Certificate of Insurance

Transcription

1 Suite 14, Grantham Office Park Somerset Park, Umhlanga Rocks, 4320 P.O. Box 250, Umhlanga Rocks, 4320 Tel: +27 ( ), Fax: +27 (0) Certificate of Insurance Policy Status: Product: Renewal Pax Effective Date: 1 Nov 2014 Customer No: Contact: The Insured: Nicholas Chirenje Professional Passenger Services (Pty) Ltd Postal Address Territorial limits : C/o Insurance Zone Administration Services P O Box 2756 BEDFORDVIEW, JOHANNESBURG 2008 Republic of South Africa, Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Kenya, Tanzania, Uganda, Zambia, Zimbabwe, Seychelles and journeys to and from Angola and Zaire Business Type: Business description: Shuttle Service Airport Transfers Period of Insurance: (a) From: 1 Nov 2014 To: 31 Oct 2015 (b) and each consecutive calendar month thereafter for which a premium is accepted by the company. Renewal Date: 1 Nov 2015 Policy inception date: 1 Sep 2004 Broker Office: Insurer Details: Safari & Tourism Insurance Brokers (Pty) Ltd. Lloyd's of London Percentage 100% Signed At: Durban - Safari & Tourism Insurance Brokers (Pty) Ltd. Safari & Tourism Insurance Brokers (Pty) Ltd. Underwritten by certain underwriters at Lloyd's under agreement number : B0750RNMGC /09/2014 Page 1

2 Lloyd s Insurance This Insurance is effected with certain Underwriters at Lloyd s, London. This Certificate is issued in accordance with the authorisation granted to the Coverholder by certain Underwriters at Lloyd s (hereinafter called Underwriters), whose syndicate numbers and the proportions underwritten by them can be ascertained from the offices of said Coverholder and in consideration of the premium specified herein, Underwriters do hereby bind themselves, severally and not jointly, each for his own part and not one for another, their Executors and Administrators. The Coverholder referred to herein is Safari & Tourism Insurance Brokers (Pty) Limited The Assured is requested to read this Certificate, and if not correct, return it immediately to the Coverholder for appropriate alteration. In the event of a claim under this Certificate, please notify the Coverholder who is acting as the agent of Underwriters. CERTIFICATE PROVISIONS 1) Service of Suit. In the event of any litigation arising out of insurance assumed hereunder, Lloyd s General Representative in South Africa, The Forum, 2 Maude Street, 7th Floor, Sandton, 2196, South Africa,Boulevard, Johannesburg 2196, South Africa, is required, in terms of the Short-Term Insurance Act No 53 of 1998, to accept service of suit against Underwriters. 2) Assignment. This Certificate shall not be assigned either in whole or in part without the written consent of the Coverholder endorsed hereon. 3) Complaints. If you have any complaints concerning your insurance, please contact the Coverholder. 4) Attached Conditions Incorporated. This Certificate is issued and accepted subject to all the provisions,conditions and warranties set forth herein,attached or endorsed, all of which are to be considered incorporated herein. It is understood and agreed that wherever the words Insured/Company appear herein the same shall be deemed to read Assured/Underwriters respectively. This Insurance shall be governed by the laws of the Republic of South Africa, whose courts shall have jurisdiction in any dispute arising hereunder. Effected through Safari & Tourism Insurance Brokers (Pty) Limited P.O. Box 250, Umhlanga Rocks, Durban, South Africa 4320 This is to certfiy that in accordance with the authorisation granted under the Contract (the number of which is specified in the schedule) to the undersigned by certain Underwriters at Lloyd's, whose definitive numbers and the proportions underwritten by them, which will be supplied on application, can be ascertained by reference to the said Contract which bears the Seal of Lloyd's Certificate Signing Officer and in consideration of the payment of the premium specified herein, the said Underwriters are hereby bound, several and not jointly, their Executors and Administrators, to insure in accordance with the terms and conditions contained herein or endorsed hereon. If the Assured shall make any claim knowing the same to be false or fraudulent, as regards amount or otherwise, this Certificate shall become void and all claim hereunder shall be forfeited. In witness whereof this Certificate has been signed at the place stated and on the date specified in the Schedule. 17/09/2014 Page 2

