1. The money back benefit

   This is an automatic benefit.

   We will pay back 20% of the benefit premiums we have received, regardless of whether we have paid any claims.

   The following conditions apply to this benefit:

   1. We must have received all 60 benefit premiums in full, consecutively and within the 30-day grace period (extra time).
   2. The policy must have been in force for 60 consecutive months.
   3. We will not pay back any policy fees as set out in the policy schedule.
   4. We will pay the money back benefit as a lump sum after every 60 months.
   5. If the policy is restarted, the money back benefit will start again from zero on the date the policy restarts.
   6. If the policy is reinstated, the money back benefit will continue as if the policy has been active since the original Policy Start Date.

2. The premium waiver benefit

   This is an automatic benefit.

   In the event of the death of the main insured person, the benefit premiums for all insured persons and benefits will be waived for a period no greater than 12 months following the event date.

   The following conditions apply to this benefit:

   1. We must have received all 24 benefit premiums in full, consecutively and within the 30-day grace period (extra time).
   2. The policy must have been in force for 24 consecutive months.
   3. If the policy is restarted, the death premium waiver benefit will start again from zero on the date the policy restarts.
   4. If the policy is reinstated, the death premium waiver benefit will continue as if the policy has been active since the original Policy Start Date.

3. There are waiting periods that apply

   We will not pay a funeral, tombstone, monthly provider or cow benefit claim caused by certain events during the waiting periods as set out below:

   1. The insured person died of natural causes:

      • 6 months for the main insured person, partner or children;

      • for parents

        • 18 years or older but younger than 71 the waiting period is 6 months
        • 71 years or older but younger than 86 the waiting period is 9 months;

      • for extended family members

        • 1 years or older but younger than 71 the waiting period is 6 months
        • 71 years or older but younger than 86 the waiting period is 9 months.

   2. The insured person’s death was caused by suicide, attempted suicide or self-inflicted injury

      • 6 months for the main insured person, partner or children;

      • for parents

        • 18 years or older but younger than 71 the waiting period is 6 months
        • 71 years or older but younger than 86 the waiting period is 9 months;

      • for extended family members

        • 1 years or older but younger than 71 the waiting period is 6 months
        • 71 years or older but younger than 86 the waiting period is 9 months.

   3. The insured person’s death was caused directly or indirectly by a pre-existing condition:

      • 12 months for any insured person.

   4. No waiting period will apply if an insured person dies because of an accident that happened during the period of insurance.

   5. If the Individual funeral cover replaces existing cover with another insurer, we will not apply the 6-month waiting period for death because of natural causes. The following conditions apply:

      • the insured persons:

        • are the same under this policy as they were under the previous policy;
        • were covered under the previous policy on the day before the benefit start date; and
        • enjoyed uninterrupted cover under the previous policy for at least six months.
      • the previous cover was with a registered insurer in Lesotho or South Africa;
      • the amount of the benefit payable on this policy is not higher than the benefit that was payable under the previous policy. If the benefit is higher, the full waiting period will apply to the difference in cover; and
      • you give us proof of cover including all the above information.

1. The monthly total premium

   1. What you must pay

      You must pay the total premium as set out in the policy schedule. We may decide to change the total premium at any time. We will tell you at least one month before the effective date of the revised total premium.

   2. When you must pay

      1. The total premium is due in advance on the first of every month, but we will collect the total premium on the premium collection date.
         • For the policy to start, we must receive the first total premium. If we do not receive your first total premium the policy will not start.
         • For the policy to renew each month, the total premium is due on the premium collection date.
      2. We will allow a 30-day grace period (extra time) from the first of every month for you to pay your total premium. This grace period does not apply to the payment of the first total premium.
      3. If the premium collection date falls on a weekend or public holiday, we will debit your bank account on the first working day before or after the weekend or public holiday.

   3. If you do not pay the monthly total premium

      1. We will tell you when we do not receive the total premium.
      2. If you chose to pay your total premium via salary deduction and we do not receive your monthly payment, you should follow up with your employer and make an arrangement to pay outstanding total premium within the 30 days grace period (extra time).
      3. If any debit order instruction is rejected because of insufficient funds or for whatever reason, we will attempt to debit your bank account again within the 30 days grace period (extra time). If we are able to collect the total premium, the policy will continue.
      4. The policy will end on the last day of the month for which a total premium was received if:
         • the payment is not received within 30 days; or
         • you stop the debit order directly with the bank.
      5. We will pay a valid claim that happens during the 30 days grace period (extra time), but we will deduct the unpaid total premium.

