Credit Life Death Claim Form

Section A: Details of Insured

Section B: Nominated Credit Provider Details (If Applicable)

Credit Provider Bank Account Details (If Applicable)

Section C: Details of Person Completing this Form

Section D: Nominated Beneficiary

Section E: Supporting Documentation Required

Death Claim Form

Copy of Loan Contract (If Applicable)

Copy of Sanlam Developing Markets Policy Certificate

Client/Borrower Statement from your Loan Management System (If Applicable)

Copy of Policy Holder’s (Deceased’s) Identity Document

Copy of Death Certificate

If the claim event is due to unnatural causes, please include the police report

Copy of Beneficiary’s Identity Document

Proof of Beneficiary’s Bank Account

BI 1663 (Notification of death/still-birth) Form

POPI Act Disclosure and Permission:

(1) In line with the Protection of Personal Information Act no. 4 of 2013 I hereby give consent that all personal information supplied herewith may be used for the sole purpose related to the document intent herewith.

(2) I further consent that the data be used or exchanged with 3rd parties to validate information, fraud prevention, investigations, payments processing and product related marketing campaigns. I provide consent for Groups Are Us (PTY) Ltd to share my information with the external compliance officers for quality control and risk mitigating matters.

(3) Section 18 of the FAIS Act requires that records like client transactions, complaints, cancellations and financial records be kept for five (5) years. I understand that I can exercise my right to opt-out and avoid or stop any further use of my personal data within this disclosure after the record keeping requirement period is over.

(4) I acknowledge and understand that I can make contact with the Information Officer of Groups Are us (Pty) Ltd to lodge a complaint for any suspected abuse and/or
regulatory misconduct around my personal information processing or if personal information is being used for any reasons outside the intent of this document.

*For our privacy policy please refer or visit: www.groupsrus.co.za