MR PRICE GROUP LTD CUSTOMER PROTECTION PLAN POLICY

Transcription

1 MR PRICE GROUP LTD CUSTOMER PROTECTION PLAN POLICY Administered by V & A Risk Management (Pty) Limited VM Centre, 356 Pretoria Avenue, Randburg, Tel: Underwritten by Guardrisk Life Ltd and Guardrisk Insurance Ltd Policy Number : MPCPP 788 In return for You paying the premium and continuing to meet all the conditions for cover, if Guardrisk Life Ltd (Guardrisk) AND Guardrisk Insurance Ltd (Guardrisk) accepts the premium it will provide insurance cover under the Mr Price Group Ltd Customer Protection Plan Policy, as described in this document. POLICY PART A UNDERWRITTEN BY GUARDRISK LIFE LTD. THIS PROVIDES COVER FOR DEATH, CRITICAL ILLNESS, HOSPITALISATION AND RETRENCHMENT SECTION 1: DEFINITIONS Accidental Death Your death caused by accidental, violent, external and visible means. In the event of accidental death, it must occur solely and independently of all other causes within 365 days of the injury being sustained. Administrator V & A Risk Management (Pty) Ltd. Agreement The agreement with Mr Price Group Ltd with which You have arranged insurance cover under the policy, and if so, through which you have elected to pay your premium. Credit and Financial Services Provider The Credit Provider is registered in terms of the National Credit Act 34 of 2005 ( National Credit Act ) under number NCRCP46. Mr Price Group Limited (FSP Licence No 31450) has been licensed by the Financial Services Board in terms of the FAIS Act to render intermediary Services in respect of Long Term Category A and B as well as Short Term Category 1 Personal and Commercial Lines. A copy of our FSP licence and the conditions of the licence are available on request. Cancer Malignant tumours characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue. This includes leukaemia and Hodgkin's Disease but excludes non-invasive cancers in situ and skin cancer other than malignant melanoma. Coronary Artery Disease Requiring Bypass Surgery A condition for which you undergo open-heart surgery on the advice of a Consultant Cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts. No cover will be provided in respect of non-surgical techniques such as balloon angioplasty or laser relief. Critical Illness One or more of the following conditions: heart attack, cancer, stroke, major organ transplant, coronary artery disease requiring bypass surgery and kidney failure. Critical illness must be confirmed by a doctor with the applicable specialist knowledge. Doctor A medical practitioner registered with the South African Medical and Dental Council. The doctor who confirms your condition when you are making a claim cannot be you, a relative or a close friend. End Date The last day of Your insurance cover as defined in Section 9 "WHEN THE COVER ENDS". Full-time Employment When You are working for at least 20 hours a week and receiving a salary or wages under a contract of employment that does not

2 have a known or implied finish date. Self Employed are not eligible for Retrenchment cover under this policy. Hazardous Pursuit Flying other than as a fare paying passenger, hang gliding, ballooning, land and water-based motor sports, winter sports, sub aqua diving, mountain climbing, and any other activity which would reasonably be expected to enhance the chance of a claim under the policy. Heart Attack The death of a portion of the heart muscle as a result of inadequate blood supply as evidenced by an episode of chest pains, new electro-cardio graphic changes and elevation of cardiac enzyme levels. Hospitalisation Being admitted to hospital and registered as an in-patient because of an accident or illness. Insurer / We / Us / Our Guardrisk Life Limited and Guardrisk Insurance Limited. Kidney Failure End stage renal failure resulting in chronic irreversible failure of both kidneys, as a result of which regular renal dialysis or a renal transplant is required. Major Organ Transplant The receipt of a heart, liver, lung, kidney, pancreas or bone marrow by means of a transplant. Monthly Premium The premium You must pay to the Insurer each month for cover under the policy. Period of Insurance The period between the start date and the end date for which You have paid the premium and We have agreed to accept it. The first period of insurance begins at the start date and all periods of insurance must be consecutive. Policy The Mr Price Group Ltd Customer Protection Plan Policyholder Mr Price Group Ltd. For Accidental Death claims, the Proven Beneficiary.. Proven Beneficiary The person who on providing evidence to the satisfaction of the Administrator within 90 days of the Accidental Death is entitled to receive and disburse the benefit under Section 4 of this policy. Retrench / Retrenchment Termination of Your work by Your employer due to adverse business conditions, the liquidation of the company, or the introduction of new technology, or the re-organisation of Your employer's business, resulting in staff reductions. You must be in full-time employment and not self-employed to be eligible for this cover. Self-employed When You are working for at least 20 hours a week for profit in a profession or business, whether alone or with others and are liable to pay income tax for that profession or business. Start Date The date Your agreement starts. For Critical Illness benefits this shall be deemed to be the later of the 1 st June 2009 or the Start Date of the Policy. Stroke A cerebrovascular incident lasting more than 24 hours and resulting in permanent neurological damage. Evidence of permanent neurological deficit must be produced. Unemployed / Unemployment