2. When the policy conditions will change

   We will tell you at least one month before the effective date of any changes we make as set out below. We will send you an updated policy schedule, policy wording and an explanation of the changes.

   Unless you tell us that you do not want to continue with this policy, we will automatically renew your policy on the terms set out in the updated policy schedule and policy wording.

   1. Annual policy fee review

      The policy fee is included in your total premium and goes towards the cost of managing this policy.

   2. We may make changes to the policy conditions

      We may change the terms and conditions of this policy at any time and not just at the policy review date. Any change we make will not affect the extent of cover already provided and in force in terms of this policy.

      If any statutory authority introduces measures which affect this policy or if the law changes, we will make the necessary changes and tell you of the reason for the changes. This could mean that we have to cancel a benefit section.

   3. You may make changes to the policy

      If you ask us to make any changes to the policy, it will be effective from the date agreed to by us.

1. You must give us information

   You must tell us when any of the following information changes.

   1. Information about the policyholder or main insured person

      • full name, address, and contact details
      • identity number, date of birth and gender; and
      • salary deduction/bank account details and any other information we need to collect your total premium;
      • premium collection date.

   2. Information about the beneficiary for the policyholder

      • full name, address and contact details;
      • identity number, date of birth and gender; and
      • relationship to the main insured person.

   3. Information about each of the other insured persons

      • full name, address and contact details;
      • identity number, date of birth and gender; and
      • relationship to the main insured person.

2. You must give us true information

   We base our decision to insure the insured persons on the information you give to us. If any of this information is incomplete or incorrect, our decision will have been based on incomplete or incorrect information. If we had known the complete and correct information, we may not have agreed to cover the insured persons for the amount set out in the policy schedule.

   It is your responsibility to ensure that all material information we receive is complete and correct.

   Proof of age is required before any benefit is payable.

   • If the age was incorrectly stated, we will recalculate the total premium according to the correct age and will adjust the benefits accordingly.
   • If we would not have covered the insured person on his benefit start date, we will pay back the total premiums from his benefit start date, less an administration fee.

3. There must be insurable interest

   In order for this insurance policy to be valid, there must be insurable interest. This means there must be a recognised relationship between two people and because of this relationship one of the two people will suffer a financial loss on the death of the other person.

   1. If the policyholder and the main insured person are the same person

      • The main insured person must have an insurable interest in the other insured persons on this policy.
      • Each benefit section will set out which relationship an insured person may have with the main insured person.

   2. If no insurable interest exists

      • If we discover that no insurable interest existed as at the policy start date, we will cancel this policy from the policy start date. You will lose your right to claim as well as the total premiums paid.
      • If we discover that no insurable interest existed as at an insured person’s benefit start date, we will cancel his benefit from his benefit start date. You will lose your right to claim as well as the benefit premiums paid for that insured person.

4. You must always be honest

   All dealings about this policy must be done honestly and in good faith. We will not accept any responsibility under this policy if you, any of the insured persons or any person acting for you is dishonest or misrepresents any information.

   1. You will lose your right to claim if we are prejudiced or suffer a loss because of:

      • dishonest behaviour;
      • misrepresentation; or
      • criminal activity.
   2. We will cancel your policy from the policy start date or from the date of the actions listed above. If we cancel your policy from the policy start date, we may refund all total premiums paid less an administration fee.
   3. We will take legal steps to recover damages from you.

5. You must keep to the terms and conditions

   You must keep to all the rules, terms, conditions and the claims process set out in this policy.

6. When you can transfer your rights under this policy to another person

   You may not transfer your rights or benefits payable under this policy to another person or entity, except as provided for by any of the Continuation of cover options, set out in the Conditions for cover section.

   If you try to transfer the rights to any other benefits in this policy to another person or entity, we will not recognise that contract. We will continue our contract with you on any of the other benefits as if you had not made a contract with someone else.

7. You may choose different benefits

   There are different benefits that you may choose from and each benefit has different maximum benefits or payment periods. You may cancel benefits, choose different benefits or increase your existing benefits at any time by contacting us.

