Shackleton Life (Pty) Ltd

Authorised Financial Services Provider, FSP Number: 44723

P O Box 2507 Mount Edgecombe 4301
333 Anton Lembede Street Durban 4001
Tel: 087 232 7014 Fax: 087 232 7013
Email: clientservices@shackletonlife.co.za

Policy Schedule - Premium Notification

Life Assured Details:
Policy Number ZUMAP001/0001
Nature of Business Bond Insurance - Single Life
Life Assured Mr Phumlani Doctor Zuma
ID Number 8506265327088

Contact Details:
Postal Address 2290 Leadwood Street
Mapleton
1479
Work Telephone Number (072) 8108214
Cellphone Number 0728054248
Email Address pzuma@tmtservices.co.za

Insurance Details:
Broker Shackleton Life
Broker Agent D Naicker
Insurer Old Mutual Alternative Risk Transfer Limited
Administrator Multiline Insurance Administrators (Pty) Ltd

Period of Insurance:
Policy Acceptance Date 01/01/2014
Policy Commencement Date 01/01/2014
Policy Annual Review Date 01/01/2018
Notwithstanding the wording in your policy document, your policy will commence on the abovementioned commencement
date on condition that your first premium deduction is successful.

Signed at Pietermaritzburg on the ______day of ____________________ 2013

on behalf of Old Mutual Alternative Risk Transfer Limited

Shackleton Life (Pty) Ltd

Authorised Financial Services Provider, FSP Number: 44723

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Bond Protection Insurance - Single Life

DETAILS

Cession Details:
Credit Provider / Cessionary First National Bank Pty Ltd
Bond Account number 3000703788285
Bond Registration Date 01/01/2014
Bond Term 20 Years
Policy Term 17 Years
Frequency of Payment Monthly
This policy may only exist as collateral security for a Mortgage Loan and must be ceded to the financial institution
that has granted the loan. The Life Assured agrees to the cession of this policy to the Credit Provider as collateral
security for the outstanding debt in terms of the Mortgage Loan. Accordingly, in the event of a valid claim, OMART
will pay the benefit in terms of this policy to the Credit Provider. The cession of this policy supersedes and cancels
any other beneficiary nominated by the Life Assured.

Assured Details:
Phumlani Doctor Zuma
ID Number 8506265327088
Date of Birth 26/06/1985
Age Next Birthday 32
Smoker Status No
Gender Male
Occupation Fuel Controller
Education 3 year degree/diploma
Monthly Income R20 000 - R24 999

Shackleton Life (Pty) Ltd

Authorised Financial Services Provider, FSP Number: 44723

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DETAILS

Policy Termination Date:

l Death Benefit and Dread Disease (when selected) 01/01/2034
l 24 Month Instalment Protection Benefit, Full Term Instalment Protection 01/01/2034
Benefit, Permanent Disability Benefit and Retrenchment (when selected)
As noted please be advised that the policy may terminate earlier if the bond is settled or any benefits paid, or otherwise
as set out in the policy wording.

Policy Benefits:
Sum Assured /
Instalment Benefit Premium
1. Death Benefit 109.12
Lump Sum Benefit 405,000

2a. 24 Month Instalment Protection Benefit Not Selected

Instalment Benefit max 24 months

2b. Full Term Instalment Protection Benefit Not Selected

Instalment Benefit max remaining term and months

2c. Permanent Disability Benefit 63.81

Instalment Benefit x 24 month 4,180
Lump Sum Benefit 405,000

3. Retrenchment Benefit Not Selected

Instalment Benefit max 6 months

4. Dread Disease Benefit 13.87

Lump Sum Benefit 405,000

Premium Total 186.80

Notes:

l Premiums are not guaranteed and Old Mutual Alternative Risk Transfer Limited has the right to review the premiums
from time to time by giving 30 days notice of such increase.
l The Sum Assured remains level and will only be reduced on written request from both the Life Assured and
Cessionary.
l This policy has no investment element.
l Disability and Retrenchment benefits cease at the age 65.
l Death and Dread Disease benefits cease at the age 80.
l All benefits cease on bond amount being nil.
l The policy wording and this schedule must be read together as one contract.

Shackleton Life (Pty) Ltd

Authorised Financial Services Provider, FSP Number: 44723

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Banking Details
Account Holder : ZUMA, PD
Bank Name : CAPITEC BANK
Branch Code : 470010 CAPITEC ELECTRONIC PAYMENTS
Account Number : 1178972702
Account Type : Savings

Shackleton Life (Pty) Ltd

Authorised Financial Services Provider, FSP Number: 44723

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