PSGTP016266 SCH 20110920 14 48 12

Administrated by Topexec Management Bureau (Pty) Ltd. (2000/003839/07) FSP4520, an affiliate of PSG Konsult Ltd, on behalf of the insurer.
SHORT TERM INSURANCE POLICY SCHEDULE

BROKER DETAILS
Broker Agent Contact Details
PSG Konsult ST Tygerberg PSG Client Care Centre

Tel: 0860 774 566 Fax: 0866 156 172 Email: psg@psgkonsult.co.za 4050194820 728 Address Details PO Box 68277 Highveld Park 0067
VAT Registration no. FSP License no.
POLICY DETAILS
Policy Number Inception Date Payment Frequency Period of Insurance PSGTP016266 (Old policy number: AGIB94330) 21 March 1989 Monthly (a) From 01 September 2011 to 30 September 2011 (both dates inclusive) (b) and any subsequent period for which the Insurer agrees to renew this policy or any section thereof. Review Date Insurer 01 March 2012 Santam Limited
DETAILS OF INSURED
The Insured Co Insured Occupation Contact Details Mr AH GIBBONS & MRS S GIBBONS None Unknown Cell : Work : Home : Fax : Email : +2783-725-8791 Postal Address 46 F KLEINBOSCH CRESCENT KLEINBOSCH(PAROW) 7500 ID / Passport no. : 8208295084082
alex@edgemeadprimary.co.za
TRANSACTION DETAILS
Effective Date Date Processed Transaction Reason 20 September 2011 20 September 2011 ADJUSTED VEHICLE RETAIL VALUES
The Broker must be informed of any discrepancies within 30 days after print date, after which the broker will not be liable for errors or ommissions. This Schedule forms part of the Insurer's policy wording and must be read in conjunction with the applicable policy wording and excess structure.
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Administrated by Topexec Management Bureau (Pty) Ltd. (2000/003839/07) FSP4520, an affiliate of PSG Konsult Ltd, on behalf of the insurer.
Insured Policy No Effective Date Payment Frequency Collection Day
Mr AH GIBBONS & MRS S GIBBONS PSGTP016266 20 September 2011 Monthly 1st Day Of Month
Please note that this is only a summary of the elements of the policy. Make sure that this information is correct as it can affect your cover and premium. For a complete description of the cover and conditions the policy wording should be read. Particular attention should be paid to first amounts payable (excesses) and the restrictions or exceptions. Sections House Contents Buildings All Risks Motor Motorcycle Caravan & Trailer Watercraft Personal Accident Personal Legal Liability Death Benefit Plan Optional Cover Extended Legal Liability (PLIP) PSG Assist (Tel: 0860 522 522 ) EFS Comprehensive Car Hire Credit Life Domestic Employee Compensation Plan Funeral Benefit Plan Windscreen - Excess Buy-back TyreSure X'S Sure X'S Sure - 2010 Cover Yes No Yes Yes No No No Yes Yes No Sum Insured 380,932.00 25,400.00 121,370.00 Pro-Rata Premium Premium 128.25 70.22 629.15
-6.34
20,000.00 2,500,000.00
9.28 3.25
No Yes No Yes Yes No No No No No
29.00 6.25 5.00
15,000.00
Legal Costs and Expenses
Yes
30,000.00
6.00
Sub Total Sasria EDS Electronic Debit Order and System Fee Administration Fee Insurer Policy Fee Broker Fee Total R
-6.34 2.00 -4.34 R
886.40 9.00 10.00 8.60 19.37 933.37
We have arranged SASRIA cover on your behalf in respect of property insured under this policy unless otherwise stated on the schedule. SASRIA terms and conditions are available on request. Total commission component included in the premium: R 128.43 This schedule becomes a VAT invoice after inception of the cover when payment due has been made. VAT is included at 14%. Santam VAT Number: 4440102095
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EXCESS DEFINITIONS
HOUSE CONTENTS Lightning damage Any occurrence which leads to a claim due to lightening damage BUILDINGS Each and every occurrence Any occurrence which leads to a claim. VEHICLES Compulsory Any occurrence, excluding theft/hi-jacking which leads to a claim. This excess does not apply if an excess for "other" applies Other Any occurrence, excluding theft/hi-jacking which leads to a claim due to the driving of the car or light delivery vehicle by a person other than yourself, or your spouse (if you are 55 years or older), under the vehicle in the schedule, and the damage result form driving. Under 25 Any occurrence which leads to a claim due to the driving of the car or light delivery vehicle by a person under the age of 25 years. Add this excess to the "compulsory" or, if applicable, the "other" excess. This excess does not apply if the excess for license less than 2 years applies. Theft/Hi-jacking Any occurrence which leads to a claim for theft/hi-jacking. If the stolen/hi-jacked car or light delivery vehicle is found and delivered to us after we have paid the claim for theft/hi-jacking to you, the excess which you have paid, excluding any voluntary excess, will be paid back to you. If the car or light delivery vehicle is found before we have paid the claim for theft/hi-jacking to you and there is damage to the car or light delivery vehicle, the "compulsory" excess will be applicable. Window Any occurrence which leads to a claim for glass of the windows of the car or light delivery vehicle. This excess is applicable on its own unless an excess for "window glass additional compulsory" is also applicable. Window glass additional compulsory Any occurrence which leads to a claim for the glass of the windows of the car or light delivery vehicle. Add this excess to the excess for "window glass". Drivers license less than 2 years Any occurrence which leads to a claim due to the driving of a car or light delivery vehicle by a person who has a driver's license less than 2 years. Add this excess to the "compulsory" excess or, if applicable, to the "other" excess. Tools and parts Any occurrence which leads to a claim. This excess is applicable on its own. Loss of keys Excess for loss of keys.
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HOUSE CONTENTS SECTION

