Statutory Notice To Short-Term Insurance Policyholder Important

Statutory Notice To Short-Term Insurance Policyholder 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 Administrator

Your Administrator

GENRIC Insurance Company LTD Registration number: 2005/037828/06
PO BOX 1115, Bromhof, 2154
Midrand Business Park, Building 3, 563 Old Pretoria Main Road, Midrand, 1685

Tel: 0875500968
E-mail: info@GENRIC.co.za
Website: www.GENRIC.co.za

GENRIC Insurance Company Limited is an authorised financial services provider, FSP number 43638.
– We are in possession of Professional Indemnity Insurance.
– A Conflict of Interest Management Policy and associated gift register is available for inspection upon request.

Compliance Officer

Compliance Officer

Moonstone Information Refinery (Pty) Ltd
FSB Reg. No. 188 – Represented by Bronwen Allan

PO Box 12662, Die Boord, Stellenbosch, 7613

Tel: 021 883 8000
Fax: 086 601 9872
E-mail: ballan@moonstonecompliance.co.za
Website: www.moonstoneinfo.com

Your Insurer

Your Insurer

GENRIC Insurance Company Limited (Reg No. 2005/037828/06)
PO BOX 1115, Bromhof, 2154
Midrand Business Park, Building 3, 563 Old Pretoria Main Road, Midrand, 1685

Tel: 0861 44 44 62
Fax: 086 685 0357
FSP Registration Number: 43638
E-mail: info@genric.co.za
Website: www.genric.co.za

– We are in possession of Professional Indemnity Insurance.
– We do hold Fidelity Guarantee Insurance.
– We are in possession of a mandated to act on behalf of the insurer.
– A Conflict of Interest Management Policy and associated gift register is
available for inspection upon request.

Compliance Officer

Compliance Officer

Moonstone Information Refinery (Pty) Ltd
FSB Reg. No. 188 – Represented by Bronwen Allan

PO Box 12662, Die Boord, Stellenbosch, 7613

Tel: 021 883 8000
Fax: 086 601 9872
E-mail: ballan@moonstonecompliance.co.za
Website: www.moonstoneinfo.com

Other Matters of Importance

Other Matters of Importance

General
As a client, no product provider of FSP may request or induce you, in any manner whatsoever, to waive any right or benefit conferred on you, or in terms of, any provision of the FAIS Act and Codes of Conduct.

– You must be informed of any material changes to the information provided above.
– If the information above was given to you verbally, it must be confirmed to you in writing within 30 days.
– If any complaint of the broker or Insurer is not resolved to your satisfaction, you may submit a complaint to the Registrar of Short-term Insurance or to the FAIS Ombudsman.
– 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 the claim.
– If the premium is paid by debit order
i) It may only be in favour of one person and may not be transferred without your approval;
ii) The Insurer must inform you at least 30 days before the cancellation thereof, in writing, of its intention to cancel such debit order.
– The Insurer and not the Intermediary must give reasons for repudiating your
claim.
– If you need advice on any aspect of your Policy, First Amounts Payable, claims procedure or your responsibility to pay premiums, please contact your Broker or the Insurer at the above address.

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

Short-term Insurance Ombudsman
P.O. Box 32334, BRAAMFONTEIN, 2017
Sunnyside Office Park, 32 Princess of Wales Terrace, 5th Floor, Building D, Parktown, 2193

Tel: (011) 726-8900
Fax: (011) 726-5501
info@osti.co.za / www.osti.co.za

FAIS Ombudsman
P.O. Box 74571, LYNWOODRIF, 0040

Tel: (012) 470-9080 / 0860 432 766
Fax: (012) 348-3447
E-mail: info@faisombud.co.za
Website: www.faisombud.co.za

Registrar of Short-term Insurance
P.O. Box 35655
Menlo Park
0102

Tel: (012) 428-8000
Fax: (012) 347-0221

FAIS Compliance

FAIS Compliance

Further information in compliance with the Financial Advisory and Intermediary Services (FAIS) Act No. 37 of 2002 – Please read carefully.

Services the FSP is permitted to provide

Services the FSP is permitted to provide

Short-term Insurance (Personal Lines & Commercial Lines Policies) – Advice and
Intermediary Service The name, address and contact details of the product suppliers are provided in the documentation covering each of the products purchased and provided as accompanying documentation to your Finance Agreement, where applicable

All conditions or restrictions imposed by the product supplier are set out in the
applicable policy documentation.

Financial Products Provided

Financial Products Provided

The name, class or type of product and the nature and extent of the benefits provided are set out in the accompanying policy documentation provided by the product suppliers and include information about the nature and extent of their obligations to you and your obligations to them.

Customer Responsibility

Customer Responsibility

It is important that all of the information provided by you or on your behalf is complete and accurate. Should this not be so, the possible consequences of incomplete, missrepresented or non-disclosed information associated with your application include the cancellation of the products applied for and the forfeiture of any monies paid to date, the repudiation of all claims irrespective of their cause or nature, and the possible institution of criminal action against you.

Whilst reasonable steps have been taken to ensure that the products applied for by yourself are suitable for providing cover appropriate to the purchase you have made, no analysis of your financial needs or risk profile has or will be made by the FSP or those associated with it. It is therefore vital that you take particular care to ensure that the product or products you have purchased are appropriate and adequate for your needs.