Family Plan

Emkay Funeral Services Family Plan Policy
  • Policy Owner Information

  • Family Information

    Max. age for main member and spouse is 64 years. Children must be under the age of 21 years
  • Children

    Please click on the + sign to add more children and the - to remove
  • +-
  • Cover Options

    Please choose the option you require:
  • Beneficiary

    I hereby authorise the Underwriter to pay the proceeds of this Funeral Plan directly to:
  • Beneficiary: Emkay Funeral Solutions cc
    Reg No: 2004/074565/23
    Tel No: 079 386 5922
    Relationship to policy owner: Funeral Parlour

    PLEASE READ this before you sign:

    DO NOT sign unless you are committed to this policy. DO NOT sign if the agent says he / she will get back to you. DO NOT give the agent money. DO NOT sign unless you have read the terms and conditions at the bottom of this page. We do not give advise. DO NOT phone the agent to cancel this membership.

    Declaration:
    I do declare to my knowledge that the particulars given are true and correct. I am satisfied that the plan chosen by me, suits my needs. I am able to afford the monthly premium of the plan chosen by me. I have read and understood the Summary of the Terms and Conditions on the bottom of this document.




    Date Signed:_________________________________ Member (policy owner) Signature:__________________________________________

  • Debit Order Authority

    Debit Order Authority This signed Authority and Mandate refers to our contract as dated as on signature hereof ("the Agreement"). I hereby authorise you to issue and deliver payment instructions to the bank for collection against my below mentioned account at my below mentioned bank (or any other bank or branch to which I may transfer my account) on condition that the sum of such payment instructions will never exceed my obligations as agreed to in the Agreement, and commencing on the below mentioned date and continuing until this Authority and Mandate is terminated by me by giving you notice in writing of no less than 20 ordinary working days, and sent by prepaid registered post or delivered to your address indicated below. The individual payment instructions so authorised to be issued must be issued and delivered as follows: In the event that the payment day falls on a Saturday, Sunday or recognized South African public holiday, the payment day will automatically be the very next ordinary business day. I understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction. The abbreviated name that will reflect on your statement is POLBUILDER. I shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you. I acknowledge that all payment instructions issued by you shall be treated by my below mentioned bank as if the instructions had been issued by me personally. I agree that although this Authority and Mandate may be cancelled by me, such cancellation will not cancel the Agreement. I shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you. I acknowledge that this Authority may be ceded to or assigned to a third party if the agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.




  • Account Holder Signature:________________________________________________ Date Signed: ___________________________________________



    OFFICE USE ONLY

    Agent Name:______________________________________________________ Signature:___________________________________________________



  • THE POLICY BUILDER’S FAMILY PLAN | TERMS AND CONDITIONS - UNDERWRITTEN BY AFRICAN UNITY LIFE LTD.

    PRINCIPAL MEMBER:
    Any person who has completed an application form and been admitted to membership of the Scheme and is allowed to elect participation in the Policy, in accordance with the eligibility conditions as stated in the policy schedule, and who is at least 18 years of age but has not reached the age of 65 years. If an Insured or his/her Family Member dies, an amount elected in writing to The Policy Builder by the Insured in terms of the policy at the time of qualifying for the insurance, is paid as follows:
    Relations % Of Benefit Paid
    Principal Member 100%
    Spouse 100%
    Child 14 – 21 years 100%
    Child 6 – 13 years 50%
    Child 0 – 5 years 25%
    Stillborn 15%

