Health insurance with included Lifestyle, Day-2-day Primary Care and Hospital bene ts from only R248 pm. (Family rates also available, see brochure)

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1 CALL CENTRE MAHALA HEALTH INSURANCE powered by ESSENTIAL MED MAKING MEDICAL HEALTH AFFORDABLE TO ALL SOUTH AFRICANS FOR PEACE OF MIND WHEN FACED WITH MEDICAL NEEDS. Mahala Loyalty Pty Ltd is a fully edged FSP since 2004 and in partnership with Essential Med established in 2005 hereby bring you affordable and convenient medical insurance. We want to make medical service in South Africa available to all salaryearning individuals; not a service only available to the elite few, but to all. Together we strive to offer our members fresh thinking, agile service delivery, open communication and great personal service. An apple a day keeps the Doctor away! :) Health insurance with included Lifestyle, Day2day Primary Care and Hospital bene ts from only R248 pm. (Family rates also available, see brochure) MAHALA LOYALTY in All Packages Discounts, Points & Coupons galore! SAFETY TRACKER in All Packages GPS tracking for your family MISSING ASSIST in All packages Find a missing person immediately with PSARU DRIVER PROTECT in Silver and Gold Packages Bail Assist, RAF claim assistance & Legal representation on the road EMS (EMERGENCY MEDICAL ASSIST) in Silver & Gold packages Transport via Ambulance, Helicopter etc in an emergency Mahala Loyalty Programme (Pty) Ltd. Authorised Financial Services Provider FSP number: Reg. no 2001/030145/07 DIRECTORS: Tanya Grobler (CEO), Len Lubbe, Fourie & Botha (Company Secretary) Essential Med is a registered Financial Services Provider. FSP No: Reg No: 2003/016142/06. Essential Med DIRECTORS: Paul Cox (Managing Director), Earle Loxton, Danie Kok, Michael Jordaan, Michael Scott

2 Benefits: See package details for benefit inclusion MAHALA LOYALTY in All Packages Your Mahala Loyalty card gives you a WORLD of discounts and points at more than 2000 Partners nationwide. SAFETY TRACKER in All Packages Safety Tracker is a personal safety APP / Mobi designed to keep you and your friends safer 24/7. It s packed with features for both daytoday safety and real emergencies, making it the ultimate safety tool for you and everyone you love. You can share your location via an array of sharing options and when you are in trouble, the 911 Alert button will immediately notify your friend and family members that you need help, and let them know where you are (GPS). MISSING ASSIST in All packages What do you do when a loved one goes missing? The People Search and Rescue Unit (PSARU ) is a 24/7 call centre help line specialized in providing support in missing persons cases. We assist with the following: 24/7 Call Centre for immediate assistance, Trauma support and a specialised investigation team to be dispatched immediately. DRIVER PROTECT in Silver and Gold Packages Driver Protect addresses the urgent demand for the legal protection and empowerment of motorists and passengers regarding the use of a vehicle. The Driver Protect Offers: Comprehensive legal advice & assistance A 24/7, 365 days a year call centre service Full RAF claims assistance Legal representation in the High and Magistrate's Courts nationwide Traf c Offences above R1 500 nes Drunken driving Reckless driving Negligent driving Culpable Homicide as a result of an accident and more! CALL CENTRE Members Covered: Principal Member Age of Inception: Single Single + 1 Single + 2 Single + 3 Single + 4 Bronze Silver Gold yrs yrs yrs R R R R R R R R R R R R R R R R R R R R R R R R R R Over 55 yrs R R Essential Med is a registered Financial Services Provider. FSP No: Your welcome pack containing your full benefit schedule will be posted after your first successful premium collection by Essential Med.

