Genoa Policy Schedule Document

Schedule of Insurance

Safire Insurance Company Limited

Safire Insurance Company Limited is an authorised Financial Services Provider 02092.
Reg No: 2000/027673/06 Vat Number: 4370196034
Physical Address: Safire House, Redlands Estate, 1 George Macfarlane Lane, Wembley, KwaZulu Natal, 3201
Postal Address: P.O. Box 11475, Dorpspruit, KwaZulu Natal, 3206
Phone: +27 (0)33 2648500 Fax: +27 (0)33 2648501 E-Mail: [email protected]
This policy is underwritten by Safire Insurance Company Limited, an authorised Financial Services Provider.

MEDICAL MALPRACTICE CASA0001/0001

Policy Details CASA0001/0001

Policy Number Safire Insurance Company Limited
Insurer
Payment Frequency Monthly Inception Date 01 January 2021
Period of Insurance 01 January 2023
The period of insurance shall commence on the Renewal Date
Payment due date
Inception/Retroactive date stated in the schedule and

terminate on the cancellation date stated in the schedule.

You will be debited on the 1st day of each month, or nearest working day thereafter.

Policy Holder • The Chiropractic Association of South Africa (CASA)

Insured • CASA Life Members (those who have been awarded honorary Life membership subject to their having been fully paid-up members prior to being awarded Life
membership, Past President Emeritus Members)
Insured Vat Number
Email Address • Current and past CASA employees, directors, committee members, office bearers, volunteers, officials, peer review panelists and Association- appointed Ombudsman
Insured Business
Description • All paid-up qualified, student and intern members of the Association

• Paid-up affiliate members of other agreed professions being osteopaths as well as students and interns of the agreed affiliate member professions

4600229878 Phone Number 086 188 7772

[email protected]

The Chiropractic Association of South Africa (CASA), Qualified chiropractors, student and intern chiropractors, and paid-up members of other agreed affiliate membership
professions being osteopaths as well as students and interns of the agreed affiliate membership professions.

Physical Address CASA Head Office, Crossway Office Park, Building 2, 240 Lenchen Avenue (cnr Jean), Centurion 0157

Underwriting Manager

Name Genoa Underwriting Managers (Pty) Ltd
Postal Address P O Box 393, Strathavon, Gauteng, 2031

Physical Address Upper Grayston Office Park, Block E, 150 Linden Road, Sandton, Gauteng, 2196

Registration Number 2005/027420/07 Telephone +27 (0)10 2861915
[email protected]
Vat Number 4530234634

FSP Number 38225 E-Mail

Broker Details BB - Shackleton Risk Management (Pty) Ltd - JHB

Name P O Box 6200, Pretoria, Gauteng, 0001
Postal Address
Physical Address Equity Office Park, Block B, 257 Brooklyn Road, Brooklyn, Gauteng, 0181
Registration Number
Vat Number 2002/030125/07 Telephone +27 (0)11 7845373
FSP Number [email protected]
4040240840

33621 E-Mail

AUTHORISED SIGNATORY

(on behalf of Safire Insurance Company Limited)
06 December 2021

Policy Holder : The Chiropractic Association of South Africa (CASA) 1/8
Date Printed: 06 December 2021
Schedule Version: 1

PREMIUM SCHEDULE AND INDEX OF COVER Policy Number: CASA0001/0001

Section of Cover Items Cover Cumulative Scheme Sum Insured
Included (in the aggregate)
Professional Indemnity R50 000 000
Additional Extended Reporting Period 1 Yes
Forensic Audit Opposition Costs 0 No
1 Yes
Fidelity Guarantee 0 No

IMPORTANT INFORMATION

Kindly go through this document and advise us immediately of any changes to ensure that the cover accurately reflects the insured’s present insurance requirements. If we
are not advised of any errors or omissions, no liability will be accepted for such error or omission in the event of a loss.
The policy schedule and policy wording must be read as one. Kindly familiarise yourself with the conditions, exceptions, clauses, exclusions and excesses applicable to the
insurance classes stated on the policy.

In terms of a ruling issued by SARS, this document together with proof of payment of premium, constitutes an alternative to a tax invoice, debit note or credit note as
contemplated in sections 20(7) and 21(5) of the VAT Act respectively. VAT is included at 15 %. Safire Insurance Company Limited VAT vendor:4370196034. All Sums Insured
/ Limits of Indemnity / Compensation specified in this Policy Schedule are inclusive of VAT. This Policyschedule read together with the policy wording constitutes the
contract between Safire Insurance Company Limited (the insurer) and you(the insured) and revokes all previous schedules which may have been issued in terms of this
policy.

