer: 3416 / VAT number: 4440102095

b) Details of the legal compliance department The Compliance Officer, Santam Limited

1 Sportica Crescent, Tyger Valley, Bellville, 7530

PO Box 3881, Tyger Valley, 7536

Telephone: 021 915 7000 / Fax: 021 914 7149

c) Type of policy involved Short Term Personal Lines

d) Premium obligations assumed by you as The amount of premium due and payment frequency is contained in the Schedule of

policyholder Insurance. Please note that your premium is payable in advance and that you will only

be covered for that period in respect of which your premium has already been paid.

It is your duty to check with your bank to ensure that your premium has been deducted

from your account and paid to the insurer or its nominated. If the premium is not received

on due date a double premium will be collected the forthcoming month. If the double

premium is also not received your policy will be considered cancelled from 24h00 on the

last day of the month for which premium was received. You must also inform us

immediately if you change your banking details.

OTHER MATTERS OF IMPORTANCE

• You must be informed of any material changes to the information about the broker and/or insurer.

• If the information about the broker and/or insurer was given orally, it must be confirmed in writing within 30 days.

• If any complaint which has been lodged with the intermediary or the insurer is not resolved to your satisfaction, you may submit a complaint to

the Registrar of Short-term Insurance at:

Financial Services Board

PO Box 35655

Menlo Park

0102

• Polygraph or any lie detector test is not obligatory in the event of a claim and the failure thereof may not be the sole reason for repudiating a claim.

• If premium is paid by debit order:

(i) it may only be in favor of one person and may not be transferred without your approval; and

(ii) the insurer must inform you at least 30 days before the cancellation thereof, in writing, of it's intention to cancel the policy.

• The insurer and not the intermediary must give reasons for repudiating your claim.

• Your insurer may not cancel your policy merely by informing your intermediary. There is an obligation to make sure the notice has been sent

to you.

• You are entitled to a copy of your policy free of charge

WARNING

• Do not sign any blank or partially completed application form.

• Complete all forms in ink.

• Keep all documents handed to you.

• Take notes as to what is said to you.

• Don't be pressurised to buy the product.

• Incorrect or non-disclosure of information may impact on claims arising from your policy.

• Always insist on confirmation of cover to you when taking out new insurance or adding assets to an existing policy.

20/09/2011 (24 / 24)

PARTICULARS OF FAIS OMBUD FAIS Ombudsman

Celestis House, Eastwood Office Park, Lynnwood Road

PO Box 74571, Lynnwood, 0040

Telephone: (012) 470-9080 to (012) 470-9097

Fax: (012) 348-3447

Email: [email protected] / Web Site: www.faisombud.co.za

Complaints number: 0860 324 766

PARTICULARS OF SHORT-TERM OMBUDSMAN Short-Term Insurance Ombudsman

PO Box 32334

Braamfontein

2017

Telephone: (011) 726 8900

Fax: (011) 726 5501

PARTICULARS OF COMPLIANCE OFFICER You can contact our compliance officer if you are unsatisfied with our service or advice.

We will furninsh you with the required details of the compliance officer and will never

withhold such information from you:

Ms Rika Pieterse

PO Box 68277

Highveldpark

0169

Telephone: (012) 679 0580

Fax: (012) 679 0480

E-mail: [email protected]

Should you have requested cover provided by SASRIA LIMITED then you are entitled to details as follows

PARTICULARS OF SASRIA LIMITED SASRIA LIMITED

47 Wierda Road West, Wierda Valley, Sandton, 2196

PO Box 7380, Johannesburg, 2000

Telephone: (011) 881 1300

Fax: (011) 783 0781

Email: [email protected] / Website: www.sasria.co.za

PARTICULARS OF SASRIA LIMITED If you have any complaints about the product supplier/insurer regarding SASRIA cover,

COMPLIANCE OFFICE then you may contact:

Ms Nomsa Wabanie

PO Box 7380

Johannesburg

2000

Telephone: (011) 881 1311

Fax: (011) 783 0781

E-mail: [email protected]

FAIS DISCLOSURE NOTICE TO SHORT-TERM INSURANCE POLICYHOLDERS

The full Disclosure Notice is attached to all New Business and Renewal documents but not to all other transactions.

Should you require a copy of this, please contact your Financial Services Provider or Product Supplier.