3 Lifestyle Bene ts: Bronze Silver Gold Principal Member Age of Inception: yrs yrs yrs Mahala Loyalty Safety Tracker Missing Assist Driver Protect EMS (Emergency Medical Services) Day2Day Bene ts: GP Visits Radiology & Pathology Acute & Chronic Medication Dentistry Managed unlimited dentist consultations and procedures as per formulary, including cleaning, pain control, amalgam llings and normal extractions. Managed unlimited dentist consultations and procedures as per formulary, including cleaning, pain control, amalgam llings and normal extractions. 1 Root Canal Treatment to the value of R2000 per event per bene ciary within a 12 month period. 1 Crown per bene ciary to the value of R4500 per event within a 24 month period. Resin Fillings included. Optometry Free Single Vision Lenses and frames Free Single Vision Lenses and frames Free Single or Bifocal lenses and frames Specialist Hospital Bene ts Accident Up to R per event for single, with an AOL of R R per incident per family with an AOL of R EMS included. R2 000 Bene t Per Policy Per Annum Up to R per event for single, with an AOL of R R per incident per family with an AOL of R EMS included. Illness 1st 24 hrs: Up to R Day 2: Up to R6 500 Day 3: Up to R5 000 Day 4 Onwards: Up to R Maximum 21 days total admission. Subject to a 3 month waiting period. 1st 24 hrs: Up to R Day 2: Up to R6 500 Day 3: Up to R5 000 Day 4 Onwards: Up to R Maximum 21 days total admission. Subject to a 3 month waiting period. Maternity Dread Disease R9 000 a day while admitted for a con rmed Dread Disease and up to the maximum bene t limit of R will be paid out according to the staging of the disease. Casualty Ward Up to R2 000 in total per annum. Up to R2 000 in total per annum. health Terms GP Visits: R250 reimbursed if NonNetwork GP is used. Radiology & Pathology: Within provided network (basics). GP Visits, Radiology & Pathology: A 30 day waiting period applies for these bene ts. Acute & Chronic Medication: An extensive list of acute and chronic medication is available. 30 day waiting period applies to acute & 6 month waiting period applies to chronic. Dentistry: These services are obtained from an Essential Med network registered provider. 6 month waiting period applies. Optometry: Your Optometry bene t includes an eye test per bene ciary. 12 month waiting period applies, available from Specsavers. Specialist: If your doctor requires you to be seen by a Specialist, an annual bene t amount is available to help cover these costs. A 90 day waiting period applies. Accident: No waiting periods are applicable to events that are related to accidents. Emergency Medical Services are automatically included. AOL = Annual Overall Limit. EMS = Ambulance transport to the nearest medical facility. Illness: ONLY in the Gold package Stated Conditions amounts paid regardless of admission days, but not in addition to the Daily Illness Bene t. Certain procedures no longer require extended periods of admission. For this reason we have cover for speci c events: Hernia: R Appendectomy: R Gall / Kidney: R Miscarriage: R A 12 month waiting period is applicable to the stated bene ts. Hysterectomy: R A 24 month waiting period is applicable. In the event your Doctor advises: a CSection: R bene t available. Normal delivery: R is available. Subject to a 12 month waiting period. 1 event per 12 months. Dread Disease: Heart attacks, Coronary Hearth Disease, Stroke, Cancer and Kidney Failure are a few of the conditions that are covered by this bene t. 12 Months waiting period applies. Casualty Ward: For those after hours emergences that are never planned for and don t require admission, we offer generous cover to helps pay for costs at Casualty. 30 day waiting period if due to illness.

4 1. POLICY HOLDER INFORMATION CELL PHONE POSTAL ADDRESS RESIDENTIAL ADDRESS 2. MAIN MEMBER INFORMATION AGENT DETAILS (FOR OFFICE USE ONLY): NAME: : CONTACT NO. AGENT CODE: CALL US: HEALTH@MAHALAS.CO.ZA TITLE (DR, MR, MRS, MS) PLEASE SPECIFY ADDRESS FOR CORRESPONDENCE POSTAL HOME MARITAL STATUS POSTAL CODE POSTAL CODE Any preexisting conditions not disclosed on application, may result in the policy being cancelled with immediate effect, with no refunds. This pertains to main member as well as to dependants. 3. DEPENDENT INFORMATION SPOUSE/PARTNER: A person to whom the principal applicant is either married or has a committed and serious relationship with, similar to that of a marriage in which there is mutual and emotional support and a shared household, irrespective of the gender of either party. D1 D2 D3 D4 D5 DEPENDANTS: Children or other immediate family members in respect of whom the principal member is liable for care and support. Maximum age of child dependent is 21, unless the dependent child is studying full time or is mentally or physically handicapped and fully dependent on the principal. 4. MEDICAL RELATED QUESTIONS: 1. Currently receiving treatment of have received treatment for any medical/dental condition? 2. Concerned about/aware of any condition which may require medical/dental attention? 3. Currently using any medication? 4. Pregnant? 5. Have you applied for life insurance in the past 5 years for which you have been medically underwritten? 6. Has your health deteriorated since you last applied for this policy? 7. Have you ever suffered from, or do you currently have any of the following? 7.1 High blood pressure 7.2 Diabetes 7.3 Cancer or any kind of growth 7.4 Heart attack or heart disease 7.5 Shortness of breath 8. Have you, your spouse or any sexual partner been tested for or received treatment or medical advice in respect of AIDS or conditions related to AIDS or the HIV virus, or are you waiting for a test result? 9. Do you take regular (daily / weekly) prescription medication for any illness or disease? 10. Have you been off work for an illness or accident longer than 3 consecutive weeks in the last 2 years? MM D1 D2 D3 D4 D5 NO