3 When You: - Are entirely without work, including assisting, managing and or carrying out of any part of the day to day running of a business - Are not receiving any earnings from employment including payment in lieu of notice; - Are available for and actively seeking work and can provide evidence of this. Work / Working Full-time employment or self-employment. You / Your A person who is eligible for cover under the policy, who has applied for and been accepted for insurance cover and is named as the person insured in the application form. SECTION 2 ELIGIBILITY To be eligible for cover under the policy You must meet the following conditions at the start date: - You must be the first named borrower on the agreement, or be specified as the Partner of the first named borrower; - You must be at least 18 and less than 65 years of age on the date of application for cover; - You must be in good health; - You must have been working continuously for 6 months immediately before the start date; - You must work, live and have the right to reside permanently in South Africa; - You must not be aware of any impending unemployment; - You must apply for cover and pay the premium; - You must agree to abide by the terms and conditions of the policy SECTION 3 - LIFE COVER AND CRITICAL ILLNESS COVER WHAT WE WILL PAY If You should die or suffer from a critical illness during the period of insurance, We will pay the outstanding balance of Your Miladys account at the date the insured event occurred: - Less any monthly instalments more than 3 months in arrears; - Less any amount owing in excess of the maximum benefit payable under the policy. WHAT WE DO NOT PAY FOR LIFE COVER We will not pay any benefit if Your death arises directly or indirectly from any of the following: - A self-inflicted injury, suicide or a suicide attempt; - Any condition You had at the Start Date; - Any condition for which You have received treatment or advice during the 12 months immediately prior to the Start Date; and for which you make a claim 12 months after the Start Date - War, riot, radioactive contamination, nuclear accidents and similar risks; - Your participation in a criminal act; - Your participation in a hazardous pursuit; - You being under the influence or above the legal limit of alcohol intake or drug abuse; - Refusing medical treatment as recommended by Your own medical practitioner. WHAT WE DO NOT PAY FOR CRITICAL ILLNESS COVER We will not pay any benefit if Your critical illness arises directly or indirectly from any of the following: - Any condition for which the life cover will not be paid; - Any condition which arises within 90 days of the start date; - Any condition for which You have received treatment or advice during the 12 months immediately prior to the Start Date; and for which you make a claim 12 months after the Start Date - Pregnancy, childbirth, the ending of pregnancy or any related complication; - A medical procedure undertaken at your request which is in the opinion of a doctor not necessary to maintain the quality of your life - A critical illness arising while you are working outside of South Africa for any period in excess of 3 consecutive months. SECTION 4 - ACCIDENTAL DEATH COVER

4 WHAT WE WILL PAY If during a period of insurance You suffer an accidental death we shall pay You or your Proven Beneficiary the following benefit. - Accidental death: R WHAT WE DO NOT PAY FOR We will not pay any benefit if Your accidental death arises directly or indirectly from any of the following: - Any condition listed in Section 3 WHAT WE DO NOT PAY FOR. SECTION 5 - RETRENCHMENT COVER WHAT WE WILL PAY If during a period of insurance You are retrenched due to new technology, re-organisation by the employer, liquidation of the company or staff reductions and remain unemployed for more than 90 continuous days, We will pay a benefit equal to the outstanding balance of Your Miladys account at the date the retrenchment occurred. The claim must be submitted immediately on You being retrenched. You must return to work for at least 12 continuous months before You can make another claim for a retrenchment benefit. WHAT WE DO NOT PAY FOR We will not pay the monthly benefit if Your unemployment arises directly or indirectly from any of the following: - If at the start date You knew or had reason to believe You might lose Your job; - You had not been working continuously for the 12 months immediately before retrenchment occurred; - You lose your job following the end of casual, seasonal, temporary or occasional work; - You come to the expected finish date of a fixed term contract or You finish the job You were specifically