Your insurance product involves two companies performing different functions:

The insurance broker:

In addition to acting as your agent and selling the product to you, this company has been granted authority by the insurer to conduct certain transactions (for example: acceptance of risk, determining your premiums and settling your claims) on the insurer’s behalf.

The insurer:

This is the insurance company that ultimately receives your premiums and is liable for claims.

PARTICULARS OF YOUR INSURANCE BROKER

Business Name

CC&A INSURANCE BROKERS (PTY) LTD

Physical Address

1 OLD MAIN ROAD, KLOOF, 3610

Postal Address

1 OLD MAIN ROAD, KLOOF, 3610

Telephone Number

(031) 716-6000

E-mail Address

info@ccainsurance.co.za

Website

www.ccainsurance.co.za

COMPLIANCE

Name of Company

Moonstone

Practice Number

188

Compliance Officer

Verousha Baijnath

Telephone Number

083 639 1539

E-mail Address

vbaijnath@moonstonecompliance.co.za

YOUR INSURANCE BROKER IS AUTHORISED TO PROVIDE FINANCIAL SERVICES IN RESPECT OF SHORT- TERM PERSONAL LINES AND COMMERCIAL LINES PRODUCTS

License Number

13960

YOUR INSURANCE BROKER HAS THE FOLLOWING INSURANCE IN PLACE WHICH PROVIDES PROTECTION TO CLIENTS

Professional Indemnity

R30,000,000

Fidelity Guarantee

R20,000,000

Directors & Officers Liability

R20,000,000

SHOULD YOU HAVE A CLAIM AGAINST YOUR POLICY, PLEASE NOTE THE FOLLOWING:

(a) Procedures for the submission of claims are detailed in the policy wording.

(b) You may contact the insurance broker’s claims department at the above address or by telephone on (031) 716-6000 for assistance.

COMPLAINTS

If you would like to lodge a formal complaint with your insurance broker, please write to:

CC&A Insurance Brokers

Complaints Officer

Lee Gouws

Email: leeg@ccainsurance.co.za

Website: www.ccainsurance.co.za

If you would like to lodge a formal complaint regarding your insurer or your broker, please refer to your policy wording for details of your insurer’s complaints department.

If you get no response or you are dissatisfied with the outcome of your complaint, you may approach the FAIS Ombud or Short-term Ombudsman, details of which appear below.

THE OMBUDSMAN FOR SHORT-TERM INSURANCE

THE FAIS OMBUD

Physical Address

Sunnyside Office Park, 5^th Floor, Building D, 32 Princess of Wales Terrace, Parktown

Physical Address

Eastwood Office Park, Baobab House, Ground Floor, Cnr. Lynnwood Road & Jacobson Drive, Lynnwood Ridge, 0081

Postal Address

P O Box 32334, Braamfontein, 2017

Postal Address

P O Box 74571, Lynnwood Ridge, 0040

Telephone Number

(0860) 726-890 / (011) 726-5501

Telephone Number

(012) 470-9080

Fax Number

(011) 726-5501

Fax Number

(012) 348-3447

E-mail Address

info@osti.co.za

E-mail Address

info@faisombud.co.za

Website

www.osti.co.za

Website

www.faisombud.co.za

YOUR SPECIAL RISKS INSURER

Name

SASRIA Limited FSP Number 39117

Physical Address

36 Fricker Rd, Illovo, Sandton, 2196

Postal Address

P O Box 653367, Benmore, 2010

Telephone Number

(0861) 727-742 / (011) 214-0800

Fax Number

(0861) 727-329 / (011) 447-8630

Website

www.sasria.co.za

Claims Procedure

In the event of a special risks claim, all relevant documentation relating to your claim must be submitted to your broker.

Compliance Officer

Mrs Nomsa Mazibuko, E-mail address: nomsa@sasria.co.za

Complaints E-mail Address

complaints@sasria.co.za

COMMISSION, BINDER AND CONFLICT OF INTEREST DISCLOSURE

Malcanter Holdings (Pty) Ltd, owns 80% of the shares in your broker. Hollard Insurance Company Limited owns 35% of the shares in Malcanter Holdings (Pty) Ltd. A Hollard employee sits on the board of Malcanter Holdings (Pty) Ltd as a non-executive director.

Your broker receives a commission from your insurer. The levels of commission vary depending upon the product type. The exact amounts are disclosed in your policy schedule. In addition, your broker may charge you a broker / policy fee which will also be shown on your policy schedule.

Your broker may also be paid a binder fee which is calculated to be a percentage of the gross written premium it places with your insurer. The percentage payable will also be shown on your policy schedule.

BINDER DISCLOSURE

CC&A Insurance Brokers (Pty) Ltd acts as a binder holder, and has a signed binder agreement to this effect with the following insurers:

·         The Hollard Insurance Company Limited

In terms of these agreements, the binder holder may:

1) enter into, vary and renew policies;

2) determine the premiums;

3) determine policy benefits; and

4) settle all valid claims. The binder holder may not reject claims, nor may it cancel policies. This may only be done by the insurer.

OUTSOURCING DISCLOSURE

CC&A Insurance Brokers (Pty) LtD performs various administrative tasks on behalf of the following insurers

·         Mutual & Federal

·         Santam Limited

·         AIG SA Limited

·         Constantia Insurance Company Limited

·         Etana Insurance Company Limited

·         Zurich Insurance Company South Africa Limited

Your broker may also be paid an administration outsourcing fee which is calculated to be a percentage of the gross written premium it places with your insurer. The percentage payable will also be shown on your policy schedule.

OTHER KEY CONFLICT OF INTEREST DISCLOSURES

Relating to your broker:

Does your broker have a shareholding in any insurer?

NO

Does your broker receive more than 30% of their income from any insurer?

YES *

Does your broker have a relationship with any insurer that provides a financial interest other than ownership?

NO

Does your broker have a relationship with any other broker that provides an ownership or financial interest?

YES **

Does your broker have a relationship with any distribution channel that provides an ownership, financial interest or support service?

NO

Does your broker have a relationship with any other person that provides an ownership or financial interest?

NO

Any combination of these relationships and/or ownership or financial interests may present a potential conflict and as such we need to ensure you are aware of these.

A full copy of your broker’s conflict of interest management policy can be obtained from:

i)              Your broker’s offices upon written request to info@ccainsurance.co.za

ii)             Your broker’s website www.ccainsurance.co.za

DISCLOSURE OF PREMIUMS AND FEES

All premium obligations and fees are disclosed in your policy schedule.

MANNER OF PAYMENT OF PREMIUM, DUE DATE AND CONSEQUENCE OF NON PAYMENT

Please refer to your policy wording for details regarding premium payment, due dates of payment and consequences of non payment.

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 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 or the FAIS Ombud, depending on the nature of the complaint.

(d) A 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) All material facts must be accurately and properly disclosed, and the accuracy and completeness of all answers, statements or other information provided by or on your behalf remains your own responsibility.

(f) You must on request be supplied with a copy or written or printed record of any transaction requirement within a reasonable time.

WARNING

·         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.

SPECIAL NOTES

* - More than 30% of your broker’s income is derived from The Hollard Insurance Company Limited.

** - Malcanter Holdings (Pty) Ltd is also a shareholder in CC&A Anderson Insurance Brokers (Pty) Ltd. CC&A Insurance Brokers (Pty) Ltd is also a shareholder in CC&A Truck and Transport Insurance Brokers (Pty) Ltd.