Insured : Policy No : Effective Date : Insurer: Mr AH GIBBONS & MRS S GIBBONS PSGTP016266 20 September 2011 Santam Ltd
INSURANCE COVER DETAILS

Risk Address: 46 F Kleinbosch Crescent, Kleinbosch(Parow), Kleinbosch(Parow), 7500 Insured Amount R380,932.00 Premium R129.62
Construction - Walls Construction - Roof Type of Dwelling Occupancy
Standard Standard Main Residence Approved alarm system linked to 24 hour control room Private Residence Premises Occupied During the Day
Yes No 7
No Claim Bonus Optional Cover Subsidence or Landslip (Comprehensive cover) First Amounts Payable Damage by wild baboons or wild monkeys Lightning damage Accidental damage - household goods Additional First Amounts Payable None
No
R 500 R 500 R 500
Security Requirements Linked Alarm Special Conditions, Clauses & Warranties Applicable None Additional Clauses None Additional Notes OPEN FIELDS, PARKS OR STANDS It is hereby declared and agreed that : - If access to the insured residence is gained through any open stand, fields or parks which directly border the insured risk address, an additional excess payment of 10% of the claim, minimum R1000.00 will be applicable. 0
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HOUSE CONTENTS SECTION


SECURITY MEASURES Unless stated otherwise in the schedule, the following security measures are applicable. -All opening windows, including louver windows, must be fitted with steel burglar bars. -All outside doors, including doors granted entrance/exit to the main residence / residences, excluding solid wooden pivot doors, must be fitted with lockable steel security gates. These steel security gates must be locked when the main residence / residences is left unattended and also at night. The residence must meet with all the above requirements, or -Must be equipped with an alarm system linked to a twenty-four (24) hour reliable reaction unit / control room. -The alarm system must be installed under contract and maintained by a contractor approved by us. -There must be a radio link between the system and a fully manned control room with 24-hour immediate armed response. -If the residence is left unattended, the alarm system must be fully activated.
SASRIA Cover
Included
Your Cover Information (Subject to Policy Terms and Conditions) Basic cover Your property inside your private residence & outbuildings Theft or attempted theft from your outbuildings Loss or damage to money (excluding theft) Property not inside private residence, but on the premises Property on the premises where you are employed Theft from any vehicle not left unattended and unlocked Extended Basic cover Temporary increase of the insured amount Debris Removal Rent Extinguishing charges Mirrors and certain glass Death Veterinary expenses Damage by wild baboons or wild monkeys
Insured Amount
Contents Insured Amount 2% of Contents Insured Amount Minimum R5,000
R2,500
2% of Contents Insured Amount Minimum R5,000 2% of Contents Insured Amount Minimum R5,000
R 5,000 10% R5,000

Limited to Percentage of Contents Insured Amount 25%
Reasonable cost Replacement cost R10,000

2% of Contents Insured Amount Minimum R5,000 2% of Contents Insured Amount Minimum R10,000
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Convenience Benefits Medical expenses of guests or visitors R5,000 Medical expenses of domestic employees R5,000 Personal effects of guests 2% of Contents Insured Amount Minimum R5,000 Personal effects of domestic employees 2% of Contents Insured Amount Minimum R5,000 Contents of refrigerators and freezers 2% of Contents Insured Amount Minimum R5,000 Storage costs for contents after damage 2% of Contents Insured Amount Minimum R5,000 Trauma treatment R5,000 Guards R5,000 IF BED AND BREAKFAST COVER SELECTED Bed and Breakfast Cover- (Only applicable to premises risk where Limited Bed and Breakfast Cover is selected). Included Stock in trade If the House Contents insured amount is adequate Increase by percentage 10% Increase in peak period Theft of personal effects- paying guests R10,000 per event Trauma compensation- paying guests R10,000 per event External signs, blinds and canopies R2,000 Cleaning and dry cleaning of guests property R5,000 per event
SPECIAL CLAUSES, WARRANTIES AND ENDORSEMENTS