employed to do; - You resign or You accept voluntary retrenchment; - You lose Your job because of any strikes which You took part in or any lock out by Your employer; - You lose Your job as a result of nationalisation or other government action; - You lose our job because of misconduct, fraud, dishonesty or any such acts carried out by You; - If Your employer, branch, office or business moves outside of South Africa; - You lose Your job as a result of a reason listed in Section 3 "WHAT WE DO NOT PAY FOR". SECTION 6 - HOSPITALISATION COVER WHAT WE WILL PAY If during a period of insurance you are hospitalised for more than 14 consecutive days, we shall pay a benefit equal to your outstanding balance of Your Miladys account at the date you were admitted to hospital as an in-patient. To receive the hospitalisation benefit you must: - be employed at the time of the hospitalisation occurred; - be under the continuous care of a doctor in respect of the reason for hospitalisation; - be prevented from working only as a result of this hospitalisation; - give us any evidence we may request to prove your claim is valid and continues to be so. When paying your claim, we shall consider the first day of your hospitalisation to be the day you are registered as an in-patient. WHAT WE DO NOT PAY FOR We shall not pay any benefit if your hospitalisation arises directly or indirectly from any of the following: - - If you are hospitalised as a result of a reason listed in Section 3 "What We Do Not Pay For";. SECTION 7 - MAXIMUM BENEFITS PAYABLE The maximum benefit payable in the event of Your death, critical illness, hospitalization or retrenchment under this policy, together with any other policy issued by the insurer for the Mr Price Group Ltd is R Upon the happening of any event giving rise to a claim under the terms of this policy, all rights will be ceded to the credit provider and all benefits will be credited to Your agreement.

5 SECTION 8 - CLAIMS All claims must be notified as soon as possible and no later than 120 days after the insured event by contacting the scheme administrator on (011) , or by writing to the administrator at: V & A Risk Management (Pty) Limited, PO Box 983, Northlands, 2116 A claim form will be sent to You. You must return it to the administrator within 30 days of receipt. Please ensure that all sections of the claim form are fully completed and any relevant documents are enclosed and sent to the administrator. Should You need any help in completing Your claim form please contact the administrator. SETTLING A CLAIM We will need proof of Your death, accidental death, critical illness, retrenchment or hospitalisation and the circumstances leading to Your claim. A death claim must be notified in writing and We will need to see a certified copy of Your death certificate and a certified copy of Your ID Book. If You are claiming for critical illness or hospitalisation, we will require a doctor's certificate confirming your condition. We may ask You to go for a medical examination with a doctor appointed by Us. We will pay the cost of the examination. If You are claiming for retrenchment, We may require confirmation from Your employer of the reason for Your retrenchment. During the period of a claim, We may need proof that You have remained unemployed. You must pay any costs of obtaining this proof. You must take all reasonable steps to keep the period of hospitalisation or unemployment as short as possible. We may ask for other evidence in support of Your claim. If You have other insurance covering the same loss, We will settle Your claim on a proportionate basis. A claim that is accepted by Us as a completed and genuine claim, will be settled within 2 working days. SECTION 9 - WHEN THE COVER ENDS Your insurance cover under the policy will end and no further benefit will be payable, as soon as one of the following occurs: - A benefit is paid in respect of death, critical illness or hospitalisation; - You attain the age of 70; - You fail to pay the monthly premium; - You advise us that the policy should be cancelled; - We advise You that Your insurance cover has ended. SECTION 10 - GENERAL CONDITIONS If You do not keep to the terms and conditions of the policy, You will not be entitled to any benefit under the policy. If You gave false or misleading information when You applied for cover under the policy, and this information affected the decision to insure You, Your cover under the policy will end and We will not pay any benefit. If You give false or misleading information when You make a claim, You will not receive any benefit under the policy and Your cover under the policy will end. If any benefit is paid as a result of Your false claim, You will have to repay any benefit You have received and We will take legal action against You. The contract between You and Us is made up of the policy, any endorsement, any written statement of Your medical conditions and any other information provided by You including that in Your credit application. The rights under the policy cannot be transferred to anyone else and the policy cannot be used to protect any person other than You.

