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If you or any of your dependant/s are expecting surgery or planning hospitalisation or treatment in the next 12 months, are you aware that certain medical conditions and related procedures may be subject to various limitations and waiting periods? The waiting periods are stipulated on the terms and conditions document - click here to view this document.

I have read the terms and conditions and I am fully aware of the contents thereof.

I hereby authorise the disclosure of relevant medical information by my medical aid to Total Risk Administrators (Pty) Ltd ("TRA").

SHORT TERM (ST):
Gap Cover: –
Total ST debit order amount: –

You agree to allow TRA to process, transmit, and use your personal data for insurance-related purposes, in accordance with POPIA.

I hereby authorise TRA to deduct an amount of R380 from my bank account, monthly in advance, for my premiums.

I/We acknowledge that all payment instructions issued by you shall be treated by my/our Bank as if issued by me/us personally.

I/We agree that although this Authority and Mandate may be cancelled, such cancellation will not cancel the Agreement.

I/We acknowledge that this Authority may be ceded or assigned to a third party if the Agreement is also assigned to that party.

The nature of the service we provide with this product is Intermediary Services only as defined in the FAIS Act. We do not give any Advice and in depth Needs Analysis as defined in the FAIS Act on these products. If you do need any financial advice, please consult your financial adviser for this service.
- I am aware that this FSP provides an intermediary service only on the products provided to me and therefore no advice will be provided and is not needed.
- I do not require any financial needs analysis or any other analysis from this FSP and accept all the risks related thereto. I will consult my own financial advisor, if required.