I declare that the details provided on my Mech-PROTECT application form are to the very best of my knowledge True & that I am not aware of any pending claim on the vehicle. I acknowledge that the Insurer shall not be bound by any undertaking expressed or otherwise other than that which is in this document. Furthermore, I declare that the relevant disclosures as set out in the Disclosure Notice below have been made to me & note has been taken thereof.

DISCLOSURES IN TERMS OF THE SHORT-TERM INSURANCE ACT AND THE FINANCIAL ADVISORY & INTERMEDIARY SERVICES ACT (hereinafter referred to as “THE FAIS ACT”) (This does not form part of the Insurance Contract)

Mech – PROTECT WARRANTY EXTENSION

As a short-term insurance policyholder or prospective policy holder, you have the right to the following information.

1.    CLAIMS

Please note that the procedure for instituting claims is included in your policy documentation.

2.    COMPLAINTS

Any complaints relating to this policy will be handled by the Administrator, whose complaints department can be contacted on the telephone number for customer care as provided in the Policy document. Please note that the Administrators complaints policy and procedure is available on the Administrator’s website or from the Administrator by contacting the numbers listed below.

3.    THE INSURER (PRODUCT SUPPLIER)

Guardrisk Insurance Company Ltd

Alexander Forbes Place, 4^th Floor, 90 Rivonia Road, Sandton, 2196

Tel: (011) 669 1000                      Fax: (011) 669 1938                Complaints Department          Tel: (011) 669 1000

4.    THE DEALER (INTERMEDIARY)

If the policy was sold through a dealership, the dealer is required to make certain disclosures in terms of the FAIS Act. The dealer should provide you with the details of the premiums, commissions and any monetary obligations assumed by you directly or indirectly when buying this policy.

5.    PARTICULARS OF ADMINISTRATOR

Innovation Group (Pty) Ltd Reg No: 1997/005662/07

Building 2, Fourways Office Park, Cnr Roos & Fourways Boulevard, Fourways, 2005

Private Bag X99, Bryanston, 2021.

www.za.innovation-group.com       Tel: 0860 21 0007   Fax: 0860 41 0007

Compliance department

Email: compliance@za.innovation-group.com              Tel: 0861 378 257

The administrator is an authorised Financial Services Provider in terms of the FAIS Act and may render Intermediary Services and provide advice relating to short-term insurance products. The administrator has contractual relationships with different insurers and holds Professional Indemnity Insurance.

6.    WARNING

Do not sign any blank or partially completed application forms and complete all forms in ink. If however, any form is to be completed on your behalf by the Financial Services Provider, you must be satisfied with the accuracy and the completeness thereof. Non-payment of your premium or any misrepresentations, incorrect information provided by you, or non-disclosure of any relevant facts, may influence the benefits you would have received in terms of this policy or could result in rendering this policy void.

7.    THE TELEMARKETER

If the Policy was sold by the Administrator’s telemarketer, the same details as those of the Administrator are applicable. Recordings of the telephone discussion with the telemarketer can be made available to you on request.

8.    THE SHORT-TERM INSURANCE OMBUDSMAN

The ombudsman is available to advise you in the event of claim problems which are not satisfactorily resolved by the insurance intermediary, the Administrator and / or the Insurer.

P O Box 32334, Braamfontein, 2017                              Tel: (011) 726 8900                                Fax: (011) 726 5501

9.    THE FAIS OMBUDSMAN

The ombudsman is available to advise you in the event of complaints which relate to the FAIS Act and which have not been resolved to your satisfaction.

PO Box 74571, Lynwood Ridge, 0040                             Tel: (012) 470 9080

10. THE REGISTRAR OF SHORT-TERM INSURANCE

Financial Services Board

PO Box 35655, Menlo Park, 0102                                    Tel: (012) 412 8000                                Fax: (012) 347 0221

(All premiums and commissions include VAT at the ruling rate) The premium amount is payable in advance for the cover provided. Fees and commissions are paid by the Insurer.

Please Note: Amendment Notice to the General Code Of Conduct for Authorised Financial Services Providers & Representatives 2008 issued in terms of the Financial Advisory & Intermediary Services Act 2002 (Act No 37 of 2002)

The Insured is with effect from 15^th August 2008 entitled to additional disclosures pertaining to premiums & product information. For queries regarding this please contact the administrator on the following email address fais@za.innovation-group.com