6 You are to inform the Administrator within 30 days, of any change in Your personal details or those of Your partner, if Your Partner is a life assured, from those originally stated on Your application form when You applied for cover. When Your cover under the policy ends it will not have a cash value. We have the right to change or cancel Your insurance cover under the policy. You will be told at least 30 days before the change or cancellation takes effect. We warrant that for the purposes of disclosure of private underwriting and claims information Your consent and acknowledgement of the sharing of claims information and underwriting information (including credit information) by Insurers will only be utilised to underwrite policies and assess risks fairly and to reduce the incidence of fraudulent claims, and accordingly You waive any rights of privacy of insurance information in respect of any claim made. You also acknowledge that the information provided by You may be verified against other legitimate sources or databases. You also Waive any rights of privacy and consent to the disclosure of any information relevant to any insurance policy or claim concerning You. Should You wish to cancel Your cover under the policy, please do so in writing with one calendar month's notice to the following address: V & A Risk Management (Pty) Ltd P O Box 983 Northlands 2116 The law and currency of South Africa governs this policy. SIGNED ON BEHALF OF GUARDRISK LIFE LIMITED BY HERMAN SCHOEMAN: MANAGING DIRECTOR.

7 POLICY PART B UNDERWRITTEN BY GUARDRISK INSURANCE LTD. THIS PROVIDES BENEFITS IN THE EVENT OF IDENTITY THEFT DEFINITIONS Where the following words are shown in this document they shall have the following meanings: Business Your occupation, profession, trade or other means of employment. Certificate of Insurance The certificate that we send you that shows the value of your cover and excess and the period of insurance. Claim Any claim that you make under this policy. Communication Cost The cost of a phone call, fax or postage (including registered post). Cover The benefits available to you under this policy. Excess The first amount of each claim that you have to pay. Fee The difference between the premium and the total amount you must pay. Identity Theft The theft or unauthorised use of your personal identification or identity, which has or could reasonably result in the unlawful use of your identity and has arisen from a number of reasonably associated acts. Insurer Guardrisk Insurance Company Ltd. Registered No 1992/001639/06 Period of Insurance The period of insurance starting on the start date. It includes any future period for which you make a renewal payment. Policy These terms and conditions and any changes that we may agree with you from time to time. Premium The agreed amount payable per month or any other amount we agree with you from time to time. V & A V & A Risk Management (Pty) Ltd Renewal Date The renewal date shown in your certificate of insurance or which we agree with you from time to time. SAFPS South African Fraud Prevention Services. A not for profit membership organisation dedicated solely to the prevention of financial crime in the Republic of South Africa Start Date The start date shown in your certificate of insurance.

