Thari ya Baruti Terms & Conditions

61 7. Claim Documents for Thari ya Baruti Funeral Benefi t 7.1 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 a Thari ya Baruti Funeral Benefit: 7.1.1 FBCN Form signed by 3 (three) Committee Members and all such documents as set out in the FBCN Form. In the event that the Committee Members are unable or unwilling for whatsoever reason to sign the FBCN Form, the Beneficiary can approach the Insurer directly with such claim, or lodge a complaint as contemplated in clause 19 of Part I; 7.1.2 original or certified copy of the identity document or identity card (copied both sides) of the Policyholder; 7.1.3 original or certified copy of the identity document or identity card (copied both sides) of the Beneficiary where the Policyholder is deceased; 7.1.4 confirmation of Membership to the Kganya Benefits Fund Trust; 7.1.5 original and/or certified copy of the Payment Receipt Booklet to verify Receipts; 7.1.6 original or certified copy of the death certificate of the Assured Life; 7.1.7 confirmation of bank account into which the Thari ya Baruti Funeral Benefit must be paid; 7.1.8 where the Assured Life is - 7.1.8.1 a Dependent Child and/or Paid-up Dependant, the original or certified copy of the identity document, identity card (copied both sides) or birth certificate of the Dependent Child and/or Paid-up Dependant; 7.1.8.2 a Dependent Child and/or Paid-up Dependant 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 of the Dependent Child and/or Paid-up Dependant as well as proof of the mental and/ or physical disability of such Dependent Child and/or Paid-up Dependant, 7.1.9 where the Assured Life has died by Accident, a copy of the police report confirming such Accidental Death; and 7.1.10 any other documents required by the Insurer from time to time including but not limited to – 7.1.10.1 medical confirmation in the case of a Stillbirth; 7.1.10.2 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 and/or Paid-up Dependant. 7.2 The Insurer will notify the Beneficiary within 2 (two) Business Days after receipt of all the Claim Documents to the satisfaction of the Insurer whether it accepts (and authorises payment of the Thari ya Baruti Funeral Benefit), repudiates or disputes the Claim. 8. Cessation of cover in respect of Thari ya Baruti Funeral Benefit 8.1 Insurance cover in terms of this Thari ya Baruti Funeral Policy for all Assured Lives shall cease in the event that - 8.1.1 this Thari ya Baruti Pukwana ya Kganya Contract is cancelled; or 8.1.2 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 Enhanced Benefits Regulations; or 8.1.3 the last Assured Life covered in terms of the Thari ya Baruti Funeral Policy dies; or 8.1.4 the Kganya Benefits Fund Trust fails to pay the Premiums and the Additional Premiums in respect of the Assured Lives as a result of the Policyholder’s failure, as a Member, to pay his Membership Contribution, subject at all times to the Forgiveness Rules. PART III: THARI YA BARUTI DREAD DISEASE AND PERSONAL ACCIDENT POLICY 1. Introduction 1.1 This Thari ya Baruti Pukwana ya Kganya Contract comprises Part I, Part II, this Part III and Part IV (in respect of Existing Members). 1.2 Part III constitutes a several and distinct Thari ya Baruti Dread Disease and Personal Accident Policy which is offered to all Members of the Kganya Benefits Fund Trust who are Policyholders in terms of this Thari ya Baruti Pukwana ya Kganya Contract. 1.3 All capitalised terms defined in Part I, bear the same meaning in this Part III. 1.4 All terms and conditions contained in Part I, and Part IV as they apply to Existing Members, are incorporated in this Part III, which collectively constitutes the Thari ya Baruti Dread Disease and Personal Accident Policy between the Policyholder and the Insurer. 2. Thari ya Baruti Dread Disease and Personal Accident Benefits 2.1 The Dread Disease Benefits and Personal Accident Benefits and Additional Personal Accident Benefits are set out in Annexe E.3 and Annexe E.4 , respectively, as amended from time to time, as provided for in Part I of this Thari ya Baruti Pukwana ya Kganya Contract. 2.2 The Trust shall pay - 2.2.1 the Premiums in respect of the Dread Disease Benefits and Personal Accident Benefits; and 2.2.2 the Additional Premiums in respect of the Additional Personal Accident Benefits, as provided for in this Thari ya Baruti Dread Disease and Personal Accident Policy, forming part of the Thari ya Baruti Pukwana ya Kganya Contract. 2.3 The Dread Disease Benefits and the Personal Accident Benefits and Additional Personal Accident Benefits are dealt with separately below. Dread Disease Benefits 3. Dread Disease Benefits 3.1 Upon the happening of an Insured Event as specified in clause 6.1.40.2.2 of Part I, the Dread Disease Benefits payable in terms of this Thari ya Baruti Dread Disease and Personal Accident Policy will be paid by the Insurer to the Policyholder, in respect of a Dread Disease contracted, experienced or suffered by a Policyholder, where the Date of Dread Disease is after the Inception Date. 3.2 The Insurer shall only pay 1 (one) Claim per Dread Disease Category regardless of the number of Claims made in respect of the same Dread Disease occurring and/or being diagnosed forming part of the same Dread Disease Category. 3.3 The Insurer may, in writing, notify the Policyholder that an examination is required by a Medical Practitioner selected by, and at the cost of the Insurer, to independently determine the cause and/or extent of the purported Dread Disease. 3.4 Subject to the Forgiveness Rules as provided for in in clause 9.3 of Part I and Annexe E.5 , Dread Disease Benefits in respect of a Policyholder as Assured Life will only be paid upon the occurrence of a Dread Disease if: 3.4.1 the Insurer (or its duly appointed administrator, Kganya Insurance Administrators), recorded a Premium in respect of the Policyholder with Dates of Payment in each of the 3 (three) consecutive Months preceding the Month in which the Date of Dread Disease occurred; and