Excesses are not subject to VAT when recovered by an insurer from an insured.

The selected optional extensions are reflected under the sections of cover.

Where a premium field for cover for a particular section of this policy schedule above (or within the contents of this schedule) does not have a premium included or where
cover is not specifically stated as being included, cover for that particular section of this policy is not in force. If further cover is required, please discuss this with your broker

NOTE TO POLICY HOLDER

This is a combined Professional Indemnity and Fidelity Guarantee Insurance Policy schedule. The sub-limits as in the schedule for Professional Indemnity and Fidelity
Guarantee Insurance cover are applicable in respect of the individual sections. All limits of Indemnity and premiums are stated inclusive of VAT.

Policy Holder : The Chiropractic Association of South Africa (CASA) 2/9
Date Printed: 06 December 2021
Schedule Version: 1

Policy Number: CASA0001/0001

COMBINED PROFESSIONAL INDEMNITY AND FIDELITY GUARANTEE POLICY SCHEDULE

Index of Cover
Total cumulative scheme limit of indemnity in the annual aggregate R50 000 000

This section provides cover for Professional Indemnity items

Professional Indemnity 2021-01-01 Basis of Aggregate in accordance with the Cumulative Scheme R50 000 000
Scheme Cover Start Date Limit of Indemnity
Limit relevant risk category selected

6th Year Chiropractor & Osteopathic Students & Interns From South Africa Only

Basis of Aggregate Excess As per main excess Limit of Indemnity R5 000 000
Limit (per member)
Risk Category 1: Annual: R936.00
Risk Category 2: Premium (incl VAT & Broker Commission) for the period (per member): Monthly: R78.00
Risk Category 3:
Fully Qualified Chiropractors & Osteopaths From South Africa Only

Basis of Aggregate Excess As per main excess Limit of Indemnity R5 000 000
Limit
(per member) Annual: R2 184.00
Monthly: R182.00
Premium (incl VAT & Broker Commission) for the period (per member):

The Chiropractic Association of South Africa and all life and honorary life members and all Past President Emeritus

members

Basis of Aggregate Excess As per main excess Limit of Indemnity R5 000 000

Limit (per member)

Premium (incl VAT & Broker Commission) for the period (per member): R0.00

Fully Qualified Chiropractors & Osteopaths from South Africa Only

Basis of Aggregate Excess As per main excess Limit of Indemnity R10 000 000
Limit (per member)
Risk Category 4: Annual: R2 995.00
Retroactive Date(s): Premium (incl VAT & Broker Commission) for the period (per member): Monthly: R250.00

Extended Reporting • 1 January 2017 in respect of the Association and all those performing functions for the Association and subject to proof of
Period (ERP): first-joining date/prior claims made cover and continuous, unbroken cover for medical malpractice insurance in respect of
each individual paid-up member and life/honorary life and past president emeritus members

• 01 January 2021 in respect of the following extensions: Claims Preparation costs; Fidelity Guarantee base cover; Fines and
Penalties Defence Costs; Good Samaritan Acts/ Emergency First Aid; Loss of Documents; Mitigation of Loss; Negligent
advice given free of charge; Paramedic Services Conditions; Public relations expenses; Students; Telehealth and Vicarious
Liability State Defence Costs in respect of Option 1 – 5.

Up to 72 months for The Chiropractic Association of South Africa (CASA), Qualified chiropractors, student and intern
chiropractors, and paid-up members of other agreed affiliate membership professions being osteopaths as well as students
and interns of the agreed affiliate membership professions.

Reinstatement: One Reinstatement for fully Qualified Chiropractors & Osteopaths only (not applicable to Students and Interns, the
Association or any other membership group) subject to the cumulative aggregate scheme limit

Policy Holder : The Chiropractic Association of South Africa (CASA) 3/9
Date Printed: 06 December 2021
Schedule Version: 1

Policy Number: CASA0001/0001

Section Excess Structure Excess (each and every claim)
Main Deductible
1st and 2nd claim or complaint against a specific R5,000 increasing to R10,000 for Dry Needling and
member during the policy period: increasing to R50,000.00 once the Reinstatement
Applies

3rd claim or complaint against a specific member R10,000 increasing to R15,000 for Dry Needling and
during the policy period: increasing to R60,000.00 once the Reinstatement
Applies