8 We, Us, Our V & A Risk Management (Pty) Ltd, registration number 2009/016248/07 Year 12 months in a row. You, Your The person whose name appears on the certificate of insurance. RECORDING CALLS We may record your telephone call to us. We do this to: provide a record of the instructions we have received from you; allow us to monitor quality standards; help us with staff training; and meet legal and regulatory requirements. All communications and policy documents will be in English unless otherwise agreed. We are committed to meeting the needs of all our policyholders, including those with special needs. YOUR POLICY Please read these terms and conditions carefully. This policy sets out the cover that we will provide in return for your premium during the period of insurance. It also sets out all the conditions, limits of liability and exclusions that apply to your cover. The policy is administered and managed by V & A Risk Management (Pty) Ltd, and underwritten by Guardrisk Insurance Company Ltd. All claims should be notified in the first instance to us. We will issue a claim form for completion. No claims will be considered until such claim form has been completed and returned to us with the supporting documentation we may require. Our claims fax number is You may also download your claim form from our web site: SECTION A: GENERAL CONDITIONS AND EXCLUSIONS A1: Conditions Your cover under this policy depends on you meeting the following conditions: a)you must meet all of our terms and conditions. This applies to the terms and conditions set out here and any others which we change or add to this policy at a later date. b) You must provide full and accurate information in connection with your cover. c) You must file a police report and notify your banks or building societies, payment card companies and issuers of other accounts of the identity theft as soon as possible. d) You must do all you reasonably can to avoid making a claim and keep your claims as low as possible. e) You must take all reasonable action to prevent a claim. f) You may not make a claim unless the policy premium has been paid. g) You must advise us of a claim within 15 days of becoming aware of any act, incident or circumstance that may give rise to a claim. Failure to do so will invalidate your claim. h) In order to be eligible for cover for lost or stolen passports and driving licenses, you must have registered the document numbers with us prior to the loss or theft occurring. A2: Exclusions and limitations 1. This policy does not cover your liability if: a) the identity theft is committed by someone who lives at your home address; or b) the identity stolen is a commercial identity or your losses arise out of your business activity; or c) the legal costs you are claiming have not been agreed by us before they are incurred by you; or d) the losses you are claiming were not incurred during the period of insurance. However, we will provide you with the benefits detailed under sections B3 and B4 of these terms and conditions in such instances.

9 2. If your identity is used abroad unlawfully, or the identity theft occurs while you are abroad, the amount of advice we provide may be limited. 3. No liability will be accepted for any loss or cost incurred by you as a result of any action you take on the advice we may have provided. 4. An excess of R500 will apply to each claim that you make under section B1 of these terms and conditions. We will not pay more than R15000 for all claims under this policy in any calendar year. A3: Length of policy and premiums 1.This policy provides cover that begins on the start date and which continues for the period up to your renewal date in return for the premium. We will renew the policy on the renewal date unless you contact us before that date and ask us not to. 2.The premium may change from time to time but it will not change for your policy until the next renewal date. 3.You must pay the premium and fee on the date they are due. A4: Cancelling this policy 1.We will cancel your policy if we do not receive your premium on the date it is due. However, we may reinstate your policy if you then pay it. 2. We will cancel your policy if you have at any time: a) given us false or incomplete information; b) agreed to help anyone try to take money from us or the insurer dishonestly; or c) failed to meet the terms and conditions of this policy or to act openly and honestly towards us. 3. We can cancel your policy by giving you at least 14 days written notice at your last known address. A5: Other insurance If there is any other insurance which covers any of the benefits set out in this policy, you must tell us about this when you make a claim. We will not pay more than our share of any claim covered by other insurance. A6: Dishonest claims If you make a claim which is in any way dishonest, we will refuse to pay any benefit. If we pay benefit and then later discover that your claim was dishonest, we will take steps to get the money back. A7: Setting aside terms and conditions If we choose to set aside a term or condition of this policy, this will not prevent us from relying on that term or condition in the future. A8: Governing law This policy is governed by and must be interpreted in line with South African law. We, the insurer and you agree that any disputes may be settled only in South African courts SECTION B: COVER AND BENEFITS B1: Identity Theft Expenses In the event of an identity theft, we will pay a total of up to R for the following expenses: a) We will pay the communication costs you have to pay when you report an identity theft to, or when you engage in communication regarding an identity theft with, the police, credit agencies, financial service providers, other creditors, debt collection agencies or legal counsel. b) We will pay any reasonable costs, including, but not limited to, communication costs that you have to pay for the signing of Statutory Declarations or similar documents following your identity theft. c) We will pay any loan rejection fees and any reapplication administration fees for a loan when your original application is rejected on the basis that the lender received incorrect credit information following an identity theft. d) We will cover your loss of earnings for any unpaid leave you have had to take to defend or resolve an identity theft. e) We will pay reasonable legal costs you have to pay to defend any case brought against you by debt collection agencies or similar. f) We will pay reasonable legal costs you have to pay for the removal or deletion of any criminal or civil judgments incorrectly registered against you or to challenge any information in a credit report.