3 Intermediary Disclosure Document Legislation regarding disclosures by intermediaries and insurers, in the form of the Policyholder Protection Rules, came into effect as from 1 July As your independent intermediary, we at Safari and Tourism Insurance Brokers believe in protecting the rights of our policyholders and we therefore comply with the Rules. The Rules require certain disclosures, which must be made when an intermediary or insurer enters into a policy agreement with a client. These disclosures enable a policyholder to make informed decisions regarding short term insurance products and ensure that all parties involved conduct business fairly. As a short-term insurance policyholder, or prospective policyholder, you have the right to the following information: STATUTORY NOTICE TO SHORT TERM INSURANCE POLICYHOLDERS ABOUT THE INTERMEDIARY 1. Name, physical address and postal address and telephone number. Safari and Tourism Insurance Brokers (Pty) Ltd, FSP LICENCE Registration number 1996/017839/07 (SATIB) Grantham Office Park, Keynsham Road, Somerset Park, Umhlanga Rocks Box 250, Umhlanga Rocks, 4320 Telephone No , Facsimile No. (031) /0429, 2. Legal status and any interest in the Insurer: SATIB is an independent company. We have no interest in the Insurer. 3. Whether or not in possession of professional indemnity insurance: SATIB has professional indemnity insurance. 4. Whether or not in possession of professional indemnity insurance. Procedures for the submissions of claims are detailed in the policy wording document in the section headed GENERAL CONDITIONS or CONDITIONS. In the event of a possible claim you must notify an office of SATIB immediately and within the number of days stated in the policy wording. You must notify the police within 24 hours of theft of property or any accident involving your vehicle. In the case of any vehicle accident where there are injuries, you must notify the police immediately. You will be required to supply the following:- i) Details of other insurance covering the same property and event ii) Written details of the event unless otherwise instructed iii) Information and proof in support of the iv) Documents or details of any communication in connection with the claim You must make no admission or statement of liability or make any offer to any third party. You must notify Safari and Tourism Insurance Brokers immediately you become aware of any impending prosecution. In the event of a claim you may become responsible for a first amount payable or deductible in respect of such claim. Details of any such responsibility are shown in the policy and the amount is shown in the policy schedule. 5. Fees and commission payable: The amount of any fees and commission earned by the intermediary are stated in the policy schedule. ABOUT THE INSURER 1. Name, physical address and postal address and telephone number: Your insurer s details are stated in the policy schedule/s. 2. Details of how to institute a claim and/ or complaint: See point 4 above. If any complaint to an intermediary of insurer is not resolved to your satisfaction, you may submit the complaint to the Registrar of Short-Term Insurance. 3. Type of policy involved: Refer to the policy schedule. 4. Extent of premium obligations you assume as policyholder: You agreed to pay the premium. Details of the premium due and the frequency of payment are contained in the policy schedule 5. Manner of payment of premium, due date of premiums and consequences of non-payment: The manner of premium payment and due date of premiums is reflected in the policy schedule. You will be entitled to a period of 15 (fifteen) days from the premium due date in which to pay your premium. If you do not pay the premium within 15 days of the due date cover will be cancelled from midnight on the day before the due date. Where the premium is payable monthly this 15 day extension only applies from the second month after your policy is issued. However in respect of a monthly policy if the premium is not paid on the date that it was due to be paid as a result of payment having been stopped by you cover will be cancelled from midnight on the day before the due date. 6. Other matters of importance a) You must be informed of any material changes to the information referred to in paragraph 1 and 2. b) If the information in paragraphs 1 and 2 was given orally, it must be confirmed in writing within 30 days. c) If any complaint to the intermediary or insurer is not resolved to your satisfaction, you may submit the complaint to the Registrar of Short-term Insurance. d) 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. e) If premium is paid by debit order: i) it may only be in favour 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 its intention to cancel such debit order iii) The insurer and not the intermediary must give reasons for repudiating your claim. iv) Your insurer may not cancel your insurance merely by informing your intermediary. There is an obligation to make sure the notice has been sent to you. v) You are entitled to copy of the policy free of charge. Short-term Insurance Ombudsman P.O. Box 30619, Braamfontein, 2017 Tel (011) , Fax (011) Registrar of Short-term Insurance Financial Service Board, P.O. Box 35655, Menlo Park, 0102 Tel (012) Fax (012) Warning 1. Do not sign any blank or partially completed application form. 2. Complete all forms in ink. 3. Keep all documents handed to you. 4. Make notes as to what is said to you. 5. Don t be pressurised to buy the product. 6. Incorrect or non-disclosure by you of relevant facts may influence an insurer on any claims arising from your contract of insurance. 17/09/2014 Page 3