The following Special Clauses, Warranties and Endorsements apply to the House Contents section of your policy:
261 VALUATION CERTIFICATE FOR ARTICLES WITH VALUE OF MORE THAN R 25 000. You must give us a valuation certificate (dated before the occurrence) for each of your furs, jewels, jewellery, gemstones, watches, articles of platinum, gold or silver (pairs and sets included) with a value of more than R 25 000. If we do not receive the certificate after the event that leads to a claim, we shall not pay more than R 25 000 per article.
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ALL RISKS SECTION


Item Insured BICYCLES Sum Insured R400.00 Premium R2.91
Bank Safe Deposit Box First Amount Payable None
No 0
Applicable Clauses & Warranties None Additional Clauses None Additional Notes
SASRIA Cover
Included
Item Insured
CLOTHING AND PERSONAL EFFECTS
Sum Insured R5,000.00 Premium R24.80
No 0
SASRIA Cover
Included
Item Insured
1X MUSICAL TRUMPERT
Sum Insured R20,000.00 Premium R44.14
No 0
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ALL RISKS SECTION


MUSIC INSTRUMENTS It is hereby declared and agreed that : - The standard payment with regard to musical instruments with an insured value exceeding R5 000-00, is amended to 10% of the claim, minimum R500.00.
SASRIA Cover
Included

The following Special Clauses, Warranties and Endorsements apply to the All Risks section of your policy:
261 VALUATION CERTIFICATE FOR ARTICLES WITH VALUE OF MORE THAN R 25 000. You must give us a valuation certificate (dated before the occurrence) for each of your furs, jewels, jewellery, gemstones, watches, articles of platinum, gold or silver (pairs and sets included) with a value of more than R 25 000. If we do not receive the certificate after the event that leads to a claim, we shall not pay more than R 25 000 per article.
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MOTOR SECTION

Make and Model Limit of Indemnity Year of Manufacture Registration Number Vin Number Engine Number Meadnet code Risk Address Canopy fitted Security Detail Vehicle parked at night Approved Tracking device Approved Immobilizer Gear-Lever Lock Alarm System Data Dot Optional Cover Care Assist Breakdown OPEL CORSA UTILITY 1.4i P/U S/C Cover Type R 36,700.00 2003 Class of use CY115138 Registered Owner Regular Driver ADMRC80AM3H161220 2K0006577 Regular Driver Date of Birth Claim Free Group 480|21101|2003|2|2|0|| 46 F Kleinbosch Crescent, Kleinbosch(Parow), 7500 R 5,000.00 Premium Comprehensive Private INSURED AH GIBBONS & MRS S GIBBONS 29 August 1982 5 R210.70
Locked Garage No VSS No Yes No Applicable No
Limit of Indemnity
First Amounts Payable If you are not a pensioner (*) / If you are a pensioner (**) (55 years or older) Any occurrence which leads to a claim: (*)Compulsory 5% of claim, minimum R 2,000 (*)(**)Loss of keys R 100 (*)Repatriation R 2,500 (*)Loss of keys (4X4) R 100 (*)Loss of keys (Luxury) R 100 (*)Other driver 5% of claim, minimum R 2,000 (*)Under 25 R 1,000 (*)Theft / Hi-Jacking 10% of claim, minimum R 3,000 (*)Specified articles R 100 (*)Drivers licence less than 2 years R 2,000 (*)Excess Waiver No (*)Window 20% of claim, minimum R 350
First Amounts Payable do not apply to Extended Basic cover or Convenience Benefits, unless otherwise stated.
Security Requirements Immobiliser Applicable Clauses & Warranties None Additional Clauses None Additional Notes None
SASRIA Cover
Included
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MOTOR SECTION

Make and Model Limit of Indemnity Year of Manufacture Registration Number Vin Number Engine Number Meadnet code Risk Address BMW 318I (E46) Cover Type R 49,770.00 2000 Class of use CA313873 Registered Owner Regular Driver WBAAN92020NB11983 02149413 Regular Driver Date of Birth Claim Free Group 050|34050|2000|2|0|0|| 46 F Kleinbosch Crescent, Kleinbosch(Parow), 7500 Premium Comprehensive Private AH GIBBONS GIBBONS & MRS S GIBBONS 29 August 1982 6 R215.08
Security Detail Vehicle parked at night Approved Tracking device Approved Immobilizer Gear-Lever Lock Alarm System Data Dot Yes Vehicle Financed Optional Cover Care Assist Breakdown
Unknown No VSS No No No Finance Details Applicable No
CASH Limit of Indemnity
Security Requirements Applicable Clauses & Warranties None Additional Clauses None Additional Notes
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MOTOR SECTION

