Application for the Classic or Essential Funeral Plan

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1 Application for the Classic or Essential Funeral Plan Contact us Tel: , PO Box 3888, Rivonia 2128, How to complete this form To enable Discovery to process the application form promptly and accurately, please ensure that it is completed in full. Write one letter per block in black ink, print clearly, mark selections with an X and sign and date any changes made. All lives assured must have a valid South African identity number to apply. On completion of the application form, it can be ed to Policy start date Start date depends on if the premiums are collected through debit order or payroll deduction: If we collect your premium via debit order your start date will further depend on when we receive your application form and the debit order date you have chosen: If your chosen debit order date occurs after the date on which we receive your application form, but within the same month, your start date will be the first day of that month If your chosen debit order date occurs in the month after the month in which we receive your application form, your start date will be the first day of that (later) month. For a policy where premiums are collected through payroll deduction, the policy start date is based on the date your application is activated by Discovery and your company payroll arrangement. 1. Principal life assured (This person is also the owner of the policy. Must be age 19 or older and younger than age 66 at application) ID number Title Sex M F Date of birth Y Y Y Y M M D D Contact number address Postal address Residential address 2. Additional lives assured Cellphone Code Code Spouse (Must be age 19 or older and younger than age 66 at application.)* Children (Must be younger than age 21 at application. A maximum of five children are allowed as Child Lives Assured)* Child 1 Child 2 Child 3 Page 1 of 11 Discovery Life is an authorised financial services provider. Registration number 1966/003901/ LFE E 1921 (V4) AFPE 03.15(15)

2 2. Additional lives assured (continued) Child 4 Child 5 Parents and parents-in-law (Must be age 36 or older and younger than age 76 at application. A maximum of four parents or parents-in-law are allowed as parent lives assured.)* Parent 1 Parent 2 Parent 3 Parent 4 Extended family members (Must be younger than age 66 at application. A maximum of four extended family members are allowed on the Funeral Plan.)* Extended family member 1 Extended family member 2 Extended family member 3 Page 2 of 11 Discovery Life is an authorised financial services provider. Registration number 1966/003901/06

3 2. Additional lives assured (continued) Extended family member 4 *Additional spouses, children and parents or parents-in-law must be added as extended family members, subject to the maximum number of extended family members allowed. 3. Benefit and premium details Plan option Classic Essential Lives assured Premiums* Lives assured Premiums* Principal life R Parent 1 R Spouse R Parent 2 R Child 1 R Parent 3 R Child 2 R Parent 4 R Child 3 R Extended family member 1 R Child 4 R Extended family member 2 R Child 5 R Extended family member 3 R Extended family member 4 R Total premium for policy R *Refer to the Discovery Life Funeral Plan Guide for plan option details and premium rates. The benefit amounts will increase automatically by CPI at each anniversary. The premiums will increase automatically by CPI + 1% at each anniversary. Commission will be paid to your financial adviser on the premium above. The commission is regulated by law and initial commission will not be more than 85% of the first annual premium. The cost of commission is included in the premium. Future increases in premium will result in extra commission being paid on the increased portion. 4. Beneficiary details Beneficiaries to whom the proceeds will be paid on the death of the principal life. Please complete the details of the beneficiary you wish to nominate. Proceeds of the other lives assured will be paid to the principal life. Full name Title Date of birth Y Y Y Y M M D D Sex M F ID number Percentage % Full name Title Date of birth Y Y Y Y M M D D Sex M F ID number Percentage % Full name Title Date of birth Y Y Y Y M M D D Sex M F ID number Percentage % It is your responsibility to keep your contact information up to date. If a benefit is unpaid because Discovery Life cannot contact you, your beneficiaries or dependants, using your contact details, we are required to contact a tracing company to trace you, your beneficiaries or dependants, after a prescribed period. You confirm that when you provide Discovery with personal information about any dependant or beneficiary in respect of this policy, they have given you permission to disclose that information to Discovery. This includes their permission to share their personal information with a tracing agent in order for them to help us trace you, your dependants or your beneficiaries. A tracing company will be used to try and trace you. If successful we will request the outstanding beneficiary payment details/requirements from you. Once received we will finalise the claim and deduct the tracing fee from your benefit pay-out. If they are unsuccessful in tracing you, the funds payable will be kept in an unclaimed fund for a period specified by the ASISA unclaimed benefit standard. The tracing fees are subjected to change during the term of the policy and can be made available on request. 