Founding Affidavit and Annexures

Provisionsof theexistingPersonalAccidentRegulations ("PAR") 7of8 7.Exclusions TheBenefit shallnotbepayable if: (i) the Insured Life iskilled inan Accidentordies (whetherasa. resultof injuries incurred in the Accidentor fromany causewhatsoever)prior to thedateonwhicha Claim is submitted;or (ii) thePermanentDisabilitywas causedby, related toor in consequenceofwilfulexposure todanger;anyattempt to commit suicide; self-inflicted injury; war, invasion,actofa foreignenemy,hostilities (whetherwarbe declaredornot), civilwar,mutiny, insurrection, rebellion, revolution, militaryorusurpedpowerorparticipation ina riotor strike;ornuclear weapons, ionising radiationor contaminationby radio-activity fromany nuclear fuelornuclearwaste resulting from thecombustionofnuclear fuel (includingany self-sustainingprocessofnuclear fission). Benefitsarenotpayable in respectofPaid-upDependants (asdefined in theBBRs). 7.,9.,10. and Schedule2Claims Payableupon theoccurrenceofaPermanentDisabilityofan Insured Life. No claim shallbeconsideredby theTrustunlessaMemberhas submitted the relevantdocumentswithina12monthperiodafterDate ofAccident. Any claims submittedafter the12monthperiod fornot result in the Trustbeing liable topayabenefit. (a) Theclaim ispaidby theTrustonceapproved. TheTrust shallonlypaya singleBenefitAmount regardlessof the numberofClaimsmade. Claims shallbemadebyaMemberwithin12months fromDateof Accident. Claimsmustbe submitted toSDMor itsauthorisedagentataKganya InsuranceAdministratorsServiceCentreoranydesignatedofficeof SDM. Membersmust submit the followingdocumentation: (i) theClaimForm signedby thechurch committeeof theMember'sChurch; (ii) the IDof theMember; (iii)MembershipBook; (iv) thePersonalAccidentMedical Report;and (v) confirmationofbankaccount;and (vi)anyother documents requiredby theTrust (andasdeterminedby theTrust from time to timeandas setout in theSchedule to thePAR). Suchadditionaldocuments shall include the following in respectwhere: (i) the Insured Life isaDependant theoriginal IDorbirth certificateof suchDependant; (ii) the Insured Life isaDependantwho is25 yearsor older,proof that suchDependant isdependenton theMemberbecause ofmentaland/orphysicaldisability;and (iii)additionaldocumentsas requiredby theTrust suchasmarriagecertificates,adoption certificates,otherproof to show thatan Insured Lifewho isadoptedor doesnothave the same surnameas theMember isaDependant;a certified copyof theSAPSvehicleaccident report;and theSAPS case docketnumber. Wheremore thanoneClaim ismade in respectof the sameAccident and the same Insured Life, theTrust shalldetermine theMember entitled to thePersonalAccidentBenefit Theonusofproof restson theMember toprove theywereaMember inGoodStanding,ora child isaDependant, that thePermanent Disability in include inSchedule1 to thePARand that suchdisability isa PermanentDisability likely to continue for the restof the Insured Life's life. 8.1Member inGood Standing AMember inGoodStanding shallbeaMemberwho: (i)paid ContributionswithaDateofPayment in theMonth preceding the Month inwhich theDateofAccidentoccurred;or (ii)haspaida ContributionwithaDateofPayment in theMonth inwhich theDateof Accidentoccurredprovided theDateofPayment isprior to theDateof Accident. 8.2 ForgivenessRule Inaccordancewith theFinancialSectorCharterand theZimele standards, ifat the time the relevanteventoccurredgiving rise toa claimanyof theaboveReceiptswasnotpurchasedas required in these Regulations,aMemberwill, in certain circumstances,begranted leniencyandGoodStandingwillbedeemed.Therefore,missed Receiptswillbecondoneddependingon theMember'spayment record. ThenumberofReceiptspurchasedduring completed12-monthperiods calculated retrospectively (withamaximumof six completed12-month periods) from themonthofdeathwillbeconsidered.GoodStanding willbedeemedwhere theMemberpurchased11,22,33,44,55or66 Receipts in theprior12,24,36 ,48,60or72months. 