10 We must be informed of, and we must agree to beforehand, any legal costs that we might be liable to pay under this policy. Loss of earnings cover will not exceed the weekly maximum amount we tell you about and will cover no more than 4 weeks in a row. An excess of R500 will be applied to each claim you make under this section. You must provide the documentary evidence that we ask for to support your claim. If this documentation is not available at the time of your claim we must be satisfied that such costs were incurred before we pay any benefit. B2: Passport and Driving License Cover If your passport or driving license is lost or stolen during the period of insurance we will reimburse you for any charges you have to pay for the issue of replacements, including the issue of emergency replacements whilst you are abroad. We will not pay more than R750 for all claims under this section in each year. You must have registered your passport and/or driving license with us prior to the loss or theft occurring. You must provide original documentary evidence to support your claim (for example, receipts from the issuing office or from a Consulate). B3: Legal Assistance Helpline The policy provides 24 hour legal assistance. The service is provided by qualified lawyers on any aspect of the law. The service consists of the following: 24 hour telephonic legal service. Provision of standard legal documents. A free 30 minute direct consultation with a lawyer The service is available by calling the Legal Assistance helpline on B4: Protective Registration If you lose your passport or driving license or any other forms of identification, or you think your identity is being misused, we will, at your request, register your personal details with SAFPS to reduce the risk of your identity being used unlawfully to obtain credit or funds in your name. B5: Valuable Document Registration Register your valuable document numbers by calling and we will store them securely on your behalf. If you ever lose the valuable documents or need to refer to the relevant document numbers, we will make these available to you. SIGNED ON BEHALF OF GUARDRISK INSURANCE LIMITED BY HERMAN SCHOEMAN: MANAGING DIRECTOR.

11 STATUTORY NOTICE TO LONG TERM INSURANCE POLICY HOLDERS IMPORTANT PLEASE READ CAREFULLY DISCLOSURE AND OTHER LEGAL REQUIREMENTS (This Notice does not form part of the Insurance Contract nor any other document) As a long term insurance policyholder, or prospective policyholder, you have the right to the following information 1. YOUR INTERMEDIARY Company name: Mr Price Group Limited 65 Masabalala Yengwa Avenue (Formerly NMR Avenue), Physical Address: Durban, 4001 Postal Address: PO Box, 912, Durban, 4000 Telephone Facsimile Number: Number: Legal status of the intermediary and the disclosure of any shareholding that the provider may have in excess of 10% in the insurer, any other equivalent substantial interest and if applicable disclosure of whether the intermediary has derived more than 30% of its total remuneration over the preceding 12 months from the insurer: We have a written mandate to act as Intermediary on behalf of the Insurer Mr Price Group Limited has Professional Indemnity Insurance Cover in force Mr Price Group Limited is in possession of the required written agreement to act as an intermediary of Guardrisk Life Limited Statutory commission is paid by Guardrisk Life Limited to 20% Financial Advisory and Intermediary Services (FAIS) Registration Number is Without in any way limiting and subject to the other provisions of the Services Agreement/Mandate, Mr Price Group Limited accepts responsibility for the lawful actions of their Representatives (as defined in the Financial Advisory and Intermediary Services Act) in rendering financial services within the course and scope of their employment. Claims Procedure: Completed claims forms and all required documents to be submitted to V and A Risk Management, 356 Pretoria Avenue, Randburg, 2194 Complaints Procedure: Complaints relating to any advice given to you by your intermediary may be notified in writing to: V and A Risk Management: complaints@varisk.co.za Compliance Officer: Not applicable Policy Wording: A copy of the policy wording can be obtained from Mr Price Group Limited or from the Administrator V&A Risk Management (Pty) Ltd 2. DETAILS OF THE ADMINISTRATOR V and A Risk Management (Pty) Limited Registration number 2009/016248/07 is mandated by Guardrisk Life