5. Replacement of existing policy Important note: Replacement of any insurance may be to your disadvantage Is this proposal to replace the whole or any part of your existing insurance with any insurer (whether replacement is to occur Yes No immediately or to replace an insurance discontinued within the past four months or within the next four months)? If Yes, the financial adviser must discuss and complete the Replacement Policy Advice Record and attach it to this proposal form. Does this proposal constitute a replacement of an investment policy with a recurring premium investment or risk policy that Yes No will lead to or has led to the levying/deduction of a termination charge (causal event charges and administration charges) of more than 15% of the replaced policy s fund value? Refer to the definitions in Part 3 of the Regulations to the Long-term Insurance Act, 1998 (commission regulations) (not required if replacement policy effected as a result of the internet, telephone or direct marketing). Page 3 of 11 Discovery Life is an authorised financial services provider. Registration number 1966/003901/06

4 6. Payment details How to pay the recurring premium For debit order payment complete section 6.1. Should the premium payer differ from the policy owner complete section 6.2 as well. For payroll deduction complete section 6.1 and Direct debit order authority It is important that you provide us with the correct banking details from which to collect the premium. Discovery Life will not be legally responsible if you supplied us with incorrect banking details. You must inform us if your banking details change. Accountholder name Bank name Branch name Branch code Account number Account type: Current Transmission Savings (credit cards cannot be accepted) Monthly payment day (debit order day) Is the payer the same person as the policy owner? Yes No If No, please specify the payer details below. Company/Trust name Registration number of payer Title Sex ID or passport number M F Contact number Date of birth Y Y Y Y M M D D I/we the undersigned, authorise Discovery Life: To debit my bank account (each and every month commencing on the policy start date) the full recurring premium referred to in Section 3 on or after the monthly payment day when the premiums become due. In the event that the payment day falls on a Sunday or a recognised South African public holiday, the payment day will automatically be the very next business day. Further, if there are insufficient funds in the nominated account to meet the obligation, Discovery Life is entitled to track my/our account and represent the instruction for payment as soon as sufficient funds are available in my/our account (the bank will treat every payment instruction to pay the premiums to Discovery Life as if each payment instruction came from the payer personally). To issue and deliver payment instructions to my/our bank for collection of my/our premiums against my/our above-mentioned account (or any other bank or branch to which I/we may transfer my/our account) on condition that the sum of such payment instruction(s) will never exceed my/our obligations as agreed to in the policy contract. This authority shall endure until I/we give Discovery Life 20 day s written notice of termination. To collect all premiums, charges and fees owed and to pay any amounts owed to me/us into the bank account that I/we have specified. To change the payment method to Debit order should the Payroll deduction fail. I/we agree to advise Discovery Life in writing of any changes that may occur. I/we warrant that the information supplied above is true and correct. I/we agree that I/we am/are bound by the payment terms applicable to the policy. Signature of accountholder Date signed Y Y Y Y M M D D Second signature (if applicable) 6.2 Owner payment details for the PayBack Benefit only applicable to the Classic Funeral Plan This is the bank account of the policy owner. Please fill in this section if the premium payer differs from the policy owner. The PayBack Benefit and any Funeral Benefit paid in respect of a life assured who is not the principal life, will be paid to the policy owner. Please note that proof of account is required. Bank name Branch name Branch code Account number Account type: Current Transmission Savings (credit cards cannot be accepted) 6.3 Payroll deduction details (Please complete section 6.1 and 6.3 if the payment method is Payroll deduction) A copy of your payslip must be attached. Employer name Registration number Employee number Page 4 of 11 Discovery Life is an authorised financial services provider. Registration number 1966/003901/06