4th or subsequent claim or complaint against a specific R15,000 increasing to R20,000 for Dry Needling and

member during the policy period: increasing to R60,000.00 once the Reinstatement

Applies

Automatic Extensions (per member but subject at all times to Cover Included Sub-Limit of Indemnity Excess – Excess – Excess –
(in the aggregate) Claim 1 & 2 Claim 3 Claim 4 or more
the total of all members claims never exceeding the Cumulative Scheme
R50 000 Nil Nil Nil
Limit in the annual aggregate) Yes R250 000 R3 500 R5 000 R8 000
R25 000 R3 500 R5 000 R8 000
Insured’s Attendance costs Included R3 500 R5 000 R8 000
R500 000 R3 500 R5 000 R8 000
Breach of Confidentiality Yes R25 000 R3 500 R5 000 R8 000
R50 000 R3 500 R5 000 R8 000
Claims preparation costs Yes Included R3 500 R5 000 R8 000
R50 000 R3 500 R5 000 R8 000
Criminal Defence Costs Yes R50 000 R3 500 R5 000 R8 000
10% of category LOI R3 500 R5 000 R8 000
Defamation Yes
Same as category LOI R5 000 R5 000 R8 000
Fidelity Guarantee Yes
Same as category LOI R3 500
Fines and Penalties Defence costs Yes
R50 000 R3 500
Good Samaritan Acts/Emergency First Aid Yes R15 000 R3 500
R150 000 R5 000
Loss of Documents Yes 10% of category LOI R3 500
R250 000 R5 000
Mitigation of Loss Yes

Negligent advice given free of charge Yes

Paramedic Services Conditions No

Liability for damage caused by Medical Products or Yes

Equipment (Only in respect of

category 3 & 4)

Public Liability Yes R5 000 R8 000

(Only in respect of

category 3 & 4)

Public Relations expenses Yes R5 000 R8 000
R5 000 R8 000
Students Yes R5 000 R8 000
R5 000 R8 000
Wrongful Arrest Yes R5 000 R8 000

Telehealth Services Yes

Vicarious Liability State Defence Costs Yes

Specifically Selected Extensions (per member but subject at all Cover Included Sub-Limit of Indemnity Excess
(in the aggregate) (each and every claim)
times to the total of all members claims never exceeding the Cumulative No
Scheme Limit in the annual aggregate) No (unless R10 000 or R500 R1 500 R2 500
requested at an R25 000
Additional Extended Reporting Period (AERP) additional
Medical Aid Scheme and/or Third-Party Administrator premium) Automatically included but only triggered if specifically requested in writing
for Forensic Audit Opposition costs
No
Premium Holiday and Emigration
Reinstatement of Limit of Indemnity

Endorsements

Notes

The Policy Wording, together with this Schedule and its endorsements as agreed to by the Insurer from time to time, shall be read together as one contract. The endorsements
listed below include additional extensions, exclusions, terms and conditions of cover. Please read the Policy Wording together with all the endorsements below carefully and
contact Shackleton Risk Management (your broker) if anything in these documents is unclear or requires further explanation.

1. Medical Aid Scheme and/or Third-Party Administrator for Forensic Audit Opposition costs will be excluded unless it is specifically requested and an additional
premium is paid.

✓ Option 1:
• R10,000 cover
• Additional premium of R100 per month or R1 200 per annum

✓ Option 2:
• R25,000 cover
• Additional premium of R200 per month or R2 400 per annum

2. The total limit of indemnity for all professional indemnity claims during any one insurance year under the CASA Scheme shall be R50,000,000 (Fifty Million
Rand).

3. The total limit of indemnity for all fidelity guarantee extension claims during any one insurance year under the CASA Scheme shall be R250,000 (Two Hundred
and Fifty Thousand Rand).

4. Indemnity shall extend to include chiropractic healthcare services rendered abroad by fully paid-up Students, Interns and qualified Chiropractors and Osteopaths
within the Territorial Limits of the Policy, provided that such services are rendered for a period of 60 consecutive days or less, in any one visit. If the intention of
the practitioner is to emigrate, then no cover will be provided for overseas treatment and the practitioner must obtain alternative insurance in the country that
he/she will be emigrating to.

5. Indemnity shall only be afforded to Students/Interns who perform work under the supervision of a registered and fully qualified Chiropractor who is at hand at
all times to provide guidance and confirm the proposed treatment plans prior to implementation thereof.