SECURITY Unless otherwise stated above, the following will apply: It is hereby declared and agreed that the following minimum security is required: R0 - R249 999 Vesa3/Vesa4/VSS approved device. - If the vehicle is fitted with a Vesa3/4 immobiliser, the certificate must be provided to the broker. The normal excess is applicable in case of theft/ hi-jack. - If the above mentioned vehicle does not comply with the minimum security requirements (Vesa 3/ Vesa 4/VSS or tracking device) or if no installation certificates have been received, the following will apply: The standard excess payment with regard to theft/hijacking is amended to 25% of the claim, minimum R3000 Above R250 000 Approved tracking device. - In the event of damage following Theft/Hi-jacking, no excess will be applicable if vehicle is fitted with an approved tracking device. - If the above mentioned vehicle is not fitted with a approved tracking device), there is no cover with regards to theft/hijacking
SASRIA Cover
Included
20/09/2011 (11 / 24)
MOTOR SECTION

Make and Model Limit of Indemnity Year of Manufacture Registration Number Vin Number Engine Number Meadnet code Risk Address VOLKSWAGEN CITI CHICO 1.4I Cover Type R 34,900.00 2002 Class of use CY 170519 Registered Owner Regular Driver AAVZZZ17Z3U005696 AGY045516 Regular Driver Date of Birth Claim Free Group 640|33050|2002|2|2|0|| 46 F Kleinbosch Crescent, Kleinbosch(Parow), 7500 Premium Comprehensive Private SIMONE GIBBONS (WIFE) Mr PJ Gibbons 12 August 1948 6 R209.37
Security Detail Vehicle parked at night Approved Tracking device Approved Immobilizer Gear-Lever Lock Alarm System Data Dot Optional Cover Care Assist Breakdown Driver 1: Name Driver 1: Date Of Birth Driver 1: Gender
Unknown No VSS No No No Applicable No Mr PJ Gibbons 12 August 1948 Male
Limit of Indemnity
Security Requirements Applicable Clauses & Warranties None Additional Clauses None Additional Notes
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MOTOR SECTION

SECURITY Unless otherwise stated above, the following will apply: It is hereby declared and agreed that the following minimum security is required: R0 - R249 999 Vesa3/Vesa4/VSS approved device. - If the vehicle is fitted with a Vesa3/4 immobiliser, the certificate must be provided to the broker. The normal excess is applicable in case of theft/ hi-jack. - If the above mentioned vehicle does not comply with the minimum security requirements (Vesa 3/ Vesa 4/VSS or tracking device) or if no installation certificates have been received, the following will apply: The standard excess payment with regard to theft/hijacking is amended to 25% of the claim, minimum R3000 Above R250 000 Approved tracking device. - In the event of damage following Theft/Hi-jacking, no excess will be applicable if vehicle is fitted with an approved tracking device. - If the above mentioned vehicle is not fitted with a approved tracking device), there is no cover with regards to theft/hijacking
SASRIA Cover
Included
Your Cover Information (Subject to Policy Terms and Conditions) Basic Cover The vehicle insured
Indemnity is limited to the insured amount of the vehicle or its reasonable market value whichever is the lesser.
Insured amount
Liability to Third Parties Passenger Liability- person in or on load body of LDV Limited to Extended Basic Cover Tow in costs and safeguarding after valid claim Emergency repairs Delivery after repairs Tow in cost and safeguarding after mechanical breakdown Vehicle Transfer Cover for any vehicle you buy Difference in excess cover for a rented vehicle- Comprehensive Cover only Loss of keys Convenience Benefits - Applicable to vehicles insured on a Comprehensive basis only unless otherwise stated Medical expenses for passengers- excluding family per person Emergency accommodation per event Medical expenses for passengers- family members only Emergency Costs Recovery Costs Trauma treatment per person per event
R 5,000,000.00 R 400,000.00 Reasonable cost R 5,000.00 Reasonable cost R 1,000.00 Included R 1,500.00 R 2,500.00 R 3,000.00 R 5,000.00 R 5,000.00 R 20,000.00 R 5,000.00 R 5,000.00 R 5,000.00
(This benefit does not apply if you claim under Extended Basic Cover- Tow-in cost and safeguarding after mechanical breakdown.)
Includes vehicles insured on a Limited basis Includes vehicles insured on a Limited basis
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Extended Basic Cover and Convenience Benefits do not apply to any vehicle insured on a Third Party Only basis. If vehicle is insured on Comprehensive excluding Theft and Hijack basis, no benefits apply if loss is as a result of Theft or Hijack.
Optional Cover Information- Luxury Vehicles then the following Limits of Indemnity are increased to the amounts stated below and If you have selected the Luxury vehicle option, apply to the vehicle(s) in question: Extended Basic Cover Emergency repairs R 15,000.00 Tow in cost and safeguarding after mechanical breakdown R 3,500.00 Loss of keys R 15,000.00 Wreckage removal R 1,000.00 Convenience Benefits Emergency accommodation R 500.00 per person R 10,000.00 per event In addition, the following benefits apply: Extinguishing costs R 5,000.00 Head, tail or spot lights Included Optional Cover Information- 4 X 4 Vehiclesthen the following Limits of Indemnity are increased to the amounts stated below and If you have selected the 4 x 4 cover option, apply to the vehicle(s) in question: Extended Basic Cover Emergency repairs R 15,000.00 Tow in cost and safeguarding after mechanical breakdown R 2,500.00 Loss of keys R 10,000.00 Convenience Benefits Emergency accommodation R 500.00 per person R 6,000.00 per event Medical expenses for passengers- family members only R 5,000.00 per person R 25,000.00 per event Trauma treatment R 10,000.00 In addition, the following benefits apply: Winching equipment R 15,000.00 Repatriation costs R 25,000.00 Extinguishing costs R 5,000.00 Personal Documents R 5,000.00 Wreckage removal R 1,000.00 Head, tail or spotlights Included Compensation for car hire per day maximum period 30 consecutive days R 500.00