5 6. Payment details (continued) Applicable to Persal business: A fully completed stop order authorisation form (Annexure A) must be completed. Persal number Paypoint/ department code Worksite code Net salary R Current insurance deduction R Reservation number Premium to be deducted R I, the authorised representative of the payroll department, herewith agree to make the necessary deduction as per this payroll deduction. Name and surname Contact number Payroll authorised signature Date Y Y Y Y M M D D 7. Terms and conditions for cover 1. Key terms used 7.1 Accidental death means death caused directly or by injuries, as a result of a sudden and unexpected event which happens at a known place and time and has visible, violent and external cause and which ends in the death of a life assured. 7.2 CPI is the Consumer Price Index published by Statistics South Africa. CPI increases on your Funeral Plan are limited to a minimum of 0% and a maximum of 10%. 7.3 Child means an unmarried person under the age of 21 born to you or your spouse, a step-child, a foster child or a legally adopted child who is dependent on you, your spouse or both of you. 7.4 Extended family means: Any child who meets the definition of a child in 7.3 above, who is not registered as a child on this policy Another spouse who is not registered as the spouse on this policy A parent or parent-in-law who is not registered as a parent on this policy A blood relative for whom you or your spouse are financially responsible. 7.5 Guide means Funeral Plan Guide. 7.6 Lives assured means anyone who is recorded on your Policy Schedule, for example you, your spouse, parents, children and extended family. 7.7 Parents and parents-in-law means the natural parents of you or your spouse or the parents who legally adopted you or your spouse. 7.8 Policy refers to the guide, this application form, this Policy Schedule and any changes that you make to this policy. 7.9 Policy Schedule is the summary of the policy that we send to you when we have accepted your application for cover or any changes that are made to your policy Spouse is the person that you are legally married to and includes a customary marriage, a union recognised as a marriage by any Asian religion, a member living with you as a long-term partner and any person you consider as your common law spouse and is also considered by us as such Start date depends on whether we collect your premiums via debit order or payroll deduction If we collect your premium via debit order your start date will further depend on when we receive your application form and the debit order date you have chosen: If your chosen debit order date occurs after the date on which we receive your application form, but within the same month, your start date will be the first day of that month If your chosen debit order date occurs in the month after the month in which we receive your application form, your start date will be the first day of that (later) month For a policy where premiums are collected through payroll deduction, the policy start date is based on the date your application is activated by Discovery and your company payroll arrangement We, us and our is Discovery Life Limited, a public company with limited liability registered under the company laws of the Republic of South Africa (registration number 1966/003901/07), whose principal place of business is 155 West Street, Sandton, Johannesburg, You and your is you the owner of this policy as set out in the Policy Schedule Assessing your application We will assess your application and let you know if we have accepted it or not. Cover for you or any of the lives assured under the policy starts on the start date, which has been defined in Section Your policy contract is made up of all of the following documents: This application form and any application form to change your policy The Policy Schedule The guide You have 30 days to object to any policy contract terms You have 30 days from the date that you receive your Policy Schedule to tell us if you have any objections. If we do not receive an objection in this time, we will assume you have accepted the policy. You do not have the right to object to any terms and conditions after the 30 days. If you do object, we may change the terms of the contract but we do not have to do so You confirm that we may collect premiums For policies where the premium is collected via payroll deduction: Signing the form means that you give us permission to collect all premiums, charges and fees that are owed to us. We will collect the premiums directly from your earnings on a monthly basis. Signing the form also means that you give us permission to switch the premium collection method if the payroll deduction fails For policies where the premium is collected via debit order or where the payroll deduction has failed: Signing the form means the premium payer has given us permission to collect all premiums, charges and fees that are owed to us. We will collect the premiums by debit order on the first banking day thereafter they are due. The premium payer s bank will treat every payment instruction to pay the premiums to us as if it came from the premium payer personally. The premium payer may cancel the debit order but this may lead to your policy being cancelled if you (or the premium payer) do not give us new debit order details or stops paying premiums when they are due. Neither you nor the premium payer can ask us to refund a premium you owed us in terms of the policy contract. We are not responsible for any loss you or the premium payer might suffer because the bank account details we have for you or the premium payer are incorrect. Please let us know immediately if your or the premium payer s banking details change. Page 5 of 11 Discovery Life is an authorised financial services provider. Registration number 1966/003901/06