12.Cancellation TheTrustmay terminate thePAR inwritingprovided thatwritten notice isgiven to theMembersataPaypoint.Notwithstanding such termination, theTrust shall remain liable forall claims thataroseprior to such termination. (b) Cooling-off rights This isnotprovided for in thePAR. 11.Amendments TheTrustmayamend thePAR inwriting in their solediscretionand shallhaveeffecton thedate indicated in thatamendmentoron signatureby theTrust. ComplaintsProcedure This isnotprovided for in thePAR. 13.Delegationand cession TheTrustmayappointanyadministrators toperformadministration services togiveeffect to thePAR.AMembermaynot cededorassign any rightsordutiesunder thePARor inaPersonalAccidentBenefit. UnclaimedBenefits This isnotprovided for in thePAR. Review of Changes to the Personal Accident Benefits of the Kganya Benefits Fund Trust Reasons formaterialdifferences a)Amended toprovide foramended insurance scheme.AlthoughSDM can, in termsof thecurrent insurance scheme,exercise the rights setouthere in termsof thegrouppolicies, theexerciseof such rightsbySDMwouldnotaffect theMembersor its vested rightsagainst theTrust,but rather the rightsof theTrust (asPolicyholder in termsof thegrouppolicy). It ishowevernecessary toprovide the insurerwith the rights includedhere in termsof the individualpolicy,and theprovisions complywith theapplicable laws. b)Seecommentata)above. *To theextentanydifferencesbetween theprovisionsof theexistingPersonalAccidentRegulationsand theproposedPukwanayaKganyaContractshavebeen identified thatdonotadverselyaffect the rightsof themembers to theKganyaBenefitsFundTrust, such changeshavebeenmarked inorange in the corresponding cellsbelow. **To theextentanydifferencesbetween theprovisionsof theexistingPersonalAccidentRegulationsand theproposedPukwanayaKganyaContractshavebeen identified thatdoadverselyaffect the rightsof themembers to theKganyaBenefitsFundTrust, such changeshavebeenmarked in red in the corresponding cellsbelow. ***Materialdifferencesor changes indicated in red shading shallbeaccompaniedbya letter referencing thematerialdifferenceor change in the leftmost columnof the tableand the corresponding letter referencing suchmaterialdifferenceor changewillbeaccompaniedbyanexplanation for thematerialdifferenceor change. ****Capitalised termsused in this comparison shallhave themeaningascribed to them in thedocuments considered in this comparison,unless indicatedotherwise Provisionsof thePukwanayaKganyaContract ("PYKContract") Par3 -11.Exclusions SDM shallnotpayanyPersonal AccidentBenefit if thePermanent Disabilitywas causedby, related toor in consequenceofwilfulexposure to danger;anyattempt to commit suicide; self-inflicted injury;war, invasion,actofa foreignenemy, hostilities (whetherwarbedeclared ornot), civilwar,mutiny, insurrection, rebellion, revolution, militaryorusurpedpoweror participation ina riotorunprotected strike;ornuclearweapons, ionising radiationor contaminationby radio- activity fromanynuclear fuelor nuclearwaste resulting from the combustionofnuclear fuel (including any self-sustainingprocessofnuclear fission). Part1 -6.1.61and 6.1.63andPart3 - 8.1.andAnnexeD. Determinationof personalaccident benefit Payableupon the occurrenceofa Permanent Disabilityofan Assured Life. Part1 -13.1.2andPart3 -8.3. Part1 -13.1.2and13.1.3 -SDMwillnotbe liable topayaClaim: (i) if theclaimwasnot made inaccordancewith thePYKContract oroutside the timeperdiodsprescribed;or (ii)Where the InsuredEventoccurred: (a) prior to the InceptionDate, (b)after cancellationof thePYKContract,or (c) after coverofanAssured Life ceases;or (iii)where apremiumhasnotbeenpaid, subject to the ForgivenessRulesor theWaitingPeriod still applies;or (iv) ifanAssured Life is subject to aWaitingPeriodasprovided for in termsof thePolicies,whereapplicableand the WaitingPeriodhasnotyetexpired. Part3 -8.3. . -SDM shallonlypay1 Claim perPermanentDisabilityCategory in respectofPermanentDisabilities incurredby anAssured Lifepursuant toanAccident, irrespectiveof thenumberofclaimsmade Part1 -13.4Claims Claims shallbe settled by the Insurerby electronic funds transfer ("EFT") into the bankaccount nominatedby the Beneficiaryupon submissionof the Claim. Thenominatedbank accountmustbeabank accountheldwitha SouthAfricanbank,and paymentwillbemade inSouthAfricanRands into suchbankaccount. Part1 -13.1.3Claims SDM reserves the right to cancel thePYKContract, repudiateaClaimand declareallPremiumspaid by theTrust in respectof thePolicies forfeited, should therebeevidence of,oranattempted submissionofa fictional claim, fraudor misrepresentationwhich fictional claim, fraudor misrepresentation materiallyaffects the Insurer'sability toassess the riskunder thePYK Contract. Part1 -13.2andPart3 -12.Claims Part1 -12.2andPart3.12. -Claimsmustbe submitted to SDM (or itsdulyappointedadministrator,Kganya InsuranceAdministrators)by theBeneficiarywithin12 monthsafter thehappeningofan InsuredEvent,which mustbe submittedwithallClaimsDocumentation. Part4 -12 ClaimsDocuments include: thePACNForm signedby3 CommitteeMembersandall suchdocumentsas setout in the form; theoriginalor certified copyof the IDof the Policyholder;confirmationofmembership to theTrust; originaland/or certified copyof thePaymentReceipt Booklet toverifyReceipts;a copyof thepolice report confirming theAccident resulting in thePermanent Disabilityof theAssured Life; theoriginalor certified copy of theMedicalReport; confirmationofbankaccount; if theAssured Life isaDependantChild: theoriginalor certified IDorbirth certificateof suchDependantChild; if theAssured Life isaDependantChildwho is25 yearsor older,proof that suchDependantChild isdependenton thePolicyholderbecauseofmentaland/orphysical disabilityand theoriginalor certified copyof the ID documentorbirthcertificate;and (iii)additional documentsas requiredby theTrust suchasmarriage certificates,adoption certificates,otherproof sufficient to show thatanAssured LifeDependentChildwho is adoptedordoesnothave the same surnameas the Policyholder, isaDependentChilld;andanyother documents requiredby theTrust Part1 -13.2.2 Claims AClaimmaybe repudiatedby SDM ifaClaim is madeafter12 (twelve)Months form the Insured Eventand/or if not supported withall the relevantClaims Documentation Part1 -13.2.3Claims Claimsmustbe submitted toSDMor itsappointed administrator,Kganya Insurance Administratorsata Kganya Insurance AdministratorsService Centre, thedetailsof which canbe foundon thewebsiteofKganya Insurance Administratorsat https://mykganya.co moranydesignated officeofSDM. Part1 -13.3Claims Ifdisputedor rejected, SDMwillgivea noticeof such rejection settingout the reasons.TheBeneficiarymaymake representationswithin90days regarding thisdecision.Failure tomake representationswill result inSDMnot being liable topayaClaim. If theBeneficiarymakes representations toSDMwill, SDM shall inform the Beneficiaryof itsdecisionwithin45days after receiving representations. All claimsare timebarredafteraperiod of12months tobeheard in court in order todetermineSDM's liability.This periodwillbe suspended for90days duringwhich theBeneficiary canmake representationsandprovided that the Beneficiary shallatall timeshaveat least 