Britam — Consent Form ‘We would like to inform you that Britam Life Assurance Company (K) Limited has introduced an ‘Automatic Paid Up (APU) provision as the default option for policies that have lapsed due to non-payment of premiums. Under this option the insured amount on your policy is reduced in proportion to the amount of premiums already paid up. The benefits related to the policy are also reduced in proportion to the new reduced insured amount. Previously, all policies had an Automatic Premium Loan (APL) as the default option for policies that had lapsed due to non-payment of premiums. This option came into effect after premiums remained unpaid at the end of the grace period and after the Policyholder failed to make a choice between moving the policy to a paid up state or opting to terminate the policy before its maturity date and taking the surrender amount. In such a case, the policy would continue to be serviced (maintained) by the premiums already paid and the Company would then charge interest on the unpaid premiums. In a situation Where the unpaid premiums and interest accumulate and exceed the policy's cash surrender amount, the policy would automatically terminate unless the policyholder reinstated the policy. With the introduction of an Automatic Paid Up feature as the default option for policies whose premiums remain unpaid, the Policyholder is able to conserve the policy value for the remaining policy duration. We highly recommend this option as the Policyholder is able to get a pay out in the event that the he/she is not in a position to continue with the premium payments. The above means that the following two options are available to the Policyholders once the Automatic Paid Up option clause becomes applicable to the Policy 1. Option to continue the policy with the Automatic Premium Loan until completion of the full duration of the policy. In this option, if the premiums remain unpaid after the grace period the policy will immediately move into Automatic Premium Loan unless the Policyholder elects otherwise. (Please refer to your policy contract for further details on the Automatic Premium Loan) 2. Option to move to the Automatic Paid Up state in order to conserve the policy value in the event the premiums remain unpaid. Automatic Paid Up will be the default option going forward if no communication is received from the Policyholder. The Automatic Premium Loan option shall cease to be available. Please apply for any one of the above options and submit your Consent in the enclosed format. In case the consent is not received by us by the end of the review period (45 days from the date of this communication), Option 1 will be applicable until completion of the full policy duration as per the terms and conditions of the Policy Contract. Kindly send the copy of the Consent duly signed by the Policyholder indicating your option, before the end of the review period to enable us process your request. ENA | oa | za] RIANA | OUT SUOK | UoZANBIOUE] NALA © wwwrtamcom © Brtamea @ setancAaBritam Consent Form Policy No: To, Britam Life Assurance Company (K) Ltd. Britam Centre, Mara/Ragati, Junction, Upperhill P.O. BOX 30375 ~ 00100 Nairobi. Dear Sir/ Madam, ‘Nana Rows conn 1. [have fully understood the contents of the above circular and 2. Thereby give my consent to continue the above policy under ‘Automatic Premium Loan mode 3. Thereby give my consent to change to Automatic Paid Up Declaration provided in this form. By signing this Form, I (The Policyholder) declare, agree to, and authorize the following: 1. I fully understand the meaning and scope of the changes in this Form and I am submitting the completed form of my own volition. 2. [fully understand and accept the consequences of the changes requested hereunder. 3. I therefore expressly agree to indemnify and absolve Britam against any law suits, losses, charges, damages, liabilities, expenses (including legal fees), fees or claims (including claims by third parties) suffered by Britam, incurred or that may otherwise result of any reliance by Britam on any instructions or information issued by myself or purported to be issued by the me and or on behalf of the myself through my intermediary but specific to this request as [eax] Co ‘Name of Policyholder Signature: Date: In the presence of Signature! Date: © womitamcom © ertameA @ BrtameABritam eer With you every step ofthe way ‘mesa n Consent Form For Offi T HEREBY CERTIFY that I have that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me for benefits. ‘Name of Britam Staff Designation of the Britam Staff I Use: Signature Date ENA | oa | za] RIANA | OUT SUOK | UoZANBIOUE] NALA © womitamcom © ertameA @ BrtameA