Founding Affidavit and Annexures

Provisionsof theexistingPersonalAccidentRegulations ("PAR") 9of11 7.Exclusions TheBenefit shallnotbepayable if: (i) the Insured Life iskilled in anAccidentordies (whetherasa. resultof injuries incurred in theAccidentor fromany causewhatsoever)prior to thedate onwhichaClaim is submitted;or (ii) thePermanentDisability was causedby, related toor in consequenceofwilfulexposure todanger;anyattempt to commit suicide; self-inflicted injury; war, invasion,actofa foreignenemy,hostilities (whetherwar bedeclaredornot), civilwar,mutiny, insurrection, rebellion, revolution,militaryorusurpedpowerorparticipation ina riot or strike;ornuclearweapons, ionising radiationor contaminationby radio-activity fromanynuclear fuelor nuclearwaste resulting from thecombustionofnuclear fuel (includingany self-sustainingprocessofnuclear fission). Benefitsarenotpayable in respectofPaid-upDependants (as defined in theBBRs). 7.Claims (TYBR)and7.,9.,10. andSchedule2Claims A claim foranAdditionalPersonalAccidentBenefitmustbe in termsof thePAR Payableupon theoccurrenceofaPermanentDisabilityofan Insured Life. No claim shallbe consideredby theTrustunlessaMemberhas submitted the relevantdocumentswithina12monthperiod afterDateofAccident. Any claims submittedafter the12monthperiod fornot result in theTrustbeing liable topayabenefit. (a) Theclaim ispaidby theTrustonceapproved. TheTrust shallonlypaya singleBenefitAmount regardlessof thenumberofClaimsmade. Claims shallbemadebyaMemberwithin12months fromDate ofAccident. Claimsmustbe submitted toSDMor itsauthorisedagentata Kganya InsuranceAdministratorsServiceCentreorany designatedofficeof SDM. Membersmust submit the followingdocumentation: (i) the ClaimForm signedby the church committeeof theMember's Church; (ii) the IDof theMember; (iii)MembershipBook; (iv) thePersonalAccidentMedicalReport;and (v)confirmationof bankaccount;and (vi)anyotherdocuments requiredby the Trust (andasdeterminedby theTrust from time to timeandas setout in theSchedule to thePAR). Suchadditionaldocuments shall include the following in respectwhere: (i) the Insured Life isaDependant theoriginal ID orbirth certificateof suchDependant; (ii) the Insured Life isa Dependantwho is25yearsorolder,proof that such Dependant isdependenton theMemberbecauseofmental and/orphysicaldisability;and (iii)additionaldocumentsas requiredby theTrust suchasmarriagecertificates,adoption certificates,otherproof to show thatan Insured Lifewho is adoptedordoesnothave the same surnameas theMember is aDependant;acertified copyof theSAPSvehicleaccident report;and theSAPS casedocketnumber. Wheremore thanoneClaim ismade in respectof the same Accidentand the same Insured Life, theTrust shalldetermine theMemberentitled to thePersonalAccidentBenefit Theonusofproof restson theMember toprove theywerea Member inGoodStanding,orachild isaDependant, that the PermanentDisability in include inSchedule1 to thePARand that suchdisability isaPermanentDisability likely to continue for the restof the Insured Life's life. 8.1Member inGoodStanding AMember inGood Standing shallbeaMemberwho: (i)paid ContributionswithaDateofPayment in theMonth preceding theMonth inwhich theDateofAccidentoccurred;or (ii)has paidaContributionwithaDateofPayment in theMonth in which theDateofAccidentoccurredprovided theDateof Payment isprior to theDateofAccident. 8.2ForgivenessRule Inaccordancewith theFinancialSectorCharterand theZimele standards, ifat the time the relevanteventoccurredgiving rise toaclaimanyof theaboveReceiptswasnotpurchasedas required in theseRegulations,aMemberwill, in certain circumstances,begranted leniencyandGoodStandingwillbe deemed.Therefore,missedReceiptswillbe condoned dependingon theMember'spayment record. ThenumberofReceiptspurchasedduringcompleted12- monthperiods calculated retrospectively (withamaximumof sixcompleted12-monthperiods) from themonthofdeathwill beconsidered.Good Standingwillbedeemedwhere the Memberpurchased11,22,33,44,55or66Receipts in theprior 12,24,36 ,48,60or72months. 