6monthsafter this90dayperiod to institutecourtproceedings. Part3 -8.5.and8.6Member in Good Standing SDM shallonlypayaPersonal AccidentBenefit in theeventofa PermanentDisabilityofanAssured Life if: (i)1Premium is recordedby SDMor itsdulyappointed administrator,Kganya Insurance Administratorsa)withaDateof Payment in theMonthpreceding theMonth inwhich theDateof PermanentDisabilityoccurred,orb) withaDateofPayment isin the Month inwhich theDateof PermanentDisabilityoccurredof butbefore theDateofPermanent Disability;and (ii)All Premiums recordedbySDM (or itsduly appointedadministrator,Kganya InsuranceAdministrators) shallbe paid toSDM inaccordancewith the termsof thePremiumPayment Agreement. Part1 -9.3andAnnexeEForgivenessRules In theeventofnon-paymentofaPremium ifaPolicyholder, noBenefit shallbepaidunless: (i) the requirementsofPart2, clause2.3and2.4 in relation toFuneralBenefitsaremet;or (ii) theForgivenessRules canbeapplied in respectofaMissed Premium. TheForgivenessRulesare informedby theprinciplesof“Treat YourCustomerFairly”andwas formulated togranta Policyholdera concessionwhenaClaim fora FuneralBenefits orPersonalAccidentorDreadDiseaseBenefits is submitted to the Insurer.TheForgivenessRulesprovide for leniencyby considering theconsistencyof thePremiumpaymenthistory of thePolicyholder (with reference tohis/herpaymentof MembershipContributionsas contained in thePayment ReceiptBooklet) (i)where theClaimwouldordinarilybe declinedupon theapplicationof theprovisionsof clause8.2 ofPart I;andupon submissionof theClaim, in considering the applicationof theForgivenessRules, thePYKContractmust havebeen in force foroneormorecompleted12 (twelve) Monthcycles ("Periods").ThenumberofPeriods is calculated backwards fromand including theMonthprior to theMonth inwhich the InsuredEventoccurred, toand including the Monthof the InceptionDate. In suchevent, SDM shall considerwhether thePolicyholder has the requirednumberofPremiumspaidas specified in the tableprovided for inAnnexeE foreachof thePeriods, calculated.ThePolicyholder shall therebybeallowed such numberofMissedPremiumsas specified in the table setout inAnnexeR,withoutaffecting thepaymentofBenefitseven whereaPremiummayhavebeenmissed. Part1 -16.and17.Cancellation SDMhas the right to terminate thepolicyby31days' writtennotice to thepolicyholder in theevent that: (i)any fraud is committed in respectof theconclusionand/or maintainingof thePYKContract,orClaims submitted in termsof thePYKContract; (ii) in theeventof falseand/or untrue representationsweremade toSDM (and/or its administrator)or ifmaterial informationwasnot disclosed thatmayaffectSDM'sability toassess risk (such asmisrepresentationof theageorMembershipof the Policyholder); (iii) termination is requiredbya change in lawwhich cannotbe remedied throughanamendment; (iv) thepolicyholderno longerqualifiesasaMemberof theTrust;and (v) if theTrustand/orSDM terminates the PremiumPaymentAgreementand/or its relationship for whatever reason. This cancellation shallnotaffect (i) thebenefitspayable bySDM (asapproved)prior to thedateofcancellation;or (ii)Claims if the InsuredEventsoccurredprior to thedate ofcancellation (provided thatSDM receivesnoticeof such InsuredEventwithinwithin12months from the occurenceof the InsuredEvent).NoBenefit shallbe payablewhere the InsuredEventoccursafter the cancellationof thePYKContract. In theevent that thePremiumPaymentAgreement and/or relationshipbetweenSDM and theTrust is cancelled forany reasonwhatsoever, thePukwana ya KganyaContractwill terminateat the same time. Part1 -18.Coolingoff rights Apolicyholderhasa coolingoff right foraperiodof 31days from the InceptionDate,unlessaBenefit hasbeen claimedorpaid,oran InsuredEventhas