Document Sample
(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:

 1.       About the Administrator                                                                                  Contact us at:
 (a)      Name, physical and postal address and telephone number.                                                  Premier Group
                                                                                                                   1 Lucas Drive Hillcrest 3610
                                                                                                                   P.O. Box 1985 Hillcrest 3650
                                                                                                                   Tel: 0861 PGCARE or 0861 742273
                                                                                                                   Fax: 086 5009307
 (b)      Legal status and any interest in the insurer.                                                            Private company and pref shareholder in Centriq Insurance Company Limited
 (c)      Professional indemnity insurance.                                                                        Yes
 (d)      Detail of how to institute a claim.                                                                      See Reverse.
 (e)      Rand amount of commission payable.                                                                       Nil
 (f)      Written mandate to act on behalf of insurer.                                                             Yes

 2.       Other matters of importance
 (a)      You must be informed of any material changes to the information referred to in paragraph 1 and 6.
 (b)      If the information in paragraphs 1 and 6 was given orally, it must be confirmed in writing within 30
 (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)      If premium is paid by means of debit order:                                                              Should you have any complaints about the availability or adequacy or information required to be
          (i) it may only be in favour of one person and may not be transferred without                            provided herein, please bring this to the attention of our compliance officer.
                your approval; and
          (ii) the insurer must inform you at least 30 days before the cancellation thereof, in writing, of its    Your policy document contains the name, class and type of policy as well as details of procedures
                intention to cancel cover.                                                                         to follow in the event of a claim. Should anything not be clear, please contact your insurance
 (f)      Your insurer and not the intermediary must give reasons for repudiating your claim.                      adviser or Centriq Insurance Company Limited’s office for assistance.
 (g)      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.
 (h)      You are entitled to a copy of the policy free of charge.

 3.       Warning
          Do not sign any blank or partially completed application form.
          Complete all forms in ink.
          Keep all documents handed to you.
          Make a note as to what is said to you.
          Don’t be pressurised to buy the product.
          Incorrect or non-disclosure by you of relevant facts may influence an insurer on any claims arising
          from your contract of insurance.

 4.       Particulars of Short-Term insurance Ombudsman who is available to advise you in the event of             Short-Term Insurance Ombudsman P.O. Box 32334, BRAAMFONTEIN 2017
          claim problems which are not satisfactorily resolved by the insurance intermediary and/or the            Tel: (011) 726 - 8900
          insurer.                                                                                                 Fax: (011) 726 - 5501

 5.       Particulars of registrar of Short-Term Insurance                                                         Financial Service Board P.O. Box 35655 MENLO PARK 0102
                                                                                                                   Tel: (012) 428 - 8000
                                                                                                                   Fax: (012) 347 - 0221

 6.       About the insurer                                                                                        Centriq Insurance Company Limited
 (a)      Name, physical and postal address and telephone number.                                                  First Floor, 4 Fricker Road, Illovo 2196
 (b)      Telephone number of compliance department of the insurer.                                                Tel: (011) 268 - 6490
                                                                                                                   Fax: (011) 268 - 6495

                                                                                                                   Complaints should be written or telefaxed to the Complaints Department, at the address in 6
                                                                                                                   (a) above, or through the above numbers.

 (c)      Details of how to institute a claim and/or complaint.                                                    See Documentation
 (d)      Type of policy involved.                                                                                 Personal Accident
 (e)      Extent of premium obligations you assume as policy/holder.                                               See Documentation
 (f)      Manner of payment of premium, due date of premiums and consequences of non-payment                       See Documentation

 Premiums and your monetary obligations.

 You have agreed to pay the premium shown in the schedule or certificate of insurance or policy endorsement issued. The premium collection is due on inception of the policy. The policy becomes active on the
 date of the first successful debit (Premium Collection). Should the debit order fail, you will not be covered until the next successful premium collection. Should the debit order fail 3 times in succession, the policy
 shall be deemed to have lapsed. The monthly premium is subject to an increase at the discretion of Premier Group and with 30 days notice to the insured.

 Procedures for the submission of claims in the policy document in the section or part of the policy headed either GENERAL EXCEPTIONS AND PROVISIONS or GERNERAL CONDITIONS or CONDITIONS. A
 summary of these requirements which does not overrule the specified policy conditions follows.
 You are required to notify Premier Group within 30 days of an event which could result in a claim. If a claim is to be made under the policy you are generally required to do the following.
 1.     Supply within 30 days after the event:
        1.1 details of other insurances which cover the same claim event.
        1.2 full details in writing of the claim event.
       1.3 information and proof in support of the claim.
 2.    Assault and bodily injury is to be reported immediately to the Police (S.A.P.S.) upon the happening thereof, which could give rise to a claim in terms of this policy. You are also required to provide
       the Police (S.A.P.S.) Reference Number and the Station Name (S.A.P.S.) to which the report was made. This report must be made before logging a claim with Premier Group.
 3.    Co-operate with Premier Group in the settlement of any claim and do everything reasonably possible to reduce the amount of any loss or damage and to recover any amount which would be
       payable under the policy.