12.Cancellation TheTrustmay terminate thePAR inwritingprovided that writtennotice isgiven to theMembersataPaypoint. Notwithstanding such termination, theTrust shall remain liable forallclaims thataroseprior to such termination. (b) Cooling-off rights This isnotprovided for in thePAR. 11.Amendments TheTrustmayamend thePAR inwriting in their solediscretion and shallhaveeffecton thedate indicated in thatamendment oron signatureby theTrust. ComplaintsProcedure This isnotprovided for in thePAR. 13.Delegationand cession TheTrustmayappointanyadministrators toperform administration services togiveeffect to thePAR.AMember maynotcededorassignany rightsordutiesunder thePARor inaPersonalAccidentBenefit. Part1 -16.and17.Cancellation SDMhas the right to terminate thepolicyby31days' writtennotice to thepolicyholder in theevent that: (i)any fraud iscommitted in respectof the conclusionand/or maintainingof theTYBContract,orClaims submitted in termsof theTYBContract; (ii) in theeventof falseand/or untrue representationsweremade toSDM (and/or to its administrator)or ifmaterial informationwasnotdisclosed thatmayaffectSDM'sability toassess risk (suchas misrepresentationof theageorMembershipof the Policyholder); (iii) termination is requiredbyachange in law which cannotbe remedied throughanamendment; (iv) the policyholderno longerqualifiesasaMemberof theTrust; and (v) if theTrustand/or SDM terminates its relationship forwhatever reason. This cancellation shallnotaffect (i) thebenefitspayableby SDM (asapproved)prior to thedateof cancellation;or (ii) Claims if the InsuredEventsoccurredprior to thedateof cancellation (provided thatSDM receivesnoticeof such InsuredEventwithinacertainperiodafter the Insured Event.NoBenefit shallbepayablewhere the InsuredEvent occursafter the cancellationof theTYBContract. In theevent that the thePremiumPaymentAgreementor relationshipbetweenSDMand theTrust is cancelled for any reasonwhatsoever, thePukwanayaKganyaContract will terminateat the same time. Part1 -18.Coolingoff rights Apolicyholderhasacoolingoff right foraperiodof 31days from the InceptionDate,unlessaBenefithas been claimedorpaid,oran InsuredEventhas occurred ("coolingoffperiod"). In suchanevent, it shallbedeemed that theMember similarlyexercised his/her cooling-off rights in termsofhis/her Membership to theKganyaBenefitsFundTrust,as provided for in theMasterRegulations,whereby cover in termsof theTYBContractandMembership to theTrustwillcome 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. PremiumsandAdditionalPremiumspaidafetr the EffectiveDate shallbe refunded in full to theTrust pursuant toaPolicyholderexercising the cooling-off rightsduring the coolingoffperiod inaccordance with the termsof thePremiumPaymentAgreement. TheMembershipContributionwill similarlybe refunded to thePolicyholderasMember, in termsof theMasterRegulations. Part1 -14.Amendments SDM isentitled toamendanyprovisionof the TYBContract (and, for theavoidanceofdoubt, thePolicies formingpart thereof)by giving31 days'writtennotice to thepolicyholder.SDM mayalsoamend theTYBContractas itdeems necessary togiveaffect toachange in law which impacts theTYBContract. Anyamendmentswhich changes theBenefits payableunder thepolicywillnotaffectClaims in respectofan InsuredEvent thatoccurred prior to suchamendment. Anyamendment shallhaveeffect from the date indicatedbySDM inanotice to the policyholder. Apolicyholdermayalsoamendmentany information inMPPFormand/or thePayment ReceiptBookletby (i)completinganAMPPand submitting it toSDM'sdulyappointed administrator,or through theChurch Branches;and/or (ii)by calling the callcentre of the Insurer'sdulyappointedadministrator. Part1 -19.Complaintsprocedure TheTYBContractprovides foraprocedure throughwhicha policyholdermay lodgeacomplaintwithSDMand further informs thepolicyholdersof its right toapproach the Long-Term Ombudsman, theFAISOmbudor theFinancialSectorConduct