Policy Holder : The Chiropractic Association of South Africa (CASA)

Date Printed: 06 December 2021 4/9
Schedule Version: 1

Policy Number: CASA0001/0001

6. In the event of either an insured member’s death, contracting a severe illness or suffering a permanent disability or a temporary disability which exceeds 3 months
in duration, and which prevents the Insured member from rendering any chiropractic healthcare services during the remainder of the policy period following such
event, it will be deemed that the insured member is a member in good-standing, subject to:

a) The member having made payment of the full annual premium to the Insurer in respect of the member’s selected MPI option for the period of insurance ending
31 December 2022. The member will not be entitled to any refunds from the Insurer in respect of the premium which he/she has pre-paid to the Insurer to obtain
cover.

b) the member having been in good-standing and up to date with his or her monthly membership payments to CASA (on a membership option which includes
medical malpractice insurance as a membership benefit) as at the date of his/her death or other event covered under the policy. In the event of a member
defaulting on his/ her membership fees debit order whilst still alive (or prior to the happening of the covered event), the member’s executor or representative
may still make payment of any outstanding membership fees to the Insurer before 31 December 2022 to ensure continuity of cover under this policy to 31
December 2022.

c) Subject to the member either being in good standing as a paid-up CASA member or being deemed to be a paid-up CASA member by virtue of the above provisions,
any member who ceases to practice, becomes disabled or dies during the Period of Insurance will be deemed to have been a paid-up member in good standing
as at 31 December 2022, and as such, entitled to report claims in terms of any available Extended Reporting Period, (ERP) applicable to their policy.

7. The availability of an ERP does not remove the need to comply with clause A.12 relating to notification of claims. If the insured member does not comply with
A.12 the Insurer shall not be obliged to indemnify the insured member.

8. No claims may be reported under the ERP, where a member:

a) was removed or struck from the roll of this profession (or otherwise, legally prohibited from practicing his/her profession in South Africa or elsewhere); or

b) suspended from practice by his/ her Regulatory Body; or

c) has breached the provisions of this Policy, prior to ceasing to practice, becoming physically disabled or dying in RSA.

• The total limit of indemnity enjoyed under the policy for claims reported in the ERP shall be the same as that which existed immediately prior to the
commencement of the ERP.

• The period within which to notify the Insurer of claims provided by the ERP, will terminate immediately upon the Insured commencing cover with any other
Medical Malpractice provider for work carried out in South Africa.

9. Extension in respect of Liability following employee / volunteer dishonesty

• This Extension extends to indemnify the Insured member in respect of Claims arising out of any dishonest, fraudulent or malicious professional act or omission of
any employee or volunteer (not being a director, partner or principal) of the Insured.

• Liability following employee / volunteer dishonesty extends to include the Directors, Officers, Officials, Committee and Peer Review Members and the appointed
Ombudsman of The Chiropractic Association of South Africa (“CASA”).

10. Insurance premiums are payable monthly or annually, and where paid monthly, indemnity shall be subject to such member’s name appearing on the monthly
members’ list provided to Shackleton Risk Management.

11. In the event of a Circumstance/Claim notification, CASA will be required to provide proof that the member is a paid-up member in good standing with the
Association. However, this will not apply where the Insured member is acting in their official capacity for the Association, e.g. committee member, official,
volunteer or employee (proof of official capacity will need to be provided). CASA Life, Honorary Life and Past President Emeritus Members deemed to be insured
regardless of whether or not they are paid-up members.

12. Where a notification relates to a circumstance or claim which arises out of services rendered in a previous insurance period, then the insured member will be
responsible for providing proof of his/her entitlement to retroactive cover. In order to prove such entitlement, the insured member will need to show that he/she
has held continuous medical malpractice insurance since the retroactive date, with no gaps in cover. The Insured member must therefore ensure that he/ she
retains the following important documentation relating to his/ her medical malpractice cover:

a) Copies of all previous policy schedules and documents including confirmation or proof of insurance issued by any previous underwriters or insurers, as well as
proof of payment of monthly or annual medical malpractice insurance premium;

b) Copies of all letters from ProfNet confirming the existence of medical malpractice insurance on a MPI option selected by the insured member.

Given the long-tail nature which liability claims can attract, the insured member must retain the above records, indefinitely, in a safe and accessible place.

The inclusion of any extension and applicable sub-limit will not increase the overall Limit of indemnity specified in the Schedule.

13. Honorary Life and Past President Emeritus Members

• It is noted and agreed that Honorary Life and Past President Emeritus Members will enjoy free cover under option 3. By accepting the free cover, such members
also accept the responsibility for determining if the free limit offered is adequate for their specific requirements and circumstances.