6 7. Terms and conditions for cover (continued) 7.18 Premiums You are the principal life and you must also be the owner of the policy All premiums as stated in the Policy Schedule must be paid by debit order or by payroll deduction. If the premium payer does not pay premiums when they are due for example we are unable to collect the premiums through debit order or the payroll deduction fails, we may cancel the policy from the date the premium was due (see section 7.20) We will only consider the premium as paid when our bank account is credited with the premium. In the case of a debit order, this is provided that the premium is not reversed later. You will only have rights to ownership of the policy when the first premium is received For debit order business, if there are insufficient funds in the nominated account to meet the obligation on the day that the debit order is called, we are entitled to track the account and represent instruction for payment as soon as sufficient funds are available in the nominated account Premium increases applied to the premium charged for each life assured will not exceed CPI+1% at each anniversary in the first five years but we reserve the right to increase premiums above the CPI + 1% applied at each anniversary after the first five years has passed, for that specific life assured If there is a discrepancy between the premium rates that you have filled in on your application form and the premium rates shown on the Policy Schedule, then the Policy Schedule will be followed If you apply to change the policy then the premium rates for the application will apply for the changes you make to the policy. Premium increases applied to the premium charged after the changes are applied will not exceed CPI+1% at each anniversary in the first five years but we reserve the right to increase premiums above the CPI +1% applied at each anniversary after the first five years has passed Premiums will increase automatically on the anniversary of the start date by CPI + 1%. The aggregate premium increase is limited to a maximum of 11% and a minimum of 1% The premium rates are set out in the Policy Schedule. All charges for this policy are included in the premium rates If premiums are not paid We will let you know in writing if we do not receive your premium. If the premium is not paid in time, we give you 30 days after the premium due date to make the payment. If you need to claim during this time, Discovery will consider the claim if we receive the outstanding premium If a second premium is not received your policy will be cancelled and no claim will be paid after this Cooling off period You have the right to cancel any benefit or the policy and a refund of premiums within 30 days from the date of receipt of your Policy Schedule provided that no benefit has been paid Right to cancel You have the right to cancel any benefit or the policy at any time by providing Discovery Life 30 days written notice of termination. No premiums will be refunded to you Complaints If you have a complaint about the advice you have received or if you believe you did not receive enough information about the policy, please contact our compliance department at: Telephone: Facsimile: If you lodged a complaint with us or to your financial adviser about the financial service you have received from your financial adviser in relation to this policy and you are not happy with the response you received, you can contact the FAIS Ombud at: P.O. Box 74571, Lynnwood Ridge 0040 Telephone: Facsimile: If you are unhappy with any terms of the policy or anything we have done in relation to the policy, you can contact the Ombudsman for Long-term Insurance at: Private Bag X45, Claremont 7735 Telephone: Facsimile: Fair Collection Notice 8.1 These terms and conditions explain how we obtain, use, disclose and otherwise process personal information, which may include health and financial information ( Personal Information ), as required by the Protection of Personal Information Act ( POPIA ). 8.2 Acceptance of these terms and conditions is voluntary, but is a requirement for activation and servicing of your policy. If you do not accept these terms and conditions, we cannot activate and service your policy. You acknowledge that this authorisation cannot be withdrawn or cancelled and that it will continue after your death. 8.3 We will keep any information, including personal information relating to yourself and your dependants and/or beneficiaries supplied to us in this application or collected from other sources ( Your Personal Information ) confidential. You confirm that when you provide us with your personal information, your dependants and/or beneficiaries have provided you with the appropriate permission to disclose their personal information to us for the purposes set out below and any other related purposes. 