   The waiting periods will apply from the benefit start date of the additional benefit, or the date of the increase in cover.

Certain benefit sections might have specific exclusions that apply in addition to these general exclusions. You must read this section together with each benefit section.

In addition to any specific exclusions set out in each benefit section, we will not pay a claim for an insured event because of any of the exclusions listed below:

1. Criminal activities

   We will not pay a claim if any insured event is directly or indirectly caused by criminal activities. Criminal activity means the insured person is or was:

   • under investigation for committing a crime;
   • being prosecuted for committing a crime; or
   • convicted by a Court of Law for having committed a crime.

   We will delay our claims decision until the finalisation of the investigation, or the criminal trial (as applicable).

   The claimantmust give us proof of the outcome of the investigation or the criminal trial (as applicable).

2. The insured person was not eligible

   We will not pay a claim for an insured person if he was not eligible or did not meet the definition of insured person on his benefit start date.

   If we do not pay the claim because the insured person was not eligible, we will refund all the total premiums we have received since his benefit start date.

3. Insured event or accident before the benefit start date

   We will not pay a claim for an insured person if the insured event, or accident leading to the insured event happened before his benefit start date.

1. Nominating a beneficiary

   1. The policyholder must tell us who the beneficiary is

      You must nominate a beneficiary to receive the benefits in the event of the death of an insured person, as set out in each benefit section.

      • You may nominate more than one beneficiary.
      • You may change or withdraw the nomination at any time.
      • The change or withdrawal of the nomination shall not be binding on us unless you told us in writing.
      • A beneficiary will have no interests or rights in the policy during the lifetime of the policyholder.
      • Nominations in a will or any other testamentary instrument that the policyholder agreed to, shall not affect or invalidate any existing beneficiary nomination that we have recorded.

   2. If the beneficiary is under the age of 18

      If the beneficiary is under the age of 18 we will pay the benefit to the legal guardian or the trust.

      • The policyholder must tell us who the legal guardian is or give us the details of the trust.
      • The policyholder must have set up a trust before his death for the purpose of receipt of benefits payable on his death, where the beneficiary is under the age of 18.

   3. If there is no beneficiary

      1. If there is no beneficiary it means that:

         • the policyholder died without nominating a beneficiary;
         • the beneficiary is not alive when the insured person died;
         • the beneficiary cannot be located within 12 months of the death of the insured person; or
         • the beneficiary is under the age of 18 and there is no legal guardian or trust.

      2. We will pay all benefits payable to the beneficiary to the first of the following claimants:

         • the insured person’s partner, child, parent, brother or sister. ;

      3. The claimantmust be over the age of 18 and must provide proof of his relationship to the insured person.

      4. If a person other than one of the claimants listed above contacts us to claim the insured person’s benefit, we will pay the benefit to the insured person’s estate.

2. How to claim

   If there is a claim for a benefit payable under this policy:

   1. You must tell us of the claim in writing or contacting us within 180 days from the date of the insured event. We will tell you what evidence and other documents we need to process the claim.
   2. You must send us the evidence and other documents we ask for within the time that we will give you. All the information you send must be in the format we prescribe and without expense to us.
   3. If you do not follow the steps above, or you do not send us the information we ask for within the time we gave you, you will lose your right to claim.

3. Who we will pay

   If we assess a claim as valid, we will pay the benefits to the persons as set out in each benefit section.

4. If you do not agree with our claims decision

   If we do not accept a claim, cancel this policy or if the claimantdisputes the amount of the claim, the claimantmay request us to review our decision.

   We will only review our decision if he sends us a written request to review within 90 days (the “representation period”) of the date that he receives our rejection letter and covers all costs of the review.

   Alternatively, the claimantmay contact the Central Bank of Lesotho on the contact details set out in the Additional information document. The Central Bank of Lesotho is the regulator of the insurance industry.

5. How we calculate interest

   If we assess a claim as valid, we will pay the benefits to the persons as set out in each benefit section.

   1. The benefit amounts will not attract any interest for the first six months from the date that we accepted the claim.

   2. An unclaimed benefit as set out in Section E – No. 6. If we cannot make payment, will attract interest after six months from the date that we accepted the claim. We will calculate interest on a monthly basis at a rate of:

      • The Central Bank of Lesotho money market interest rate that is applicable during the period that the benefit remains unclaimed;
      • less our administration fee.