The following Special Clauses, Warranties and Endorsements apply to the Motor section of your policy:
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PERSONAL LEGAL LIABILITY SECTION


Details of Cover: Basic Cover Personal Legal Liability Limit of Indemnity R2,500,000.00 Premium R3.25 Additional Cover Provided Personal Legal Liabilty to domestic employees Property Owners Liability (only applicable if building or its contents are covered by this policy) Tenants Liability Wrongful arrest Credit, purchase and SIM cards Hole in One Full House Applicable Clauses & Warranties None Additional Clauses None 0 R2,500,000.00 R2,500,000.00 R2,500,000.00 R 100,000.00 R 5,000.00 R 2,000.00 R 2,000.00
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PERSONAL ACCIDENT SECTION


Name of Insured mr AH GIBBONS & MRS S GIBBONS Basic Cover Benefit Death Extended Basic Cover Benefit Medical Expenses Repatriation Costs Trauma Treatment Mobility Cover Life Support Machinery Optional Cover Temporary Total Disablement
(Must be more than 7 days and not longer than 104 weeks)
Occupation Unknown
Date of Birth 29 August 1982
Limit of Compensation R10,000.00 Premium R7.52 R 5,000.00 R 10,000.00 R 10,000.00 R 10,000.00 R 10,000.00 Included Yes
R50,000.00
Additional Clauses None Additional Notes None Name of Insured mr AH GIBBONS & MRS S GIBBONS Basic Cover Benefit Death Extended Basic Cover Benefit Medical Expenses Repatriation Costs Trauma Treatment Mobility Cover Life Support Machinery Optional Cover Temporary Total Disablement
(Must be more than 7 days and not longer than 104 weeks)
Occupation Unknown
Date of Birth 29 August 1982
Limit of Compensation R10,000.00 Premium R1.76 R 5,000.00 R 10,000.00 R 10,000.00 R 10,000.00 R 10,000.00 Included Yes
R50,000.00
Additional Clauses None Additional Notes None
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DOMESTIC EMPLOYEE COMPENSATION PLAN SECTION

Insured : Policy No : Effective Date : Insurer: Mr AH GIBBONS & MRS S GIBBONS PSGTP016266 20 September 2011 Risk Solutions International (Pty) Ltd
Cover Details
DOMESTIC EMPLOYEE COMPENSATION PLAN INSURED PERSON : IDENTITY NUMBER : Benefits- Domestic Worker Death Permanent Disablement Percentage of R0 in accordance with the Table of Permanent Disablement Medical Expenses In Hospital A day is defined as a 24 hour period encompassing midnight spent in R0 per day (max.0 days) hospital Out of Hospital Emergency Medical Transportation (All reasonable costs of an ambulance to transport injured party to nearest medical facility in the case of emergency following accident). First Amount Payable Premium R5.00
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LEGAL COSTS SECTION