8.4 You hereby consent to the collection, collation, processing, storage and disclosure of your personal information for the purpose of: Administering this policy and for the assessment of any claim(s) under this policy Enabling any entity within the Discovery Group and/or any third party provider or any financial services provider or its representative approved by Discovery to advise you of, or offer to you, any enhanced benefits or new products which become available from time to time which you may become entitled to or qualify for; and Providing relevant information, including your personal information, to a contracted third party who requires such information to render a service to you in relation to this policy, provided that such contracted third party agrees to keep the information confidential. 8.5 Please note: We may amend this notice from time to time. Please check our website periodically to inform yourself of any changes You have the right to object to the processing of your personal information Should you believe that we have utilised your personal information contrary to applicable law, you will first resolve any concerns with us. If you are not satisfied with such process, you have the right to lodge a complaint with the Information Regulator, once established. 8.6 By signing this application form: You authorise us to: Obtain and share information about your creditworthiness with any credit bureau or credit providers industry association or other association for an industry in which we operate. This includes information about credit history, financial history, judgments and default history in accordance with the requirements of the National Credit Act and regulations, and sharing of information with tracing agents; and Page 6 of 11 Discovery Life is an authorised financial services provider. Registration number 1966/003901/06

7 8. Fair Collection Notice (continued) You give permission to Discovery Vitality (Pty) Ltd and FirstRand Bank Limited to obtain and verify your credit and financial information at any time and to make any queries that they consider to be necessary. If we want to share your information for any other reason, we will do so only with your permission. 8.7 You agree to receive communications electronically You agree that we may communicate electronically with you. You may unsubscribe to receiving electronic marketing material. Please contact us if you do not wish to receive any telephonic direct marketing from us. 8.8 You have the right to request a copy of the personal information we hold about you. To do this, simply complete the Data Subject Request Form on and specify what information you would like. We will take all reasonable steps to confirm your identity before providing details of your personal information. Please note that any such data subject request may be subject to a payment of a legally allowable fee. You have the right to contact and ask us to update, correct or delete your personal information. 8.9 You agree that Discovery may transfer your personal information outside the borders of the Republic of South Africa if you provide an address which is hosted outside the borders of South Africa. We may also need to transfer your personal information to another country for processing, storage or academic research. We will ensure that anyone to whom we pass your personal information agrees to treat your information with the same level of protection as we are obliged to You agree that Discovery may retain your personal information until such time as you request us to destroy them (unless we are obliged by law to retain it, regardless of such request) If Discovery Limited becomes involved in a proposed or actual merger, acquisition or any form of sale of some or all its assets, we may use and disclose your personal information to third parties in connection with the evaluation of the transaction. The surviving company, or the acquiring company in the case of a sale of assets, would have access to your personal information which would continue to be subject to this notice Discovery Life is required to collect and retain information in terms of the following legislation: The Financial Advisory and Intermediary Services Act (FAIS) The Financial Intelligence Centre Act (FICA) The National Credit Act (NCA) The Long-term Insurance Act (LTIA); amongst others You give us permission to obtain your health and other information to assess the risk of insuring you for cover, as well as to administer your policy and consider any claims you make, we may need certain information. The information we may need includes information about your identity (including personal and contact details), health (including HIV status), lifestyle, finances and creditworthiness. By signing this application form, you authorise Discovery Life to do all of the following: Obtain this information about you from any one, including from Discovery Health, Discovery Health Medical Scheme, Discovery Vitality (Pty) Ltd and DiscoveryCard, and any person which could be any doctor you have consulted with. You also