52 Allianz House Oce Number 2, 1st Floor

St Georges Mall Street Shoprite Complex

Zororo Phumulani Funeral Plan Cape Town
8001
Corner Jules and Queen St
Malvern, Johannesburg

Administered and Underwri$en by SA Life Benets FSP : 27738 Customer Services : 0218270618 | info@zororo-phumulani.co.za
and African Unity Insurance
Policy Number

Applica!on Form
Main Name Contact Number
Member Surname Address
Details
Date of Birth d d m m y y y y I.D :

Na"onality

Gender Email Address

Family Name Surname Rela"onship to Member Date of Birth (dd/mm/yyyy)

Details Spouse

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Cover COVER R2000 R5000 R10000 R15000 R18000 R25000 R30000

Op!on
Single R59 R99 R139 R159 R169 R209 R239

Please Tick Family R69 R109 R149 R169 R179 R229 R249

Extended Name Surname Rela"on DOB R2000 R3000 R4000

Family @R35 @R55 @R85

Rela!ve 1

Rela!ve 2
(Op!onal)
Rela!ve 3

Rela!ve 4

Rela!ve 5

Rela!ve 6

Payment Debit Order EasyPay Total Amount R

Details
Account Holder Contact Number
Bank Branch Code
Account Number Deduc"on Date 1st 7th 15th 25th 31st Other
Account Type Commencement Date
I, the undersigned, hereby authorize Zororo Phumulani to debit my bank account with the above amount on salary
Beneciary Full Names Contact Number credit date or such date that may otherwise be appropriate commencing on the above date and every month
Details therea#er. I understand that my salary credit date may change from "me to "me, and authorize to administer
premium requests accordingly. This includes any premium increases that may occur

Administered By
Signature Date
Agent

www.zororo-phumulani.co.za | www.facebook.com/ZororoPhumulani | 0218270618 | info@zororo-phumulani.co.za An Authorized Financial Services Provider

Terms and Condi!ons
Immediate Family and Single Plan
1. General
1. Premiums are payable monthly in advance on or before the 10th of each month.
2. Members who are 18-65 years or older may par"cipate in the scheme.
3. The insured lives will be limited to those declared on the applica"on form
4. Members who are not legally married but who are living together as a family can s"ll enjoy family benets provided that all relevant par"culars are declared on the applica-
"on form.
5. Unmarried children under the age of 21 are covered. Cover is extended up to, but not including age 26 if the child is unmarried full"me student. Cover for physically or
mentally disabled children are subject to the condi"ons contained in the Master Policy.

2. Wai!ng Periods
1. Membership under the scheme can only commence on the 1st day of the month
2. If the rst premium is received later than the rst day of the month, such covers commencement date would be the rst day of the following month
3. Immediate cover is granted for accidental death if a member has paid the rst premium, should the rst premium be received later than the rst day of the month, such
cover will commence on the rst day of the following month
4. Three (3) months wai"ng period for new members between 18-65 years who falls into the immediate family category
5. Six (6) months wai"ng period for new members who falls into the extended family category
6. A twenty-four (24) month wai"ng period for suicidal death
7. Immediate cover on receipt of the rst premium for exis"ng members who has more than six (6) months con"nued cover under the exis"ng scheme. (Such proof is required
should deaths occur during the rst three (3) months from incep"on). All members s"ll within the wai"ng period imposed by the previous insurer will serve out the balance
of such wai"ng period with Zororo-Phumulani before their cover will commence.

3. Payment of Premiums
1. Premiums shall be payable as indicated in the Schedule to the Insurer by the Policyholder at the Premium Rate as specied in the Schedule.
2. Payments shall be made from the Commencement Date to the date of termina"on of this Policy. Should the insured event occur before premium payment is eected, the
Insurer will have no liability, unless the Insurer is sa"sed that at the "me, an insurable risk did exist and that the insured had been in good standing in terms of premium
payments prior to the happening of the insured event. In the event of such a situa"on, the Insurers decision shall be nal.
3. Cover on the Scheme is provided for on a month-to-month basis. No reserves are built up under the scheme, therefore premiums are payable lifelong and there are no
surrender values when cover ceases.
4. Premiums under the scheme are not guaranteed and can adjusted by the insurer at any stage.
5. Membership for new members applicants will be restricted to a maximum entry age of 65 years (next birthday) at commencement.
6. Only claims submi$ed within six (6) months of the date of the death will be considered for payment
7. No Claim will be honoured if premiums are in arrears or short paid.
8. No claims in respect of grandchildren or foster children will be considered, unless proof of legal adop"on has been supplied.
9. In the event of the death of the Policyholder, ownership of the policy may be switched to the surviving spouse; the spouse will then become the Policyholder of the policy,
subject to the payment of the premium by the spouse. Please note, however, that this does not automa"cally happen and it is the responsibility of the remaining spouse to
no"fy the Insurer of the change.

4. Burial Repatria!on Benets

1. This benet is available on the death of any Insured or member at no charge.
2. The benet provides for transport of the deceased from South Africa to anywhere in Zimbabwe, Botswana, Mozambique, Zambia, Malawi, Tanzania and DRC
3. Repatria"on will not apply for Extended Family Members

5. Payouts
1. ILIFA/NHAKA is paid in the event of the death of main member.
2. 50% Discount of the sum assured will be oered to the family of the main member
3. ILIFA/NHAKA is only obtained should the client decides to take services. No ILIFA/NHAKA can be claimed if the client opts for a cash payout of the sum assured.

6. Termina!on of the Policy

1. The Policyholder may terminate the policy upon one (1) month no"ce of cancella"on being given to the Insurer, in wri"ng.
2. If the Policyholder fails to full the obliga"ons in terms of the master policy and the Schedule(s), the policy shall lapse.
3. The Insurer may terminate its associa"on with the Policyholder upon one (1) months no"ce of cancella"on being given to the Policyholder in wri"ng.
4. Cover for policyholders and/or dependants will cease on:
A. The Policyholder withdrawing from the policy for any reasons whatsoever;
B. Non-payment of premiums by policyholder.

NOTES:
Sums Insured for Eligible Children are payable in accordance with the following table:
14 years and Older : 100%
6 to 13 years : 50%
0 to 5 years incl S"llborn : 25%
S"llborn is dened as the death of a baby a#er 28 weeks of pregnancy.

DOVES ZIMBABWE is the contracted funeral home that will conduct the funeral and take over the policy should the policy holder returns to Zimbabwe on a permanent basis.
All funeral arrangements for the funeral in Zimbabwe will be conducted directly with DOVES ZIMBABWE.

If you have a compliant regarding the advice you were given, you can contact
The Ombud for Financial Services Providers
PO Box 74571
Lynwood Ridge
0040

IMPOTANT CONTACT DETAILS | Zororo Phumulani : +27 21 827 0618 | Doves Zimbabwe : +263 4 774013, +263 4 772570 | SA Life Benets : +27 12 998 3113