Authority. In theeventofacomplaint, suchacomplaintmustbedealtwith in termsofSDM's complaintsprocedureapplicableat thedate of the lodgingof the complaint. A complaintmaybe lodged in the followingmanner: (i)By contactingSDMon (011)3593014oremailing gbcomplaints@sanlamsky.co.za; or the Insurer'sdulyappointed administratorKganya InsuranceAdministratorson telephone number0800000538orviaemailatcomplaints@kganya.co.za andhave the following informationavailable:Policynumberas contained in theMembershipBook (referred toasControl Number), Identitynumberof thePolicyholder; andNatureof enquiryand/or complaint; (ii)Complaintswhicharenot resolved to thePolicyholder’s satisfactionmust firstbe referred toSDM's Legal&Compliancedepartment; (iii)Complaints whichare stillnot resolved to thePolicyholder’s satisfaction maybe referred toSDM'sarbitrator; (iv)Complaintswhichare stillnot resolvedmaybe referred to theOmbudsman for Long- term Insurance, theFAISOmbudor theFinancialSector ConductAuthority. Part1 -21.4 Delegationand cession Other thanas contemplated in clause7.4ofPart IV thePolicyor anyBenefitmay notbe cededor assigned. ReviewofChanges to thePersonal AccidentBenefitsof theKganyaBenefitsFund Trust Reasons formaterialdifferences a)Amended toprovide foramended insurance scheme.AlthoughSDM can, in termsof the current insurance scheme,exercise the rights setouthere in termsof thegrouppolicies, theexerciseof such rightsby SDMwouldnotaffect theMembersor itsvested 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)See commentata)above. *To theextentanydifferencesbetween theprovisionsof theexistingPersonalAccidentRegulationsand theproposedThariyaBarutiPukwanayaKganyaContractshavebeen identified thatdonotadverselyaffect the rightsof themembers to theKganyaBenefitsFundTrust, such changeshavebeenmarked inorange in the corresponding cellsbelow. **To theextentanydifferencesbetween theprovisionsof theexistingPersonalAccidentRegulationsand theproposedThariyaBarutiPukwanayaKganyaContractshavebeen 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 theThariYaBarutiPukwanaYaKganyaContract ("TYBContract") Par3 -11.Exclusions SDM shallnotpayany PersonalAccidentBenefitor AdditionalPersonalAccident Benefit if thePermanent Disabilitywas causedby, related toor in consequence ofwilfulexposure todanger; anyattempt to commit suicide; self-inflicted injury; war, invasion,actofa foreign enemy,hostilities (whether warbedeclaredornot),civil war,mutiny, insurrection, rebellion, revolution,military orusurpedpoweror participation ina riotor strike; ornuclearweapons, ionising radiationor contaminationby radio-activity fromanynuclear fuelornuclearwaste resulting from the combustionof nuclear fuel (includingany self- sustainingprocessofnuclear fission). Part1 -6.1.65and 6.1.66andPart3 - 8.1.andAnnexeD. Determinationof personalaccident benefit Payableupon the occurrenceofa PermanentDisability ofanAssured Life. Part1 -13andPart3 -8.3. Part1 -13 - SDMwillnotbe liable topayaClaim: (i) if theclaimwas notmade inaccordancewith the TYBContract;or (ii)Where the InsuredEventoccurred: (a)prior to the InceptionDate, (b)after cancellationof theTYBContract, or (c) after coverofanAssured Life ceases;or (iii)wherea premiumadnadditionalpremium hasnotbeenpaid, subject to the ForgivenessRulesor theWaiting Period stillapplies;or (iv) ifan Assured Life is subject toa WaitingPeriodasprovided for in termsof thePolicies,where applicable. Part3 -8.3. . - SDM shallonlypay 1 claim forBenefits in respectof PermanentDisabilities incurred byanAssured Lifepursuant toan Accident, irrespectiveof the numberof claimsmade Part1 -13.4Claims Claims shallbe settled by the Insurerby electronic funds transfer ("EFT") into thebankaccount nominatedby the Beneficiaryupon submissionof the Claim. Thenominatedbank accountmustbea bankaccountheld withaSouthAfrican bank,andpayment willbemade inSouth AfricanRands into suchbankaccount. Part1 -13.1.3Claims SDM reserves the right to cancel