Limited to act as an Company name: administrator for all financial products that are sold to clients on its behalf. Physical Address: 356 Pretoria Avenue, Randburg, 2194 Postal Address: 356 Pretoria Ave, Randburg, 2194 Telephone No: Facsimile No: FAIS Registration: V and A Risk Management (Pty) Limited is a juristic representative of ISS Ltd in terms of FAIS Act, FSP No Completed claims forms and all required documents to be submitted to V and A Risk Management (Pty) Limited, 356 Pretoria Avenue, Claims Procedure: Randburg, 2194 Compliance Officer: Not applicable 3. DETAILS ABOUT THE PRODUCT SUPPLIER Company Name Guardrisk Life Limited Registration No. 1999/013922/06 Postal Address P O Box , Sandton, 2146 Physical Address Alexander Forbes, 4 th Floor Rivonia Road, Sandton Telephone Number Fax Number FAIS Registration Guardrisk Life Limited is an authorised financial services provider in terms of the FAIS Act, FSP No.76 Compliance Officer The Compliance Manager, Tel , Fax , Type of Policy Mr Price Group Ltd Customer Protection Plan 4. PREMIUMS (DETAILS OF THE PREMIUMS PAYABLE) Due Date of Payment: Your monthly premium will form part of your monthly account with Mr Price Group Limited Consequence of Non-Payment: If the premium is not received as aforesaid, you have further 15 days to pay failing which the policy will cancelled and any claim will not be covered. Method of Payment: Your monthly premium will form part of your monthly account with Mr Price Group Limited 5. OTHER MATTERS OF IMPORTANCE i You will be informed of any material changes to the information about the intermediary and or insurer provided above. ii If any of the information reflected above was given to you orally, this disclosure notice serves to provide you with the information in writing. Should you not be satisfied with the policy, you are entitled a period up to 30 days within which you may cancel your policy in writing at no cost. Cover will cease upon cancellation of the policy. iii If we fail to resolve your complaint relating to an advice satisfactorily, you may submit your complaint to the FAIS Ombudsman at P.O. Box Lynwood Ridge 0040 or any other complaint to the Ombudsman of the Long Term Insurance. iv You will always be given a reason for the repudiation of your claim. v If the insurer wishes to cancel your policy, this will be done in writing, to your last known address. vi You will always be entitled to a copy of your policy at no extra charge. 6. WARNING i Do not sign any blank or partially completed application form. ii Complete all forms in ink. iii Keep notes of what is said to you and all documents handed to you. iv Don t be pressurised to buy the product. v If you fail to disclose facts relevant to your insurance, this may influence the assessment of a claim by the insurer. For complaints on claims that are not satisfactorily resolved by the product supplier contact: For complaints to the intermediary or insurer that are not resolved to your satisfaction, please contact: 7. PARTICULARS OF THE LONG TERM INSURANCE OMBUDSMAN 8. PARTICULARS OF THE REGISTRAR OF LONG TERM INSURANCE Postal Address: Private Bag X45 Postal Address: Financial Services Board Claremont, 7735 PO Box 35655, Menlo Park, 0102 Telephone Number: Telephone Number: Facsimile Number: Facsimile Number:

12 STATUTORY NOTICE TO SHORT-TERM INSURANCE POLICY HOLDERS IMPORTANT PLEASE READ CAREFULLY DISCLOSURE AND OTHER LEGAL REQUIREMENTS (This Notice does not form part of the Insurance Contract nor any other document) As a short-term insurance policyholder, or prospective policyholder, you have the right to the following information: 3. YOUR INTERMEDIARY Mr Price Group Limited Company name: 65 Masabalala Yengwa Avenue (Formerly NMR Physical Address: Avenue), Durban, 4001 Postal Address: PO Box, 912, Durban, 4000 Telephone No; Facsimile Number: Legal status of the intermediary and the disclosure of any shareholding that the provider may have in excess of 10% in the insurer, any other equivalent substantial interest and if applicable disclosure of whether the intermediary has derived more than 30% of its total remuneration over the preceding 12 months from the insurer: We have a written mandate to act as Intermediary on behalf of the Insurer Mr Price Group Limited has Professional Indemnity Insurance Cover in force Mr Price Group Limited is in possession of the required written agreement to act as an intermediary of Guardrisk Insurance Company Limited