5 CALL US: If you ticked YES to question 5 6 in the Medical Questions Section, please provide us with more detail below: Q. no Member Insurer Name Date applied If you ticked YES to question 7 10 in the Medical Questions Section, please provide us with more detail below: Q. no Member Condition / impairment detail Doctor (Initial & surname) On treatment? Last symptoms (date) Fully recovered? 5. EXISTING MEDICAL SCHEME / HOSPITAL PLAN 1. If you do have an existing medical aid or medical insurance, will you be cancelling it and replacing it with this Policy? 2. Please provide the details of the medical aid or medical insurance if you are retaining it 6. POLICY OPTIONS & FEES BRONZE SILVER GOLD Single Member Single Member + 1 Child Single Member + 2 Children Single Member + 3 Children Single Member + 4 Children + 1 Child + 2 Children + 3 Children + 4 Children Over 55 years R R R R R R R R R R R R R R R R R R R R R R R R R R R R DEBIT ORDER, AUTHORISATION & SIGNATURE I / We hereby request instruct and authorise you to draw against my / our account with the below mentioned bank (or any other bank or branch to which I / we may transfer my / our account) the amounts (as indicated in point 5 above) or any other variable amount pertaining to this agreement. This being the amounts necessary for the settlement in respect of my / our purchases / agreement. These withdrawals from my / our bank account by you shall be treated as though it has been signed by me / us personally. ACCOUNT HOLDER ACCOUNT TYPE INCEPTION DATE DEBIT ORDER DATE 1st 15th 25 th I/we understand that the withdrawal hereby authorized will be processed by Insurance Outsourcing Managers (IOM) (Pty) Ltd. And I/we also understand that the details of each withdrawal will be printed on my bank statement. I/we agree to pay any bank charges relating to this debit order instruction. This authority may be cancelled by me/us by giving 30 (thirty) days notice, either telephonically or in writing. I/we understand that I/we shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force if such amounts were legally owing to you. Any increase to the amount due to an amendment in cover or in rates, will be communicated accordingly. Authority and Mandate On the day of each and every month commencing on for the amount of R. In the event that the payment day falls on a Saturday, Sunday or recognized South African public holiday, the payment day will automatically be the very next ordinary business day. MANDATE: I/we, ID number acknowledge that although this Authority and Mandate may be cancelled by me/us, such cancellation will not the Agreement. I/we shall not be entitled to any refund of amounts which Essential Med have withdrawn while this authority was in force, if such amounts were legally owing. Acknowledgement I warrant that I have been provided with all the intermediary, insurance and bene t details. I warrant that all details and facts herein are accurate and properly disclosed, even if completed by the intermediary or representative on my behalf. I understand that the bene ts offered are risk bene ts only and that there are no surrender values. Failure to pay premiums will result in bene ts lapsing. I acknowledge that this is a Health Insurance Policy and that the bene ts are not similar or a replacement to that of a Medical Aid. I am satis ed that the plan chosen by me, best suits my needs. I understand that applications are subject to approval and that Essential Med reserves the right to decline an application. INITIAL & DATE BANK SIGNATURE ACCOUNT NUMBER MY FINAL PREMIUM IS: R BRANCH CODE VOICE RECORDING REFERENCE