    INSURED:
    Cover in terms of the Family Funeral Plan is available and limited to the additional family dependent lives stipulated in the application form. Family Dependent in relation to the Principal Member means only a person in which the Principal Member has an insurable interest and may only include the Spouse (only the husband, wife, partner or fiancé if living together for min 6 months) as well as Children (only unmarried minor children, natural and/or legally adopted or nominated foster children at inception which are dependent on the Principal Insured). A maximum of 2 (two) claims in respect of stillborn deaths are covered.
    BENEFICIARY:
    Any person nominated by the Principal Member to whom death benefits will be paid in the event of a successful claim, due to the death of the Principal Member.
    GENERAL TERMS AND CONDITIONS:
    1. The cover in respect of assured lives commences on the last date upon which the Insurer approves the application by the member for the benefits; and receives the first premium payable in terms of this policy;
    2. The Principal Member may not cede the benefit and any cession shall be null and void. Each Principal Member must complete an application form and nominate his/her beneficiary;
    3. Benefits cease upon the death of the Principal Member or his/her written instruction to terminate the contribution and benefits or in case of non-payment for the benefits;
    4. The Insurer shall be entitled to amend the benefits in terms of the benefits by means of a 30 (thirty) day written notice to the policyholders or members of the group;
    5. All assured lives in terms of this Policy must be permanently resident in the Republic of South Africa.

    WAITING PERIODS:
    1. No insurance cover shall be granted, or benefits paid in the event of the death other than the accidental death of an assured life in terms of the Policy within 6 (six) months for members younger than 65 (sixty-five) from the inception date;
    2. All waiting periods and exclusions shall apply in respect of increased benefits with effect from the inception date of the increased benefits.

    AGE LIMITATIONS:
    1. The Principal Member must be between the ages of 18 and 64 at the time of application. Dependent children, other than a still born child and a mentally or physically disabled child, must be younger than the age of 21 years at date of application and cover will cease when the age of 21 is reached;
    2. A Dependent child may be covered until the age of 26 (twenty-six) years provided he/she is a full-time student, and is unmarried, and studies at any registered university, Technicon or tertiary education institution.

    SURRENDER VALUES:
    There are no surrender values. Benefits may not be ceded or pledged in any way. The policy does not accumulate cash or a surrender value and may not be converted into a paid up policy. No loans will be allowed in terms of this policy.

    SPECIFIC EXCLUSIONS:
    The Insurer shall not be obliged to make payment in respect of any condition or event arising directly or indirectly from, contributed to by, or traceable to:
    1. Suicide within the first 24 (twenty-four) months of application;
    2. War, invasion, acts of foreign enemy, hostilities, rebellion, revolution, insurrection or military or usurped power, or by ionizing radiation or contamination by radioactivity from any nuclear fuel or waste;
    3. Any participation in hazardous sports i.e. motor/cycle racing, mountain climbing etc.;
    4. Any involvement or participation in any criminal activity;
    5. Premium payments must be up to date to qualify for benefits;
    6. Death directly caused by or arising from violent, unforeseen, physical, external forces due to an accident;
    7. The Insurer reserves the right to cancel the policy and to declare all premiums paid by the member in terms of the policy forfeited if there is any reasonable evidence of, or attempted submission of, a fictional claim, fraud or misrepresentation.
    8. in the event of death resulting directly or indirectly from, caused by, attributable to or accelerated by a.negligence, recklessness, transgression of the law or intentional exposure to danger;
    b. the additional assured life being under the influence of illegal drugs or habit forming substances or resulting from the chronic abuse by the additional assured life of drugs; c. willful self-inflicted injury.

    DESCRIPTION OF BENEFITS:
    1. Funeral Benefit for the Principal Member - The Insurer will pay the Insured’s beneficiary or estate as per the option selected on the application form being R15,000 or R20,000 or R25 000 or R30 000 (fifteen thousand or twenty thousand or twenty-five thousand or thirty thousand rand) upon death of the Principal Member if the Principal member elected to be covered under the policy;
    2. Funeral Benefit for dependents - In case of the death of the Principal Member’s dependents,the Insurer will pay the Principal Member the amount as per the option selected on the application form being R15,000 or R20,000 or R25 000 or R30 000 (fifteen thousand or twenty thousand or twenty-five thousand or thirty thousand rand) per dependent subject to the % of benefit limitations above;
    3. A maximum claim amount of R30,000 will be paid on the life of a deceased.

