Credit Life Voluntary Insurance Form

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Credit Life Voluntary Insurance Form2024-04-10T05:53:41+00:00

    Claim Information

    Insurer: Sanlam Developing Markets FSP: 11230

    Claim Received Date

    Incident Date

    Claim Amount

    Policy 1 Information:

    Cover Start Date

    Approved or Rejected

    Policy 2 Information:

    Cover Start Date

    Approved or Rejected

    Policy 3 Information:

    Cover Start Date

    Approved or Rejected

    Policy 4 Information:

    Cover Start Date

    Approved or Rejected

    Policy 5 Information:

    Cover Start Date

    Approved or Rejected

    Reason for Rejection (If Applicable)

    Total Claim Amount in Rands

    Beneficiary Details

    Death Claim Supporting Documents

    Claim Form

    Death Certificate

    Identity Document

    Insurance Contract

    Statement

    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.

    Step 1: Complaints Process
    Groups Are Us
    Suite 9A
    76 Skilpad Road
    Monument Park
    Pretoria
    0181
    Mail: info@Groupsrus.co.za

    Step 2: If complaint is not resolved
    Information regulator
    P.O Box 31533
    Braamfontein
    Johannesburg
    2017
    Mail: complaints.IR@justice.gov.za

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

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