occurred ("coolingoffperiod"). If thePolicyholder elects to cancel thisPukwana yaKganyaContractas contemplated in clause18.1of thisPart I . In such anevent, it shallbedeemed that theMember similarlyexercisedhis/her cooling-off rights in terms ofhis/herMembership to theKganyaBenefitsFund Trust,asprovided for in theMasterRegulations, whereby cover in termsof thePYKContractand Membership to theTrustwill come toanendat the same time. ThePolicyholdermust submit such cancellation instruction toSDMor itsdulyappointed administrator,Kganya InsuranceAdministrators, provided thatnotice to the Trust for cancellationof his/herMembership, shallbedeemed toalsobe notice toSDM. Premiumspaidafter theEffectiveDate in respectof anExistingMember shallbe refunded in full to the Trustpursuant toaPolicyholderexercising the cooling-off rightsduring thecoolingoffperiod in accordancewith the termsof thePremiumPayment Agreement.TheMembershipContributionwill similarlybe refunded to thePolicyholderas Member, in termsof theMasterRegulations. Part1 -14.Amendments SDM isentitled toamendanyprovisionof thePYKContract (and, for theavoidanceof doubt, thePolicies formingpart thereof)by giving31days'writtennotice to the policyholder. SDMmayalsoamend thePYK Contractas itdeemsnecessary togive affect toa change in lawwhich impacts the PYKContract. Anyamendmentswhich changes the Benefitspayableunder thepolicywillnot affectClaims in respectofan InsuredEvent thatoccurredprior to suchamendment. Anyamendment shallhaveeffect from the date indicatedbySDM inanotice to the policyholder. Apolicyholdermayalsoamendmentany information inMPPFormand/or the PaymentReceiptBookletby (i)completing anAMPPand submitting it toSDM'sduly appointedadministrator,Kganya Insurance Administrators,or through theChurch Branches;and/or (ii)by calling thecall centreof the Insurer'sdulyappointed administrator,Kganya Insurance Administrators. Part1 -19.Complaintsprocedure ThePYKContractprovides foraprocedure throughwhicha policyholdermay lodgea complaintwithSDM and further informs thepolicyholdersof its right toapproach theLong- TermOmbudsman, theFAISOmbudor theFinancialSector ConductAuthority. In theeventofa complaint, sucha complaintmustbedealt with in termsofSDM's complaintsprocedureapplicableat thedateof the lodgingof thecomplaint. 19.2A complaintmaybe lodged in the followingmanner: (i)By contacting SDMon (011)3593014oremailing gbcomplaints@sanlamsky.co.zaor the Insurer'sduly appointedadministratorKganya InsuranceAdministrators on telephonenumber0800000538or viaemailat complaints@kganya.co.zaandhav e the following informationavailable:Policynumberas contained in the MembershipBook (referred toasControlNumber), Identity numberof thePolicyholder;andNatureofenquiryand/or complaint; (ii)Complaintswhicharenot resolved to the Policyholder’s satisfactionmust firstbe referred toSDM's Legal&Compliancedepartment; (iii)Complaintswhichare stillnot resolved to thePolicyholder’s satisfactionmaybe referred toSDM'sarbitrator; (iv)Complaintswhichare still not resolvedmaybe referred to theOmbudsman for Long- term Insurance, theFAISOmbudor theFinancialSector ConductAuthority. Part1 -21.4 Delegationand cession Other thanas contemplated in clause7.4.4of Part IV, thePolicy oranyBenefitmay notbecededor assigned. Part1 -20UnclaimedBenefits AnunclaimedBenefit iswhen the Insurerbecomesaware that there isaClaim foraBenefit to bepaid,but theBeneficiary cannotbe found topay theClaim. In suchcase, the Insurerwill start theprocessof tracing the Beneficiary. If theprocessdoesnotmatch the rightfulownerwith theBenefit, the Insurer shall repeat the tracingprocesswithina3 (three) yearperiodandagainwithin10 (ten)years if theBenefit remains unclaimed.