4 TRUM PREMIUM CALCULATION: Effective Date: 1 Nov 2014 Insured: Professional Passenger Services (Pty) Ltd C/o Insurance Zone Administration Services P O Box 2756 BEDFORDVIEW, JOHANNESBURG 2008 The Business: Shuttle Service - Airport Transfers Currency of Policy: SA Rand (R) Unique Reference: B0750RNMGC Policy Sections Available: Included: Pro-Rata / Refund: Annual SASRIA: Annual Premium: PAX Liability TRUM Fee Tax Assist Yes , Yes , No SUB TOTAL: , BROKER FEE: POLICY FEE: ADMIN FEE: TOTAL: , Your premiums are to be paid Monthly Vat included in total R Next Premium Pro-Rata Premium 0.00 Monthly Premium 3, Total 3, Future Monthly Premium 3, Monthly premium includes R commission The above values include VAT at 14% Please Note: We do not provide cover for Taxis. If it is found that any of the vehicles on cover are being used as a "Taxi" - no claims will be entertained. Endorsement date: 1 Nov 2014 Endorsement reason: Renewal Quote Banking details: Name of account: Bank/Branch: IOM (Pty) Ltd - SATIB FNB Account Number: Clearing Code FIRNZAJJ657 Branch Code: /09/2014 Page 4

5 POLICY SCHEDULE: Currency: SA Rand - Motor PAX Liability Section - Insured Vehicles: Description 2010 TOYOTA QUANTUM 2.5 D-4D 14 SEAT - YYS721GP Category Seating Sum Insured / Limit of Indemnity/ Compensation Annual Premium 2009 AUDI Q5 3.0L TDI (176 KW) - YRT468GP Shuttle Vehicles 4 50,000, , TOYOTA QUANTUM 2.5 D-4D 14 SEAT - CB03FXGP 2012 TOYOTA QUANTUM 2.5 D-4D 14 SEAT - BZ97RNGP 2011 TOYOTA COROLLA 1.3 PROFESSIONAL - BG38PLGP 2010 TOYOTA COROLLA 1.3 PROFESSIONAL - ZSB210GP 2011 TOYOTA COROLLA 1.3 PROFESSIONAL - BH25VTGP 2011 TOYOTA COROLLA 1.3 PROFESSIONAL - BH42KGGP 17/09/2014 Page 5

6 POLICY SCHEDULE: 2011 TOYOTA COROLLA 1.3 PROFESSIONAL - BM13FPGP 0000 TOYOTA COROLLA 1.3 PROFESSIONAL - CG85PHGP 0000 TOYOTA COROLLA 1.3 PROFESSIONAL - CG85NYGP 0000 TOYOTA COROLLA 1.3 PROFESSIONAL - CG85KNGP 2012 TOYOTA COROLLA 1.3 PROFESSIONAL - CG85KFGP 3 50,000, TOYOTA COROLLA 160I - REQUESTED 0000 TOYOTA COROLLA 160I - REQUESTED 0000 TOYOTA QUANTAM 14 SEATER - REQUESTED 2014 TOYOTA COROLLA QUEST - DD90FWGP 17/09/2014 Page 6

7 POLICY SCHEDULE: 2014 TOYOTA COROLLA QUEST DF84NVGP 2014 TOYOTA QUANTUM GL - DD90DMGP Shuttle Vehicles 13 50,000, , TOYOTA COROLLA QUEST TBA Total Annual Premium 34, Passenger liability excess: R5,000 (each and every loss) 17/09/2014 Page 7