Pukwana ya Kganya Terms & Conditions

59 8.5.1.1 with a Date of Payment in the Month preceding the Month in which the Date of Permanent Disability occurred; or 8.5.1.2 with a Date of Payment in the Month in which the Date of Permanent Disability occurred but before the Date of Permanent Disability. 8.6 All Premiums recorded by the Insurer (or its duly appointed administrator, Kganya Insurance Administrators) shall be paid to the Insurer in accordance with the terms of the Premium Payment Agreement. 9. Death of a Assured Life 9.1 The Insurer shall not pay any Personal Accident Benefits if the Assured Life dies (whether as a result of the Insured Event or any cause whatsoever) prior to the date on which the claim for a Personal Accident Benefit is submitted. 9.2 In the event that the Insurer accepts a claim for Personal Accident Benefits in respect of a Dependent Child, and the Policyholder dies, the Insurer shall make payment of the Personal Accident Benefits to the Beneficiary (as contemplated in the Funeral Policy), in addition to any claims payable in terms of the Funeral Policy. 9.3 In the event that the Insurer accepts a claim for Personal Accident Benefits in respect of a Policyholder, and the Policyholder dies, the Insurer shall make payment of the Personal Accident Benefits to the Beneficiary (as contemplated in the Funeral Policy), in addition to any claims payable in terms of the Funeral Policy. 9.4 In the event that the Insurer accepts a claim for Personal Accident Benefits in respect of a Dependent Child, and the Dependent Child dies, the Insurer shall make payment of the Personal Accident Benefits to the Beneficiary (as contemplated in the Funeral Policy), in addition to any claims payable in terms of the Funeral Policy. 10. Waiting Period No Waiting Period is applied by the Insurer in respect of the Personal Accident Benefits in terms of this Dread Disease and Personal Accident Policy. 11. Exclusions and Limitations 11.1 The Insurer shall not pay any Personal Accident Benefit if the Permanent Disability was caused by, related to or in consequence of - 11.1.1 wilful exposure to danger; 11.1.2 any attempt to commit suicide; 11.1.3 self-inflicted injury; 11.1.4 war, invasion, act of a foreign enemy, hostilities (whether war be declared or not), civil war, mutiny, insurrection, rebellion, revolution, military or usurped power or participation in a riot or unprotected strike; or 11.1.5 nuclear weapons, ionising radiation or contamination by radio-activity from any nuclear fuel or nuclear waste resulting from the combustion of nuclear fuel (including any self-sustaining process of nuclear fission). 12. Claim documents for Personal Accident Benefits 12.1 Without limitation to the provisions of clause 13 of Part I, the following Claim Documents must be submitted to the Insurer in respect of a claim for Personal Accident Benefits: 12.1.1 PACN Form signed by 3 (three) Committee Members and all such documents as set out in the PACN Form. In the event that the Committee Members are unable or unwilling for whatsoever reason to sign the PACN Form, the Beneficiary can approach the Insurer directly with such claim, or lodge a complaint as contemplated in clause 19 of Part I; 12.1.2 original or certified copy of the Medical Report; 12.1.3 original or certified copy of the identity document or identity card (copied both sides) of the Policyholder; 12.1.4 confirmation of Membership to the Kganya Benefits Fund Trust; 12.1.5 original and/or certified copy of the Payment Receipt Booklet to verify Receipts; 12.1.6 a copy of the police report confirming the Accident resulting in the Permanent Disability of the Assured Life; 12.1.7 confirmation of bank account into which the Personal Accident Benefits must be paid; 12.1.8 where the Assured Life is - 12.1.8.1 a Dependent Child, the original or certified copy of the identity document, identity card (copied both sides) or birth certificate of the Dependent Child; 12.1.8.2 a Dependent Child who is 25 (twenty-five) years or older, the original or certified copy of the identity document, identity card (copied both sides) or the birth certificate the Dependent Child as well as proof of the mental and/or physical disability of such Dependent Child; and 12.1.9 any other documents required by the Insurer from time to time including but not limited to a marriage certificate, adoption certificate or other proof sufficient to show that a Dependent Child who is adopted or does not have the same surname as the Policyholder, is a Dependent Child. 13. Cessation of cover for Personal Accident Benefits in terms of the Dread Disease and Personal Accident Policy 13.1 Insurance cover ceases for Personal Accident Benefits in terms of the Dread Disease and Personal Accident Policy if - 13.1.1 this Pukwana ya Kganya Contract is cancelled; or 13.1.2 the Policyholder ceases to be a Member of the Kganya Benefits Fund Trust in accordance with the terms of the Master Regulations, read with the Basic Benefits Regulations; or 13.1.3 upon the death of the Policyholder; or 13.1.4 the Kganya Benefits Fund Trust fails to pay the Premiums in respect of the Assured Lives as a result of the Policyholder’s failure, as a Member to pay his/ her Membership Contribution, subject at all times to the Forgiveness Rules. PART IV: TERMS AND CONDITIONS APPLICABLE ONLY TO EXISTING MEMBERS 1. Introduction 1.1 This Pukwana ya Kganya Contract comprises Part I, Part II, Part III and this Part IV. 1.2 Part IV applies only in respect of Members who acquired Membership to the Kganya Benefits Fund Trust before the Effective Date, being the Existing Members. 1.3 This Part IV provides the additional terms and conditions applicable to all Existing Members who are Policyholders in terms of this Pukwana ya Kganya Contract, and must be read with Part I, Part II and Part III. 1.4 All capitalised terms defined in Part I, Part II and Part III bear the same meaning in this Part IV.