Details of Cover: Legal Costs First Amount Payable Family Matters Premium Applicable Clauses & Warranties Additional Clauses Additional Notes Limit of Indemnity R30,000.00
R250.00 R6.00
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PSG ASSIST SECTION

Insured : Policy No : Effective Date : Insurer: Mr AH GIBBONS & MRS S GIBBONS PSGTP016266 20 September 2011 CLC (Lifestyle Assist)

Contact PSG Call Centre Tel : 0860 522 522 Premium R29.00
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Premium R6.25
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FINANCIAL ADVISORY AND INTERMEDIARY SERVICES ACT (NO. 37 OF 2002)

Important information that must be read carefully Client Name: Policy Number: Mr AH GIBBONS & MRS S GIBBONS PSGTP016266
General Information The Financial Advisory and Intermediary Services Act (FAIS) requires compliance by Product Suppliers (insurers) and Financial Services Providers (intermediaries or brokers) with a General Code of Conduct and was introduced to assist you in making informed decisions about the insurance products that you purchase. It also aims to ensure that your Product Supplier and Financial Services Provider render financial services honestly, fairly, with due skill, care and diligence and in your interests and the integrity of the financial services industry. You will receive a Disclosure Notice at the inception of your policy and at each subsequent Renewal or Anniversary date. The Disclosure Notice relates to details about your Financial Services Provider and Product Supplier, additional general information and details about the Ombuds and the Registrar. You are entitled to this information and should you experience any difficulties in obtaining required details, please contact your Financial Services Provider or nearest Product Supplier office for further assistance.
Procedures for registering claims or complaints Procedures for the submission of claims are detailed in your policy document and are important. If you have difficulties in determining the correct procedures, please contact your Financial Services Provider or Product Supplier for assistance. Generally, you are required to advise the Product Supplier within a prescribed number of days of a loss, provide written details of the loss, provide proof in support of a claim, report theft to the police and provide any other details that may be required by the Product Supplier. If you are not satisfied with the information that you are provided with upon your request, you may choose to contact your nearest Product Supplier office, lodge a complaint with the Product Supplier or Financial Services Provider for assistance. Should you remain dissatisfied with the assistance provided, then you may contact any of the Compliance Officers at the addresses provided on the Disclosure Notice. In addition, the address of the Registrar of Short-Term Insurance is provided should your complaint still not be satisfactorily resolved.
Name, Class or Type of Policy Full details about the name, class and type of policy involved are reflected on your policy schedules and are also contained in the policy wording. Policy schedules should always be read in conjunction with the policy wording. Should you require any explanation about the terms, conditions, provisions, premiums, excesses (or deductibles) or any other information, please contact your Financial Services Provider or Product Supplier for assistance as failure to comply with terms, conditions and provisions influence the insurance contract.
Extent and nature of premium obligations Your policy document reflects the premiums payable, the due date of payment and the frequency of payment (e.g. monthly or annually). When amendments are made to the policy, an additional or refund premium may become due and such amounts are also reflected on the policy schedules or endorsements. All premiums are inclusive of Value Added Tax at the prescribed rate. Some Financial Services Providers are authorised to accept premium payment on behalf of Product Suppliers and should your Financial Services Provider be authorised to do so, then you may make payment to such Financial Services Provider. Where a Financial Services Provider is not authorised to receive payment on behalf of the Product Supplier, your payment should be made in favour of the Product Supplier. Should you not operate through a Financial Services Provider, then your payment should be made directly to your Product Supplier. In the case of monthly premiums by debit order, payment is usually made to the Product Supplier directly, unless you have authorised such payment via your Financial Services Provider or other third party, who have authority to collect premium on behalf of the Product Supplier.
Consequences of non-payment of premiums The due date for the payment is reflected on your policy schedule, renewal notice or premium advice as the case may be. Your payment should be made on or before the due date reflected to avoid the cancellation of the policy at midnight on the day before the due date.
First Amounts Payable (also known as Excesses or Deductibles) It is important that you are aware of any amounts that you will be required to pay in the unfortunate event of a claim. Your policy schedules or wording contain the amounts that you pay as a portion of a claim amount and your Financial Services Provider or Product Supplier can assist you with any queries you have in this regard.
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DISCLOSURE 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 or any other document) As a short-term insurance policyholder, or prospective policyholder, you have the right to the following information: Your insurance broker should provide this information to you within a reasonable time from the time you are provided with a quotation, take out a policy or amend your policy. If your broker does not do so after you have requested it, please contact the Financial Services Board. This information must make it clear which entity accepts responsibility for the actions of the broker or representative who has advised you. The broker or representative must disclose whether his service to you is rendered under supervision of another person.
ABOUT YOUR FINANCIAL SERVICES PROVIDER (THE BROKER) a) Name, address, contact details of your broker PSG Konsult ST Tygerberg Belvedere Office Park, Block D, Bella Rosa street Rosenpark BELLVILLE 7530 Tel: 021-970 7000 Fax: 021-914 0554 / 086 6 728 4050194820
FSP License no. VAT Registration no.