    PREMIUMS:
    1. A period of grace of 30 (thirty) days is permitted for the payment of premiums. If the premium is not paid within this period, the Insurer has the right to reject claims, subject to the provisions of the Long-Term Insurance Act, 1998;
    2. Withdrawal of the premium authorization will not be valid for the term of notice of cancellation;
    3. No premiums will be refunded should the policy be cancelled;
    4. Premiums shall be payable by the member to the Insurer monthly in advance on or before the 7th (seventh) day of each month for which insurance cover is granted without deduction or set off;
    5. In the event of the death of an additional assured life, the total premium payable in respect of the Single / Extended Funeral Plan will be reduced by the component of the premium payable in respect of the deceased additional assured life;
    6. If, upon request of the member, the benefits or cover are amended by the Insurer at any stage, the new premium shall be calculated with reference to the assured life’s current age at the inception date of the amended benefits or cover;
    7. Cover ceases when the Policy is cancelled, has been terminated by the Insurer or has lapsed, the member terminates his/her membership to the scheme, the member terminates the cover in terms of the main benefit plan, upon the death of the member, if the premium is not validly received by the Insurer within the period of grace, or when the dependent child, other than a still born child and a mentally or physically disabled child, reaches the age of 21 years, in the event of a child under the age of 26 (twenty six) years but who is a full time student, and is unmarried, at any registered university, Technicon or tertiary education institution, reaches the age of 26 (twenty six) years;
    8. The cover granted is whole life and shall remain in force until the death of the assured life, as long as premiums are paid; and is voluntary for members of the broker’s schemes brought in by the clients of the administrator, the Brokers, as members of the group scheme;
    9. If the premium has been paid as prescribed, cover is immediately effective upon the death of an assured life due to an accidental death;
    10. The Insurer be entitled to apply set-off or deduct any unpaid premiums against the benefits payable in terms of the policy;
    11. The member is responsible to ensure that the monthly premium is paid.

    CLAIMS PROCEDURE:
    1. In the event of a claim, report claims to the administrator immediately on 011 100 5384 or info@thepolicybuilder.co.za.
    2. Claim forms must be requested from the administrator and together with the relevant supporting documents, must be submitted to the administrator within 180 days of the date of event. Failure to do so could result in the benefit being forfeited;
    3. Copies must be clearly certified. The details of the commissioner of Oath with all of the relevant details must be clear. Posted documents must be sent via registered mail;
    4. In the event of a claim, the specified benefit will be paid to the member or beneficiary;
    5. Claims must be submitted to the Insurer within 6 months of the death of the assured life;
    6. Claims must be accompanied by the following clearly legible documents:o An official or certified copy of the original death certificate;
    o A completed official claim form as prescribed by the Insurer from time to time;
    o Completed BI-1663 and BI-1680 forms;
    o Clearly legible certified copies of the deceased member and payee’s ID documents. In case of third party payments, a certified copy of the third party’s ID document is required;
    o Either the policy schedule, if available or the application form;
    o Police statement, in event of death due to unnatural causes;
    o Bank details and a copy of a bank statement of the payee (or the third party in respect of third party payments) for payment of the benefit;
    o The Insurer may request a medical report in the case of stillborn babies, indicating that the pregnancy reached the 26th (twenty-sixth) week; and
    o Any additional documents that the Insurer in its sole discretion deems necessary.

    COMPLAINTS:
    Complaints that cannot be resolved via the administrator Client Service Centre should be reduced to writing and be addressed to the Complaints Officer of the administrator at the address below. Please have the following information handy:
    o Policy number;
    o Identity number;
    o Nature of enquiry;
    o Complaints which are not resolved to your satisfaction may be referred to the Insurer’s legal & compliance department;
    o Complaints which are still not resolved may be referred to the Ombudsman for Long-Term Insurance or the Registrar of Long-Term Insurance;
    1. The Policy Builder (FSP & Administrator) An Authorized Financial Services Provider FSP no. 42004, 19 Klub street, Windsor Glen, Randburg, 2194 Tel: +27 11 100 5384, Fax: 086 505 5239, P.O. Box 1272, Cresta, 2118
    2. African Unity Life Limited (Insurer) A Licensed Financial Services Provider FSP no. 8447, 99 Jip de Jager Drive, 1st floor, Riesling House, The Vineyards Office Estate, Bellville, Western Cape, 7530, Tel: 086 1234 555, Fax: 086 1234 556, PO Box 4061, Durbanville, 7550
    3. The Ombudsman for Long-term Insurance Private bag X45, Claremont, 7735, Tel: 021 657 5000 / 0860 103 236, Fax: 021 674 0951,info@ombud.co.za
    4. FAIS Ombudsman Financial Services Board, P.O. Box 74571, Lynnwood Ridge, 0040, Tel: (012) 470-9080, Fax: (012)348 344

