CASE STUDY- LONG TERM INSURANCE

Transcription

1 MOOSTONE FINAL EXTERNAL INTEGRATED SUMMATIVE ASSESSMENT- EISA OCCUPATIONAL CERTIFICATE: INSURANCE CLAIMS ADMINISTRATOR (CLAIMS ASSESSOR) SAQA ID: CREDIT: 131 DATE: TIME: 3 HOURS MARKS: 100 PASSMARK: 70% CASE STUDY- LONG TERM INSURANCE 1 of 15

2 CONTENTS Life Maturity Application Form Beneficiary Nomination Form Life Surrender Application Form Life Policy Cession From Disability Claim Form Life Cover Death Claim Form Reinsurance Contract Premium Payment Record of 15

3 LIFE MATURITY APPLICATION FORM 1. Particulars of policy holder 2. Details regarding maturity proceeds Please deposit maturity proceeds into the following account: Signature of policy holder: James Date: 21 May 2018 Witness Signature: Anabella Date: 21 May of 15

4 BENEFICIARY NOMINATION FORM 1. POLICY HOLDER DETAILS Title: Mr Surname: Scort First names : Holland Marital status : Married 2. BENEFICIARY NOMINATION I hereby nominate the following people as beneficiaries who should receive proceeds of this policy when I die. Signed at Centurion on the 25th day of September 2017 Signature: Holland 5 of 15

5 LIFE SURRENDER APPLICATION FORM 1. Particulars of policy holder 2. Declaration by the policy holder I would like to surrender my above mentioned policy. I understand that payment of the surrender value results in the cancellation of the policy and therefore I should submit my original policy document. I also understand that surrender charges as explained in the policy document will be deducted from the surrender proceeds. I give my full consent and accept all the conditions mentioned above. 3. Details regarding surrender proceeds My surrender proceeds should be deposited into the account: Signature of policy holder: Jacobus Date: 23 May 2018 Witness Signature: Marriot Date: 23 May of 15

6 LIFE POLICY CESSION FORM 1.Policy holder details I Holland scort as the owner of the said policy do hereby transfer and assign all my rights title and interest in the said policy together with all benefits and advantages to be derived there from as security to the cessionary indicated below. 2. Type of cession 3. Cessionary details Signed at Centurion on 02 March 2018 Signature ( Policy owner) Holland Signed ( Cessionary ) Construction bank on 02 March of 15

7 DISABILITY CLAIM FORM 1. Claimant details What is the reason of the claim? I was injured when a rock fell whilst operating underground. 2. Details of current employment Supply history of previous positions held with current and previous employers Have you been able to perform any part of your main duties or another job since you were unable to do your job in full. If yes give details including dates, remuneration and job description. I am currently assisting in the different offices involved in filling at the same salary of R I am not very sure for how long they are going to keep me doing a filling job at the salary rate of a rock driller. 8 of 15

8 Give detail of formal training, qualifications and any courses that you have attended during your working career. 3. Details of disability What is wrong with you? I was injured when a rock fell whilst I was working with others underground. I cannot perform my normal duties as a result of the injuries. When did it start? The incident occurred on the 25th of April Has any of the following contributed to your disability? 9 of 15

9 4. Declaration I declare that the information given above is true and correct. I authorise any doctor or any other person who has attended to me to disclose any medical information to the insurance company on request and this information can be shared with other insurance companies. Signature of claimant: Hendrik Date: 25 May 2018 Witness Signature: Sam Date: 25 May of 15

10 LIFE COVER DEATH CLAIM FORM 1.Deceased details 2.Claimant details 3.Estate executor`s details 4.Deceased employer details Occupation of deceased at time of death: Construction 5.Undertaker details 6.Circumstances surrounding the deceased`s death What was the cause of death? NUEMONIA What was the date and time of death? 12 March 2018 Where did it happen? Along NI road near vodacom When was the heath of the deceased first affected? In January 2018 When did the deceased first contacted the doctor for the illness.? 25/01/ of 15

11 7.Hospital details Can you please supply details of the hospital where the deceased was declared dead. 8.Deceased`s family doctor 9.Other doctors Please supply names and addresses of all the doctors who attended to the deceased during the five years preceding his death Doctor 1 Doctor 2 12 of 15

12 Doctor 3 10.Medical aid details Please supply the details of the medical aid the deceased belonged to in the last five years 11. Insurance details Please supply the details of the insurance policies the deceased had in the last five years 12. Declaration by the claimant I the undersigned in my capacity as brother of the deceased, confirm that the insurance company and their appointed agents and entitled to inspect the records, medical or otherwise of the deceased and to obtain copies thereof in order to proceed with the processing of a claim submitted. I authorise the person or institution to furnish any information documents or copies of records requested by the company or their agent. I further authorise the insurance company to confirm and disclose information relating to claims, insurance, financial and medical history and declare that all information provided is true and complete in every respect and that I have not withheld any relevant information from the company or their appointed agent. Signature: Dion Warren Date: 23 May 2018 Witness: Emmanuel 13 of 15

13 REINSURANCE CONTRACT This is a reinsurance agreement between ABS company being the insurer and Munic Re being the reinsurer. 1. Details of the cedent 2. Terms of agreement 3. Policy holder details Signature Cedent: Jacob Utton Date: 01/02/2000 Signature Cessionary: Munichre 14 of 15

14 PREMIUM PAYMENT RECORD James Swarts Policy No. A of 15