Policy
Schedule
Your Policy Details Your Vehicle Details
Active 2017 HYUNDAI i10 1.25 GLIDE
Policy Status Vehicle Make
(26516231)
Name Mr N Sithole Registration No. TBA
ID Number 9011175401080 Colour WHITE
Phone Number 0822253794 Mileage 22000 km
Email rhulani.norman1@gmail.com Permitted Use Business/Professional Personal
Policy Number MX109055007 Territorial Limits RSA
6992/20, KING FISCHER STREET, ABSA FINANCE's interest in the insured
Postal Address Bank Interest
ETHWATHWA EXT, DAVEYTON, 1519 Vehicle has been noted.
Policy Benefits
Main Benefit
Comprehensive Cover (Write-off and accident cover) Retail Value
Theft and hijacking Retail Value
Third Party Liability Cover R 1,000,000.00
Sasria
Towing (accidents) Unlimited
Towing (mechanical failure) Two claims per annum
Roadside Assistance As per the limitations in your Terms and Conditions
Additional Benefits
Credit Shortfall Not selected
Accidental Death Not selected
Car Hire Not selected
Tyre And Rim Not selected
Monthly Premium R 761.15
» Important: If you spot an error please be sure to bring this to our attention at your earliest convenience in order for us to provide you
with an updated schedule and premium calculation. If any of the details below change in the future, please remember to inform us of
the changes as well. The details displayed on this schedule directly influence the calculation of your monthly premium, the extent of cover
provided and even your ability to claim.
Page 1 of 4
Policy
Schedule
Standard Benefit Excess
Excess Type Excess Amount Terms and conditions
Reduce-to-zero excess • R 6,750.00 Regular Driver Under 30 • Applies to all claims except glass claims.
• R 5,000.00 Regular Driver • Reduces to zero over 36 months.
• Refer to regular driver table below • Resets to the amount shown upon claiming or where a premium has
been missed or reversed.
• Applicable to policyholders and regular drivers at the time of loss.
Early claims excess R 5,000.00 • Applies, in addition to the Reduce-to-zero or Other driver excess, to all
claims (except glass claims) incurred within and including the first six
premium payments from the date of commencement.
• Following receipt of seven premium payments, the Early claims excess
will no longer be applied to your claims.
Glass claim excess 25% • Of the replacement cost of any glass claims.
Other driver excess R 6,750.00 • Applicable to all other drivers driving or in possession of the vehicle at
the time of loss.
• Where applicable, this excess replaces the Reduce-to-zero excess
entirely i.e. it is not payable in addition to the Reduce-to-zero excess.
• This excess does not reduce to zero.
Circumstantial Excess
Excess Type Excess Amount Terms and conditions
Missing/limited information R 3,030.00 Applies where any one or more of the following essential information or
excess procedural requirements have not been met:
• 3rd Party personal and vehicle particulars not captured/not available at
the time of loss - applies to multiple vehicle accidents only; or
• No clear on-scene photographs or independently verifiable information
provided to confirm date, time, location and circumstances surrounding
the accident - applies to single vehicle accidents only; or
• Towing of the insured vehicle was not arranged through our 24-hour
contact center - applies to all accident types.
Please note that this excess will be applied in addition to your applicable
Standard Benefit Excess.
Dangerous conditions excess R 3,030.00 For this excess to apply, the damage or loss must have occurred under any one
or more of the following conditions:
• The motor vehicle accident takes place on a gravel road; or
• The motor vehicle accident takes place between 11pm and 5am; or
• Theft of the motor vehicle occurs whilst it is parked in a public place
between 11pm and 5am or where the vehicle was stolen and does not
have an installed tracking device.
Please note that this excess will be applied in addition to your applicable
Standard Benefit Excess.
Page 2 of 4
Policy
Schedule
Regular Drivers
Name Surname ID Number Relationship Reduce-to-zero excess
1 Norman Sithole 9011175401080 Policyholder R 5,000.00
Sasria
Your total premium includes cover for Sasria events. Price : R 2.02
» Important: In terms of a ruling issued by SARS, this document together with proof of payment of premium constitutes an alternative to
a tax invoice, debit note or credit note as contemplated in sections 20(7) and 21(5) of the VAT Act respectively.
Page 3 of 4
Policy
Schedule
Debit Order Details and Authorisations
Initials N Surname Sithole
ID Number 9011175401080 Policy Number MX109055007
Address 6992/20, KING FISCHER STREET, ETHWATHWA EXT, DAVEYTON, 1519
Account Holder Norman Sithole 1st Payment Date 09/11/2021
Bank Capitec Bank Salary Day 25
Account No. 1365973091 Recipient Of Premium Santam Structured Insurance Limited
Branch Code 470010 7th Floor, Alice Lane Building 3, Corner Alice Lane and 5th
Street, Sandton, South Africa. FSP1027
Branch DAVYTON
» Important: The reference that will appear on your bank statement when your debit order is processed: PRIMEMERID
You have authorised Santam Structured Insurance Limited (and/or its nominee) to draw the premium due in terms of this policy against your banking account,
and you consequently permit your bank to debit your account in terms of this instruction.This authorisation was provided by you verbally during the telephonic
purchase conversation and further through your acceptance of the written policy terms and conditions (that includes this schedule). Your ongoing payment of
monthly premiums is further indication on your acceptance of the authority granted.
Monthly premiums, payable by debit order, are due each month on your salary/agreed pay date. Should your pay date fall on a Saturday, Sunday or recognised
South African public holiday, you authorise the Insurer (or its nominee) to debit your account at its discretion on the following or previous ordinary business day.
If there are insufficient funds in your account, you authorise that the Insurer (or its nominee) can track the nominated account and/or re-present the instruction
for payment to my bank at any time when sufficient funds are available.
You further confirm that all payment instructions issued by the Insurer (or its nominee) shall be treated by your above-mentioned bank as if the instructions have
been issued by you personally. You/we agree that although this debit order mandate may be cancelled by You/us at any time, such cancellation will not result in
the cancellation of the Insurance Agreement/your policy. Where cancellation of the policy is required, this must be separately requested in accordance with the
policy terms and conditions.
You shall not be entitled to any refund of amounts which we have withdrawn while this authority was in force, if such amounts were legally owing by you.
» Important: In terms of a ruling issued by SARS, this document together with proof of payment of premium constitutes an alternative to a
tax invoice, debit note or credit note as contemplated in sections 20(7) and 21(5) of the VAT Act respectively.
Page 4 of 4