b) Interest held by the Broker in the Insurer
Your broker has no direct interest in the insurer.
c) d)
Whether professional indemnity insurance is held Details for claiming against the broker in terms of the professional indemnity insurance
Your broker is in possession of professional indemnity insurance. In the event that you wish to institute a claim against the broker in terms of professional indemnity insurance, details of your claim should be delivered in writing to the offices of the broker.
e)
Rand amount of fees, commissions payable
Rand amount of commission payable: R 128.43 A monthly or annual fee is payable depending on the term of your policy. This is disclosed on the Schedule of Insurance.
f)
Procedure to institute a claim
The procedure for the submission of claims are detailed under GENERAL CONDITIONS of the policy wording. In the event of a claim or the happening of any event which may result in a claim, you must notify your broker as soon as possible and within 30 days. Notify the police within 24 hours of loss or theft of property or accident involving your vehicle. In the event of a vehicle accident with injuries, the police must be notified immediately. You will be requested to furnish the following: (i) Details of other insurance covering the same event (ii) Written details of the event unless otherwise notified (iii) Information and proof in support of your claim (iv) Document or details of any communication in connection with the claim. No Admission, statement, offer, promise, payment or indemnity shall be made without the written consent of the insurer. You must notify your broker immediately if you become aware of any legal process against you. In the event of a claim you may become responsible for the first amount payable in respect of such claim. Details of the first amount payable are stipulated in the policy and the amount is shown in the Schedule of Insurance.
g)
How to institute a complaint
Your broker is committed to handle all complaints promptly, seeking an outcome that is fair and equitable. All telephonic complaints must be directed to the broker as per above details. All written complaints must be directed to the broker as per above details. Complaints are being registered in a complaints register. The person that has lodged such complaint will be notified within 48 hours of the outcome of the complaint.
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ABOUT THE PRODUCT SUPPLIER (INSURER) a) Name, address, contact details of product supplier Santam Limited 1 Sportica Crescent, Tyger Valley, Bellville, 7530 PO Box 3881, Tyger Valley, 7536 Telephone: 021 915 7000 FSP license nummer: 3416 b) Details of the legal compliance department / / Fax: 021 914 0700 / Web: www.santam.co.za VAT number: 4440102095 E-mail: contactus@santam.co.za
The Compliance Officer, Santam Limited 1 Sportica Crescent, Tyger Valley, Bellville, 7530 PO Box 3881, Tyger Valley, 7536 Telephone: 021 915 7000 / Fax: 021 914 7149
c) d)
Type of policy involved Premium obligations assumed by you as policyholder
Short Term Personal Lines The amount of premium due and payment frequency is contained in the Schedule of Insurance. Please note that your premium is payable in advance and that you will only be covered for that period in respect of which your premium has already been paid. It is your duty to check with your bank to ensure that your premium has been deducted from your account and paid to the insurer or its nominated. If the premium is not received on due date a double premium will be collected the forthcoming month. If the double premium is also not received your policy will be considered cancelled from 24h00 on the last day of the month for which premium was received. You must also inform us immediately if you change your banking details.
OTHER MATTERS OF IMPORTANCE You must be informed of any material changes to the information about the broker and/or insurer. If the information about the broker and/or insurer was given orally, it must be confirmed in writing within 30 days. If any complaint which has been lodged with the intermediary or the insurer is not resolved to your satisfaction, you may submit a complaint to the Registrar of Short-term Insurance at: Financial Services Board PO Box 35655 Menlo Park 0102 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. If premium is paid by debit order: (i) it may only be in favor 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 it's intention to cancel the policy. The insurer and not the intermediary must give reasons for repudiating your claim. Your insurer may not cancel your policy merely by informing your intermediary. There is an obligation to make sure the notice has been sent to you. You are entitled to a copy of your policy free of charge WARNING Do not sign any blank or partially completed application form. Complete all forms in ink. Keep all documents handed to you. Take notes as to what is said to you. Don't be pressurised to buy the product. Incorrect or non-disclosure of information may impact on claims arising from your policy. Always insist on confirmation of cover to you when taking out new insurance or adding assets to an existing policy.
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PARTICULARS OF FAIS OMBUD
FAIS Ombudsman Celestis House, Eastwood Office Park, Lynnwood Road PO Box 74571, Lynnwood, 0040 Telephone: (012) 470-9080 to (012) 470-9097 Fax: Email: (012) 348-3447 info@faisombud.co.za / Web Site: www.faisombud.co.za
Complaints number: 0860 324 766
PARTICULARS OF SHORT-TERM OMBUDSMAN
Short-Term Insurance Ombudsman PO Box 32334 Braamfontein 2017 Telephone: (011) 726 8900 Fax: (011) 726 5501
PARTICULARS OF COMPLIANCE OFFICER
You can contact our compliance officer if you are unsatisfied with our service or advice. We will furninsh you with the required details of the compliance officer and will never withhold such information from you: Ms Rika Pieterse PO Box 68277 Highveldpark 0169 Telephone: (012) 679 0580 Fax: E-mail: (012) 679 0480 rika.pieterse@topexec.co.za
Should you have requested cover provided by SASRIA LIMITED then you are entitled to details as follows
PARTICULARS OF SASRIA LIMITED
SASRIA LIMITED 47 Wierda Road West, Wierda Valley, Sandton, 2196 PO Box 7380, Johannesburg, 2000 Telephone: (011) 881 1300 Fax: Email: (011) 783 0781 info@sasria.co.za / Website: www.sasria.co.za
PARTICULARS OF SASRIA LIMITED COMPLIANCE OFFICE
If you have any complaints about the product supplier/insurer regarding SASRIA cover, then you may contact: Ms Nomsa Wabanie PO Box 7380 Johannesburg 2000 Telephone: (011) 881 1311 Fax: E-mail: (011) 783 0781 nomsa@sasria.co.za
FAIS DISCLOSURE NOTICE TO SHORT-TERM INSURANCE POLICYHOLDERS The full Disclosure Notice is attached to all New Business and Renewal documents but not to all other transactions. Should you require a copy of this, please contact your Financial Services Provider or Product Supplier.
20/09/2011 (24 / 24)

