Disclosure notice to short-term insurance policyholders
Important – please read carefully – disclosure and other legal requirements
(This notice does not form part of the Insurance Contract or any other document)
As a short-term insurance policyholder, or prospective policyholder, you have the right to the following information :
1. Your financial service provider
1.1 Name, physical address, postal address and telephone number
Business Name: HTI Insurance Brokers
Physical address: 49 St Andrews Drive, Durban North, 4051
Postal address: P.O Box 4955 Durban 4000
E-mail address: firstname.lastname@example.org
Telephone: 031-277 3500
Fax: 031-277 3520
Authorised Financial Services Provider Licence No: 12780
Authorised to provide Financial Services in respect of Short Term Personal And Short Term Commercial Lines
1.2 Legal status and any interest in the Insurer
Private Company with no direct financial interest in the Insurer. This intermediary receives less than 30% of its total income from the Insurer.
1.3 Professional Indemnity and Guarantees
Your Financial Services Provider does have Professional Indemnity Insurance.
Your Financial Services Provider does have Intermediary Guarantee Fund Cover.
Your Financial Services Provider does have Fidelity Guarantee Cover.
1.4 Details of how to institute a claim
Should you have a claim against your policy, please do the following:
(a) Notify our claims department at the above address or by telephone on 031-277 3500.
(b) A claim form will be handed, emailed, faxed or posted to you according to your instruction. Complete this form and return it to us at the above address or fax it to us at the above fax number. Our claims department will then attend to your claim.
(c) Should you have any difficulty, kindly contact our claims department and someone will assist you.
If you have a query about this policy or you are in any way unhappy with the service that you have received, please contact your Financial Services Provider in sub-section 1.1 above.
1.6 Written mandate to act on behalf of Insurer
This certifies that the Insurer has granted a mandate to the intermediary to represent the Insurer and to accept business and issue policies on behalf of the Insurer.
2.1 Particulars of your financial services provider compliance officer:
Name, physical address, postal address and telephone number
Name : Louise Pardy of L Pardy & Associates (Pty) Ltd
Physical address : Suite 5, La Lucia Park, 64 Armstrong Avenue, La Lucia
Telephone : 031-5821419
Email : email@example.com
Practice Number : 6507
3. Particulars of SASRIA LIMITED
Should you have requested cover provided by SASRIA LIMITED then you are entitled to details as follows:
Physical address : 32 Fricker Road, Illovo, Sandton, 2196
Postal address : P.O.Box 653367, Benmore, 2010
Telephone : 011 214 0800
Email / Website : firstname.lastname@example.org / email@example.com / www.sasria.co.za
Claims Procedure : In the event of a claim, all relevant documentation relating to your claim must be submitted to The Insurer at the Local Branch in your area
Claims Procedure : If you have any complaints about the Insurer regarding SASRIA cover then you may contact; The Compliance Office, SASRIA Limited, P.O.Box 653367, Benmore, 2010
4.1 Particulars of the short term insurance ombudsman
If the complaint to your Financial Services Provider and/or your Insurer, has not been resolved, you may contact;
Name : The Ombudsman for Short Term Insurance
Physical address : Sunnyside Office Park, 5th Floor, Building D, 32 Princess of Wales Terrace, Parktown
Postal address : P.O. Box 32334, Braamfontein, 2017
Telephone : 011-726 8900
Fax: 011-726 5501
Email : firstname.lastname@example.org
Web Site : http://osti.co.za
4.2 Particulars of the FAIS ombudsman
If you have a FAIS complaint, you may contact:
Name : The FAIS Ombudsman
Physical address : Sussex Office Park, Ground Floor, Block B, 473 Lynnwood Road Cnr Lynnwood Road & Sussex Ave, Lynnwood, 0081
Postal address : P.O. Box 74571, Lynnwood Ridge, 0040
Telephone : 012-470 9080
Fax: 012-348 3447
Email : email@example.com
Web Site : www.faisombud.co.za
5.1 Type of policy involved
hti is authorised to provide Commercial and Personal Short Term Insurance under FSP licence number 12780
5.3 Manner of payment of premium, due date and consequence of non-payment
Premiums are paid by debit order. Premiums are paid monthly and are due on the 1st day of each month.
Consequences of non payment: Please refer to your Policy Wording.
6. Other matters of importance
(a) You must be informed of any material changes to the information provided above.
(b) If the information above was given to you verbally, it must be confirmed to you in writing within 30 days.
(c) If any complaint to the broker or Insurer is not resolved to your satisfaction, you may submit a complaint to the Short-term Insurance Ombudsman.
(d) Polygraph or any lie detector test is not obligatory in the event of a claim and the failure thereof may not be the sole reason for repudiating the claim.
(e) The Insurer and not the intermediary must give reasons for repudiating your claim.
(f) Your Insurer may not cancel your insurance merely by informing your intermediary. There is an obligation to make sure the notice has been sent to you.
(g) You are entitled to a copy of the policy free of charge.
(h) If premium is paid by debit order it may only be in favour of one person and may not be transferred without your approval; and the Insurer must inform you at least 30 days before the cancellation thereof, in writing, of its intention to cancel such debit order.
– Do not sign any blank or partially completed application form.
– Complete all forms in ink.
– Keep all documents handed to you.
– Make note as to what is said to you.
– Don’t be pressurised to buy the product.
– Incorrect or non-disclosure by you of relevant facts may influence an Insurer on any claims arising from your contract of Insurance.
8. Sharing of insurance information
Insurers share information with each other regarding policies and claims with a view to prevent fraudulent claims and obtain material information regarding the assessment of risks proposed for insurance. By reducing the incidents of fraud and assessing risks fairly, future premium increases may be limited. This is done in the public interest and in the interest of all current and potential policyholders.
The sharing of information includes, but is not limited to information sharing via the Information Data Sharing System operated by TransUnion ITC on behalf of the South African Insurance Association. By the Insurer accepting or renewing this insurance, you or any other person that is represented herein gives consent to the said information being disclosed to any other insurance company or its agent.
You also similarly give consent to the information in regard to past insurance policies and claims that you have made. You also acknowledge that information provided by yourself or your representative may be verified against any legally recognised sources or databases.
By insuring or renewing your insurance, you hereby not only consent to such information sharing but also waive any rights of confidentiality with regard to underwriting or claims information that you have provided or that has been provided by another person on your behalf.
In the event of a claim, the information you have supplied with your application together with the information you supply in relation to the claim, will be included on the system and made available to other Insurers participating in the Information Data Sharing System.
9. SECTION 21 of the Code Of Conduct
The Code of Conduct provides that no provider may request or induce in any manner a client to waiver any right or benefit conferred on the client by, or in terms of, any provisions of this code, or recognise, accept or act on any such waiver by the client and any such waiver is null and void.
10. Fraud and complaints service:
Fraud : If you become aware of irregularity on any policy you can contact your Insurer where your call will be treated in confidence. 011-5404000
Complaints : If you would like to lodge a complaint regarding your Insurer or your Intermediary, please contact your Insurer Complaints Department on 011-5404000