6. If we cannot make payment

   It is your responsibility to ensure that the contact details of the policyholder, the main insured person and the nominated beneficiary are correct.

   If anything prevents us from making a payment within six months from the date that we accepted a claim, the benefit is an unclaimed benefit. We will keep the claim open until we have obtained the outstanding information that will enable us to pay the claim

   We will take the following steps to trace the policyholder, main insured person or the nominated beneficiary (as applicable):

   • We will attempt to contact the policyholder, main insured person or the nominated beneficiary (as applicable) to tell them of the available benefit.
   • If we cannot reach the policyholder, main insured person or the nominated beneficiary (as applicable) we will compare our internal database with an external database, or make use of an external tracing company.
   • We will repeat the tracing process after three years from the date that we accepted the claim, and again after ten years from the date that we accepted the claim.
   • If after ten years from the date that we accepted the claim we are still unable to trace the policyholder, main insured person or the nominated beneficiary (as applicable), we will not repeat the tracing process.
   • If we have to repeat the tracing process at any time, we will deduct administrative, tracing and management fees that we incur because of tracing, from the value of the claim. The administrative, tracing and management fees may change over time.
   • We will not trace the policyholder, main insured person or the nominated beneficiary (as applicable) where the value of the claim is less than M 1,000.00, and where the cost of tracing is more than the benefit.

1. Cancelling this policy

   1. When we may cancel

      We may cancel this policy by giving you one month’s written notice.

   2. When you may cancel

      1. Cooling off period

         • You may cancel this policy by giving us immediate notice, if it is within the first month from the policy start date or of receiving the policy summary.
         • If we have not paid a benefit or no insured event has yet occurred, we will refund all the total premiums paid, less the deduction of costs for any cover provided for risk benefits.

      2. Cancellation

         • You may cancel this policy by giving us one month’s written notice, if it is any date later than one month after the policy start date of receiving the policy summary.
         • At the end of the notice period, this policy will automatically end. You may ask us to restart or reinstate the policy as set out in Section C - Continuation of cover.

   3. Total premiums paid after cancellation

      If you pay us any total premium after the date that this policy ends, we will refund the total premiums to you.

2. When this policy ends

   The policy ends when:

   1. you do not pay the total premiums due under this policy as set out in the total premium and changes to the policy section;
   2. all benefits under this policy have been paid;
   3. the policyholder or the main insured person dies, unless the benefits for the remaining insured persons continue as set out in the Conditions for cover section under the Continuation of cover heading;
   4. the notice period for cancelling this policy (as set out above) comes to an end.

1. Good faith

   We will always act in good faith in our mutual dealings. If we make an administration error, it will not take away any cover you have, or give you any cover that you do not have.

2. Our liability

   Our liability in terms of this policy is conditional on you, or anyone acting on your behalf, keeping to all the terms and conditions of this policy.

   • All claim payments are subject to the verification of the validity of any claim.
   • Our payment of any benefit is a full and final discharge of our responsibilities under this policy. Once we have paid a valid claim, we will not be responsible for anything else.
   • Our responsibility does not exceed the benefit for which you have paid total premiums.
   • Payment of a benefit under this policy will not affect any other benefit under this policy, as long as we received total premiums for all benefits.
   • No benefit under this policy will acquire any investment or surrender value.

3. Your privacy

   We respect the confidentiality of your personal information. However, it is essential for insurance companies to share claims and underwriting information with outside parties for the fair assessment and underwriting of risks, and to reduce the number of fraudulent claims.

   We may communicate your personal information to other insurance companies, and to our service providers who assist us in managing your cover and our relationship with you. We will always do this as permitted by the relevant privacy legislation.

4. We will send correspondence to you

   We will send all correspondence to your last known address or email address. We assume that you received and read our correspondence if it was addressed to you.

5. No waiver

   If we agree to change any deadlines or requirements in terms of this policy, it does not mean that we have agreed generally or in all cases to change the deadlines or requirements.

6. Currency

   total premium and benefits payable under this policy must be paid in Lesotho Maloti only.

7. Law

   We will govern and interpret the policy in accordance with the law in the courts of Lesotho.