authorise and instruct the person with the information to give the information to Discovery Life. You also confirm that your personal and health information may be provided to any other entity within the Discovery Group where you or your dependant/s already have a relationship with or where you or your dependant/s have applied for a product or benefit. This information will be provided for the administration of your or your dependant/s products or benefits. You authorise Discovery Life to share information, including personal information, in this application or in any related document with other assurers and re-insurers. This authority extends to sharing such information directly with an assurer and/or through any database for assurers at any time (even after your death) and in any form, including detailed, abbreviated or coded form. This also includes sharing of information on industry registers such as ASISA and ASTUTE. You authorise Discovery Life to do all of the following: Give your financial adviser the policy information, including your personal information, necessary to ensure the efficient administration of your policy and to ensure that we comply with all relevant legislation Share your health information with your financial adviser during any underwriting process. 9. Warranty 9.1 I have read and understood the contents of this application form, and the Classic and Essential Plan premiums page. 9.2 I agree to be bound by the terms and conditions of this application form, the Discovery Life Funeral Plan Guide, the Policy Schedule, and any servicing alteration requests, which read together, make up the contract. 9.3 I agree that any commission payable in terms of the Long-term Insurance Act of 1998, may be paid to my appointed financial adviser. These commissions have been explained to me by my appointed financial adviser. 9.4 I agree that Discovery Life will not be at risk for any alterations to the policy made by me or my financial adviser or anyone acting on my behalf until Discovery Life has accepted, in writing, such alterations and for which they have received a premium (if applicable). 9.5 I confirm that, to the extent that Discovery is not my appointed financial adviser, Discovery has not advised me and as such are not responsible for any choices I have made. 9.6 I confirm that Discovery can take instructions from my financial adviser. If Discovery acts on any instruction from my financial adviser and it is later found that my financial adviser did not act in terms of the instructions or authority that I gave him/her, I confirm and agree that, unless my financial adviser is an employee of Discovery, Discovery will not be liable for any loss or damage I may have suffered. 9.7 Discovery will not be responsible for any failure, malfunction or delay of any networks or electronic or mechanical device or any other form of communication used in the submission, acceptance and processing of applications and/or transactions. Discovery will not be liable to make good or compensate me or any third party for any damages (whether direct or consequential), losses, claims or expenses. 9.8 I understand and agree that, subject to the waiting periods, Discovery Life will only be at risk from the policy start date which is explained in clauses 2.15 and 4 of the Discovery Life Funeral Plan Guide. 9.9 I warrant and confirm that all information given by me in this application form, whether in my handwriting or not, is true and correct. I understand that if any information I have provided herein is false or I have failed to disclose material facts then Discovery Life may cancel the policy or benefits. Signed at (town or city) on Y Y Y Y M M D D Signature of principal life Page 7 of 11 Discovery Life is an authorised financial services provider. Registration number 1966/003901/06

8 10. Financial adviser details Primary financial adviser Financial adviser name Financial adviser house DCS/DFC/DSI Branch DCS/DFC/DSI Consultant name PRI number (ABSA and FNB intermediaries) I am a registered representative and represent a Financial Services Provider authorised by the Financial Services Board in terms of the Financial Advisory and Intermediary Services Act. No 37 of I confirm that I have rendered the financial services in respect of the benefit in accordance with the prescripts of the general code of conduct for authorised financial services providers and representatives (BN80). Public sector employee declaration In cases where the applicant is a public sector employee and in adherence to the 15% affordability rule recommended by the Accountant General, I confirm that I have ascertained and ensured that the premium in respect of this proposed policy together with existing insurance deductions will not exceed 15% of the applicant s monthly basic salary. Replacement of an existing policy declaration I hereby declare that I have requested and recorded the client s responses to the questions (refer to Section 5) with regard to replacement and that the client is fully aware of the possible detrimental consequences of the replacement of an insurance policy. I further declare that, irrespective of the client s response to the questions in section 5, I explained the following to the client: The meaning of replacement That a replacement is potentially prejudicial The levying/deduction of a termination charge and That where a replacement is considered, the client is legally entitled to comprehensive information regarding the consequences of replacement Signature of financial adviser Date Y Y Y Y M M D D Code Code Code Page 8 of 11 Discovery Life is an authorised financial services provider. Registration number 1966/003901/06

