Kganya Botswana Pukwana ya Kganya Payment Book

2 13. I acknowledge that the Premium and Contribution payable from time to time will vary in line with changes to the cost of providing the Benefits and Services, where applicable. Notice of any increase will be given through the Church Branch and the amount payable will be shown on the receipt. 14. I understand that all of the details provided in the Policyholder Application Form will form the basis of my Policy. 15. All of the details provided in the Policyholder Application Form, whether in my own handwriting or not, are truthful and correct. 16. I am aware that if any of the details provided in the Policyholder Application Form are false or incorrect, any claim made in the future may be invalidated. 17. I am aware that this Payment Book and the receipts contained therein are valuable documents and must be produced for claim purposes. 18. I grant permission to both the Insurer and the Insurance Agent to contact me on the cellphone numbers provided and I will always keep these numbers current. 19. I understand that should any of the Policy terms and conditions remain unclear to me I may contact a Kganya Service Centre for assistance. 20. I understand that children who no longer qualify as Dependants in terms of the Policy rules must obtain their own Payment Book. 21. I confirm having read and understood the Privacy Policy as contained in the Payment Book Annexure. 22. I am hereby notified that in accordance with such Privacy Policy, the Insurance Agent undertakes to treat all information supplied by me as a potential Policyholder / Policyholder as confidential. The Insurance Agent undertakes not to divulge to any persons, not party to this Policy arrangement, any such information without my prior written consent. 23. I give my consent to the Insurer and the Insurance Agent to use my personal information to take any action necessary to trace me or my Beneficiary for the purpose of any unclaimed Benefits and to make such information accessible to the relevant tracing agents. 24. I absolve the Insurer and the Insurance Agent from any liability arising from any administrative error that occurs outside of their control and any decisions made by Zion Christian Church relating to the closure, subdivision or relocation of any Church Branch in Botswana. DECLARATION