    GENERAL TERMS AND CONDITIONS OF THE COMMUTER CASH PLAN
    The Insured Persons will only be covered in the event of a death being due to a motor vehicle accident (as the driver or as a passenger). Vehicle is defined to include any vehicle, whether on land, water, rail or air (and whether public or private). The Principal Member may not cede the benefit and any cession shall be null and void. Each Principal Member must complete an application form and nominate his/her beneficiary. Benefits cease upon the death of the Principal Member or his/her written instruction to terminate the contribution and benefits or in case of non-payment for the benefits.

    WAITING PERIODS
    1. No insurance cover shall be granted or benefits paid in the event of the death other than the accidental death of an assured life in terms of the Policy within 0 (Zero) months for members younger than 65 (eighty-five) from the inception date and members will be covered from the first premium paid.
    2. All waiting periods and exclusions shall apply in respect of increased benefits with effect from the inception date of the increased benefits.

    AGE LIMITATIONS
    The Principal Member must be between the ages of 18 and 64 at the time of application. Dependent Children must be between the ages of 0 and 21 at the time of application.

    SURRENDER VALUES
    There are no surrender values. Benefits may not be ceded or pledged in any way. The policy does not accumulate cash or a surrender value and may not be converted into a paid up policy. No loans will be allowed in terms of this policy.

    SPECIFIC EXCLUSIONS
    The Underwriter shall not be obliged to make payment in respect of any condition or event arising directly or indirectly from, contributed to by, or traceable to:
    1. Death due to natural causes, or in the event of an accidental death, which is not attributable to a vehicle accident;
    2. Suicide;
    3. War, invasion, acts of foreign enemy, hostilities, rebellion, revolution, insurrection or military or usurped power, or by ionizing radiation or contamination by radioactivity from any nuclear fuel or waste;
    4. Any participation in hazardous sports i.e. motor/cycle racing, mountain climbing etc.;
    5. Any involvement or participation in any criminal activity;
    6. Premium payments must be up to date to qualify for benefits;
    7. The Insurer reserves the right to cancel the policy and to declare all premiums paid by the member in terms of the policy forfeited if there is any reasonable evidence of, or attempted submission of, a fictional claim, fraud or misrepresentation.

    DESCRIPTION OF BENEFITS:
    Commuter Cover Benefit for the Principal Member & Spouse. The Insurer will pay the Insured’s beneficiary or estate R10 000 (ten thousand rand) upon the death of the Principal Member due to motor vehicle accident. In case of the death of the Principal Member’s dependents due to a motor vehicle accident, the Insurer will pay the Principal Member R10 000 (ten thousand rand).

    RIGHT TO CANCEL
    Once the Insurer has accepted the member’s application for insurance cover, the member may decide to instruct the Insurer to cancel the policy. The member must submit this instruction in writing to the Insurer within 30 days after receipt of this policy schedule. The member may only submit such cancellation instruction to the Insurer if no benefit has yet been paid or claimed or the insured event has not yet occurred. The Insurer may deduct the cost of any risk cover the member enjoyed under the policy before it was cancelled.

    REPLACEMENT
    If this policy is being purchased to replace another policy that has been cancelled or which will be cancelled in the near future, the member should be aware that it might be to their disadvantage to do so. The member must please contact the Insurer or the administrator in order to be informed of these disadvantages and consequences and ensure that a Policy Replacement Advice Record is completed, if applicable.