9 Annexure A Stop Order authorisation Contact us Tel: , PO Box 3888, Rivonia 2128, I, the undersigned First names Title Sex M F Date of birth Y Y Y Y M M D D Previous/maiden name ID or passport number Persal number hereby authorise the department of: Nationality (as per passport) to deduct monthly with effect from Y Y Y Y M M the premium / payment of R from my salary and to remit it to Discovery Life, of which I am a member until such time as I cancel this authorisation in writing, or until I substitute it with a new authorisation. Should the relevant premium/payment rate be adjusted by Discovery Life as a result of an inflation related increase in the premium/payment rate, I confirm that the adjusted premium/payment rate may be deducted from my salary until such time as I cancel this authorisation in writing or until I substitute it with a new authorisation. Public sector employees I confirm that the premium in respect of this proposed policy together with existing insurance deductions will not exceed 15% of my monthly basic salary. Signed at (town or city) on Y Y Y Y M M D D Signature of policy holder Page 9 of 11 Discovery Life is an authorised financial services provider. Registration number 1966/003901/06

10 Classic or Essential Funeral Plan Premiums Contact us Tel: , PO Box 3888, Rivonia 2128, Premium and benefit tables Plan Principal Life R R R R R R Spouse R R R R R R Extended family (older than 21) R R R R R R Parents R R R R R R Children and extended family (age 15-21) R7 500 R R R R R Children and extended family (age 6-14) R5 000 R R R R R Children and extended family (age 0-5) R3 000 R R R R R Automatic baby cover R1 000 R4 000 R4 000 R4 000 R4 000 R4 000 Classic Funeral Plan premiums principal life funeral spouse life funeral R64 R84 R102 R129 R149 R R77 R105 R132 R170 R199 R R85 R117 R149 R194 R228 R R99 R141 R181 R240 R284 R R114 R167 R219 R293 R349 R R134 R201 R266 R358 R429 R R26 R43 R60 R85 R104 R R39 R66 R92 R130 R159 R R42 R70 R97 R138 R168 R R51 R85 R118 R166 R203 R R65 R107 R148 R208 R253 R R81 R133 R184 R257 R313 R369 Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 child cover R15 R26 R26 R26 R26 R26 extended family funeral parent funeral <20 R16 R33 R33 R33 R33 R R20 R41 R41 R41 R41 R R31 R62 R62 R62 R62 R R38 R77 R77 R77 R77 R R53 R106 R106 R106 R106 R R70 R139 R139 R139 R139 R R89 R178 R178 R178 R178 R R36 R71 R71 R71 R71 R R49 R98 R98 R98 R98 R R65 R130 R130 R130 R130 R R83 R166 R166 R166 R166 R R117 R235 R235 R235 R235 R R167 R333 R333 R333 R333 R333 Page 10 of of 111 Discovery Life is an authorised financial services provider. Registration number 1966/003901/06

11 Classic Plan additional benefit Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Education Benefit R3 000 R3 300 R3 600 R3 900 R4 200 R4 500 Memorial Benefit R5 000 R5 000 R5 000 R5 000 R5 000 R5 000 Grocery Benefit R1 800 R2 400 R2 700 R3 000 R3 300 R3 600 Essential Funeral Plan premiums R48 R63 R78 R98 R114 R129 principal life funeral R58 R79 R100 R129 R152 R R63 R88 R113 R147 R173 R R74 R106 R138 R182 R216 R R87 R129 R169 R227 R271 R R104 R157 R209 R282 R339 R R19 R32 R45 R63 R77 R91 spouse life funeral R29 R49 R69 R98 R120 R R31 R52 R73 R104 R127 R R38 R63 R89 R125 R153 R R49 R82 R114 R161 R197 R R62 R104 R145 R204 R249 R294 Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 child cover R10 R19 R19 R19 R19 R19 <20 R12 R23 R23 R23 R23 R R15 R29 R29 R29 R29 R29 extended family funeral R23 R45 R45 R45 R45 R R28 R55 R55 R55 R55 R R38 R77 R77 R77 R77 R R52 R105 R105 R105 R105 R R69 R138 R138 R138 R138 R R26 R51 R51 R51 R51 R51 parent funeral R36 R71 R71 R71 R71 R R49 R97 R97 R97 R97 R R64 R128 R128 R128 R128 R R92 R184 R184 R184 R184 R R132 R264 R264 R264 R264 R264 Essential Plan additional benefit Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Education Benefit R2 400 R2 700 R3 000 R3 300 R3 600 R3 900 Memorial Benefit R5 000 R5 000 R5 000 R5 000 R5 000 R5 000 Grocery Benefit R1 200 R1 800 R2 100 R2 400 R2 700 R3 000 Example Your premium will increase by CPI +1% at each policy anniversary. Your Funeral Benefit will increase by CPI at each policy anniversary. The example below shows the premium and Funeral Benefit increases over a 20-year period. Mr Smith chooses a Funeral Benefit of R His premium is R200 per month. CPI is assumed to be 5%. Over the next 20 years Mr Smith s premium and Funeral Benefit will increase as follows: Year 1 Year 2 Year 3 Year 4 Year 5 Year 10 Year 15 Year 20 Premium R200 R212 R225 R238 R252 R338 R452 R605 Insured amount R R R R R R R R Page 11 of 11 Discovery Life is an authorised financial services provider. Registration number 1966/003901/06

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