PSGTP016266 SCH 20110920 14 48 12

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Administrated by Topexec Management Bureau (Pty) Ltd. (2000/003839/07) FSP4520, an affiliate of PSG Konsult Ltd, on behalf of the insurer.

SHORT TERM INSURANCE POLICY SCHEDULE

PSG Konsult ST Tygerberg PSG Client Care Centre

VAT Registration no. FSP License no.

Insured Policy No Effective Date Payment Frequency Collection Day

No Yes No Yes Yes No No No No No

29.00 6.25 5.00

Legal Costs and Expenses

-6.34 2.00 -4.34 R

886.40 9.00 10.00 8.60 19.37 933.37

HOUSE CONTENTS SECTION

INSURANCE COVER DETAILS

Construction - Walls Construction - Roof Type of Dwelling Occupancy

R 500 R 500 R 500

HOUSE CONTENTS SECTION

INSURANCE COVER DETAILS

Contents Insured Amount 2% of Contents Insured Amount Minimum R5,000

R 5,000 10% R5,000

Reasonable cost Replacement cost R10,000

SPECIAL CLAUSES, WARRANTIES AND ENDORSEMENTS

ALL RISKS SECTION

INSURANCE COVER DETAILS

Bank Safe Deposit Box First Amount Payable None

CLOTHING AND PERSONAL EFFECTS

Sum Insured R5,000.00 Premium R24.80

Bank Safe Deposit Box First Amount Payable None

Sum Insured R20,000.00 Premium R44.14

Bank Safe Deposit Box First Amount Payable None

ALL RISKS SECTION

INSURANCE COVER DETAILS

SPECIAL CLAUSES, WARRANTIES AND ENDORSEMENTS

INSURANCE COVER DETAILS

Locked Garage No VSS No Yes No Applicable No

INSURANCE COVER DETAILS

Unknown No VSS No No No Finance Details Applicable No

CASH Limit of Indemnity

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INSURANCE COVER DETAILS

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INSURANCE COVER DETAILS

Unknown No VSS No No No Applicable No Mr PJ Gibbons 12 August 1948 Male

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INSURANCE COVER DETAILS

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SPECIAL CLAUSES, WARRANTIES AND ENDORSEMENTS

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PERSONAL LEGAL LIABILITY SECTION

INSURANCE COVER DETAILS

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PERSONAL ACCIDENT SECTION

INSURANCE COVER DETAILS

Date of Birth 29 August 1982

Date of Birth 29 August 1982

Additional Clauses None Additional Notes None

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DOMESTIC EMPLOYEE COMPENSATION PLAN SECTION

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LEGAL COSTS SECTION

INSURANCE COVER DETAILS

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PSG ASSIST SECTION

INSURANCE COVER DETAILS

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