theTYB Contract, repudiatea Claimanddeclareall Premiumsadn AdditionalPremiums paidby theTrust in respectof thePolicies forfeited, should there beevidenceof,oran attempted submission ofa fictionalclaim, fraudor misrepresentation which fictionalclaim, fraudor misrepresentation materiallyaffects the Insurer'sability to assess the riskunder theTYBContract. Part1 -13.2andPart3 -12.Claims Part1 -13.2andPart3.12. - Submitted toSDM (or its dulyappointedadministrator,Kganya Insurance Administrators)by theBeneficiarywithin12months after thehappeningofan InsuredEvent,whichmust be submittedwithallClaimsDocumentation, Claimdocuments include: (i) theClaimForm signedby 3CommitteeMembersandallsuchdocumentsas set out in the form; (ii) theoriginalor certified copyof the IDof thePolicyholder; (iii)confirmationof membership to theTrust; (iv) theoriginalor certified copyof theMedicalReport;and (v)confirmationof bankaccount; (vi)acopyof thepolice report confirming theAccident resulting in thePermanent Disabilityof theAssured Life; and (vii)anyother documents requiredby theSDM. Part3 -12. - Suchadditionaldocuments shall include the following in respectwhere: (i) theAssured Life isa DependantChild: theoriginalor certified IDorbirth certificateof suchDependantChild; (ii) theAssured Life isaDependantChildwho is25yearsorolder, proof that suchDependantChild isdependenton the Policyholderbecauseofmentaland/orphysical disabilityand theoriginalor certified copyof the ID documentorbirth certificate;and (iii)additional documentsas requiredby theTrust suchasmarriage certificates,adoption certificates,otherproof sufficient to show thatanAssured LifeDependent Childwho isadoptedordoesnothave the same surnameas thePolicyholder, isaDependentChild. 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 Administrators ServiceCentre, the detailsofwhich can be foundon the websiteofKganya Insurance Administratorat https://mykganya.co moranydesignated officeof SDM. 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. Allclaimsare 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 inGoodStanding It is recorded for the sakeof clarity that: thePersonalAccidentBenefitsarepayable in respectofallAssured Lives;and theAdditionalPersonalAccidentBenefitsare payableonly in respectof thePolicyholderas Assured Life. SDM shallonlypayAdditionalPersonalAccident Benefits in theeventofaPermanentDisability ofanAssured Life if: (i)1Premiumand AdditionalPremium is recordedbySDMor its dulyappointedadministrator,Kganya Insurance Administrators,withaDateofPaymenteither in theMonthpreceding theMonth inwhich the DateofPermanentDisabilityoccurred,orwitha DateofPayment in theMonth inwhich theDate ofPermanentDisabilityoccurredofbutbefore theDateofPermanentDisability;and (ii)All PremiumsandAdditionalPremiums recordedby SDM (or itsdulyappointedadministrator,Kganya InsuranceAdministrators) shallbepaid toSDM in accordancewith the termsof thePremium PaymentAgreement. Part1 -9.3andAnnexeEForgivenessRules In theeventofnon-paymentofaPremiumorAdditional PremiumsofaPolicyholder,noBenefit shallbepaidunless: (i) the requirementsofPart1clause8.2of theTYBContractare met;or (ii) theForgivenessRules setout inAnnexeE canbe applied in respectofaMissedPremium(s). TheForgivenessRulesare informedby theprinciplesof “Treat YourCustomer Fairly”andwas formulated togranta PolicyholderaconcessionwhenaClaim foraThariyaBaruti DreadDiseaseBenefit is submitted to the Insurer.The ForgivenessRulesprovide for leniencyby considering the consistencyof thePremiumpaymenthistoryof the Policyholder (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, theTYBContractmust havebeen in force foroneormorecompleted12 (twelve) Month cycles ("Periods").ThenumberofPeriods is calculated backwards fromand including theMonthprior to theMonth inwhich the InsuredEventoccurred, toand including the Monthof the InceptionDate. In suchevent,SDM shallconsiderwhether 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.