Statutory commission is paid by Guardrisk Insurance Company Limited to 20% Financial Advisory and Intermediary Services (FAIS) Registration Number is Without in any way limiting and subject to the other provisions of the Services Agreement/Mandate, Mr Price Group Limited accepts responsibility for the lawful actions of their Representatives (as defined in the Financial Advisory and Intermediary Services Act) in rendering financial services within the course and scope of their employment. Claims Procedure: Completed claims forms and all required documents to be submitted to V and A Risk Management, 356 Pretoria Avenue, Randburg, 2194 Complaints Procedure: Complaints relating to any advice given to you by your intermediary may be notified in writing to: V and A Risk Management: complaints@varisk.co.za Compliance Officer: Not applicable Policy Wording: A copy of the policy wording can be obtained from Mr Price Group Limited or from the Administrator V&A Risk Management (Pty) Ltd 4. DETAILS OF THE ADMINISTRATOR V and A Risk Management (Pty) Limited Registration number 2009/016248/07 is mandated by Guardrisk Insurance Company Limited Company name: to act as an Administrator for all financial products that are sold to clients on its behalf. Physical Address: 356 Pretoria Avenue, Randburg, 2194 Postal Address: 356 Pretoria Avenue, Randburg, 2194 Telephone Number: Facsimile Number: FAIS Registration: V and A Risk Management (Pty) Limited is a juristic representative of ISS Ltd in terms of FAIS Act, FSP No Completed claims forms and all required documents to be submitted to V and A Risk Management (Pty) Limited, 356 Pretoria Avenue, Claims Procedure: Randburg, 2194 Compliance Officer: Not applicable 3. DETAILS ABOUT THE PRODUCT SUPPLIER Company Name Guardrisk Insurance Company Limited Registration No. 1992/001639/06 Postal Address P O Box , Sandton, 2146 Physical Address Alexander Forbes, 4 th Floor Rivonia Road, Sandton Telephone Number Fax Number FAIS Registration Guardrisk Insurance Company Limited is an authorised financial services provider in terms of the FAIS Act, FSP No.75 Compliance Officer The Compliance Manager, Tel , Fax , Type of Policy Mr Price Group Ltd Customer Protection Plan 4. PREMIUMS (DETAILS OF THE PREMIUMS PAYABLE) Due Date of Payment: Your monthly premium will form part of your monthly account with Mr Price Group Limited Consequence of Non-Payment: If the premium is not received as aforesaid, you have further 15 days to pay failing which the policy will cancelled and any claim will not be covered. Method of Payment: Your monthly premium will form part of your monthly account with Mr Price Group Limited i ii iii iv v vi i ii iii iv v 5. OTHER MATTERS OF IMPORTANCE You will be informed of any material changes to the information about the intermediary and or insurer provided above. If any of the information reflected above was given to you orally, this disclosure notice serves to provide you with the information in writing. Should you not be satisfied with the policy, you are entitled a period up to 30 days within which you may cancel your policy in writing at no cost. Cover will cease upon cancellation of the policy. If we fail to resolve your complaint relating to an advice satisfactorily, you may submit your complaint to the FAIS Ombudsman at P.O. Box Lynwood Ridge 0040 or any other complaint to the Ombudsman of the Short Term Insurance. You will always be given a reason for the repudiation of your claim. If the insurer wishes to cancel your policy, this will be done in writing, to your last known address. You will always be entitled to a copy of your policy at no extra charge. 6. WARNING Do not sign any blank or partially completed application form. Complete all forms in ink. Keep notes of what is said to you and all documents handed to you. Don t be pressurised to buy the product. If you fail to disclose facts relevant to your insurance, this may influence the assessment of a claim by the insurer. For complaints on claims that are not satisfactorily resolve by the product For complaints to the intermediary or insurer that are not resolved to your supplier contact: satisfaction, please contact: 7. PARTICULARS OF THE SHORT-TERM INSURANCE 8. PARTICULARS OF THE REGISTRAR OF SHORT-TERM OMBUDSMAN INSURANCE Postal Address: PO Box Postal Address: Financial Services Board Braamfontein, 2017 PO Box 35655, Menlo Park, 0102 Telephone Number: Telephone Number: Facsimile Number: Facsimile Number: