Thari ya Baruti Terms & Conditions

56 9.2.4 The Insurer shall, following the outcome of the review mentioned above, be entitled to change the Premium and the Additional Premium with effect from the date as specified by the Insurer, by giving 31 (thirty-one) days prior written notice to the Policyholder, subject at all times to the Applicable Laws. 9.3 Non-payment of Premiums and Additional Premiums and Forgiveness Rules 9.3.1 In the event of non-payment of a Premium and/or Additional Premium of a Policyholder referred to in clause 9.1.5 of Part I, no Benefits shall be paid in respect of such Policyholder unless - 9.3.1.1 the requirements of clause 8.2 of this Part I are met; or 9.3.1.2 the Forgiveness Rules as set out in Annexe E.5 can be applied in respect of the Missed Premium(s). 9.3.2 If the requirements set out in clause 9.3.1 are not met, then no Benefits will be paid by the Insurer in respect of the Policyholder upon the happening of an Insured Event. 10. Exclusions and limitation s All exclusions and limitations applicable to the Policies are set out in Part II and Part III, respectively. 11. Waiting Periods 11.1 The Waiting Periods in terms of the Policies, if applicable, are as set out in Part II and Part III below. 11.2 As provided for in clause 8.2 of this Part I, payment of Benefits will always depend on whether or not the applicable Waiting Period in terms of the Policies has ended. 11.3 If the Insured Event happens during the Waiting Period (i.e before the Waiting Period has ended) (if applicable in terms of the Policies), the Benefits will not be paid. 12. Dependent Children 12.1 A Dependent Child in relation to a Policyholder is the following persons: 12.1.1 a child born to the Policyholder, subject to the provisions of clause 12.4 of this Part I; 12.1.2 a legally adopted child of the Policyholder; 12.1.3 a child adopted by custom (provided that both natural parents are deceased) by the Policyholder, who are indicated as Dependent Children in the Payment Receipt Booklet, but excludes – 12.1.4 a child who survives a Policyholder and does not qualify as a Paid-up Dependant; 12.1.5 a child of any Dependent Child of a Policyholder (i.e. grandchildren); or 12.1.6 a child who is 25 (twenty-five) years or older, subject to clause 12.2 of this Part I. 12.2 Notwithstanding the provisions of clause 12.1.6 above, a child who is 25 (twenty-five) years or older and permanently dependent on the Policyholder because of mental and/or physical disability, will qualify as a Dependent Child if - 12.2.1 the mental and/or physical disability existed or occurred whilst the child otherwise qualified as a Dependent Child; and 12.2.2 at least 1 (one) Premium was paid by the Kganya Benefits Fund Trust in respect of the Policyholder prior to the date the child would otherwise cease to qualify as a Dependent Child. 12.3 New-born children born to the Policyholder and children adopted by the Policyholder must be indicated in the Payment Receipt Booklet within 6 (six) Months after the date of birth or adoption, as the case may be. 12.4 A child of a Policyholder (who is the father) shall not be a Dependent Child of the Policyholder unless – 12.4.1 the natural mother is (i) deceased, or (ii) not a Member of the ZCC; or 12.4.2 the Policyholder is the legal guardian of such a child. 12.5 The Policyholder shall provide all such documentary and other evidence, as may be required by the Insurer from time to time, to establish whether a child qualifies as a Dependent Child for purposes of this Thari ya Baruti Pukwana ya Kganya Contract. 13. Claims 13.1 Liability for Claims 13.1.1 The Beneficiary shall follow the claims procedure as set out in this Thari ya Baruti Pukwana ya Kganya Contract in the event of a Claim in relation to an Assured Life. 13.1.2 The Insurer shall not be liable for a Claim - 13.1.2.1 where such Claim is not submitted in accordance with the provisions of this Thari ya Baruti Pukwana ya Kganya Contract, or outside the time periods prescribed; 13.1.2.2 where the Insured Event occurred - 13.1.2.2.1 prior to the Inception Date; or 13.1.2.2.2 after cancellation of this Thari ya Baruti Pukwana ya Kganya Contract; or 13.1.2.2.3 after cover in respect of an Assured Life in accordance with the terms and conditions of the Policies, has ceased; 13.1.2.3 in instances where a Premium and/or an Additional Premium in respect of a Policyholder is not paid, thereby constituting a Missed Premium, subject to - 13.1.2.3.1 the provisions of clause 8.2 of this Part I; and 13.1.2.3.2 the Forgiveness Rules, 13.1.2.4 if an Assured Life is subject to a Waiting Period as provided for in terms of the Policies, where applicable, and the Waiting Period has not yet expired. 13.1.3 Notwithstanding the provisions of this Thari ya Baruti Pukwana ya Kganya Contract relating to Claims, the Insurer reserves the right to cancel this Thari ya Baruti Pukwana ya Kganya Contract, repudiate a Claim and declare all Premiums and Additional Premiums paid by the Kganya Benefits Fund Trust in respect of the Policies forfeited, should there be evidence of, or an attempted submission of a fictional claim, fraud or misrepresentation which fictional claim, fraud or misrepresentation materially affects the Insurer’s ability to assess the risk under this Thari ya Baruti Pukwana ya Kganya Contract. 13.2 Submission of Claims 13.2.1 Claims must be submitted by the Beneficiary to the Insurer (or its duly appointed administrator, Kganya Insurance Administrators) i) within a period of 12 (twelve) Months after the happening of the Insured Event, and ii) must include the submission of all the Claim Documents as required in terms of the Policies.