• Life, Honorary Life and Past President Emeritus members may elect to take up cover under option 4 (that is they may elect to increase their cover from R5 million
to R10 million, with public liability cover) and will be entitled to only pay 50% of the annual premium due for cover under Option 4. No set-off or deduction will
be allowed for the free cover offered under option 3, should the member so elect to increase their limit of cover.

14. If the policy is endorsed then the insurer will be liable to the extent of the policy at the time that the act, error or omission giving rise to the claim arose, unless
otherwise agreed in the Schedule. Refer to clause A.7. Endorsement or Limit Increase or Decrease in the policy wording.

15. Where an existing CASA member who had cover under this policy and was a paid-up member of CASA at 31 December 2021 has not paid to renew their cover/CASA
membership before 1 April 2022, they will only be covered for chiropractic healthcare services rendered from the date that they make payment to CASA of their
membership fees including the amount due for cover under this policy and will forfeit all retroactive cover that they may previously have been entitled to under
this policy. The Insured member’s new retroactive cover date will then become a date on or after 1 April 2022 when making payment to CASA of his/ her
membership fee on a membership option which includes cover under this policy. Payment will be deemed to have been made on the date that the member’s first
instalment was debited successfully.

16. in the event of a monthly debit order being unpaid, the Insurer may at its sole discretion elect to raise a double debit on the first day of the following calendar
month. In the event that the debit order is unpaid on the second debit request then the Policy will be cancelled with effect from the first date of non-payment.
If, however, in the event that a claim arises between the first unpaid debit order and prior to the date of the double debit payment request the indemnity granted
by this Policy will remain in force, and the Insurer will be entitled to deduct all premiums due from the claims settlement. Any bank charges accruing to the unpaid
debit order shall be borne by the Insured.

17. Any stop payment by the Insured, shall be deemed to be a cancellation of the Policy by the Insured.

18. Where an Insured member becomes aware of a Circumstance or Claim before 31 March 2022 and he/ she has not yet renewed or paid for insurance, it will be
assumed that he/she intended to pay for the cover and to renew his/ her CASA membership for 2022 on the cover option selected the year before provided that:

a) He/ she was a fully-paid up member in good-standing with CASA as at 31 December 2021; and

b) He/ she makes payment of his/ her membership fees within 7 working days of being requested to do so by Shackleton Risk Management

19. Previous members who have not renewed their 2022 membership on an option which included medical malpractice insurance will be deemed to be ‘new
members’.

20. Insured members must ensure that they undertake regular Continuing Professional Development (CPD) Training if required to do so in terms of legislation and/or

Policy Holder : The Chiropractic Association of South Africa (CASA) 5/9
Date Printed: 06 December 2021
Schedule Version: 1

Policy Number: CASA0001/0001

by his/her Regulatory Body.

21. It is hereby noted and agreed that if an insured member under this policy has misplaced his/her Certifications proving their qualifications and if proof of such
qualifications are required by the Insurer, that Insurer will accept in lieu of the said Certifications:

a) a written affidavit attested to by the member confirming their qualification/s, duly commissioned by the SAPS or a Commissioner of Oaths; and

b) or any other documentation agreed to by the Insurer for this purpose.

22. Any equipment / instruments used in the provision of healthcare services must be properly sterilised and maintained in accordance with manufacturer’s
stipulations.

23. All equipment must be regularly maintained and calibrated in accordance with the manufacturer’s specifications, or in the absence of such specifications, once a
year.

24. Medico-legal work Extension

Members acting as an Expert or other witness in any court proceedings, will enjoy indemnity under this policy, in the event of circumstances/ claims arising from
medico- legal work provided the medico-legal work falls within the members registered profession.

25. Consent Condition

It is a condition precedent to liability that the Insured member will be required to provide evidence to the satisfaction of the Insurer, that they obtained informed
consent prior to rendering any new advice, procedure, screening or treatment undertaken, prescribing any medication, conducting any tests or supplying any
products or devices. In establishing whether such informed consent was obtained, Insurer will have regard to the guidelines set out by the relevant Regulatory
Body such as HPCSA /AHPCSA and the applicable provisions of the National Health Act, (Act No. 61 of 2003), as amended from time to time. The insured member
should therefore familiarise himself/ herself with the said guidelines and legislation to ensure compliance.

26. The Insurer will be entitled to reject or repudiate any claim under this policy where the insured member has failed to produce satisfactory evidence of informed
consent. Where treatments or screening is undertaken proof of consent must have been obtained, prior to the commencement thereof.

27. Public Liability Extension

• Where a member enjoys indemnity under this extension either automatically or specifically selected:

• It is hereby noted and agreed that the extension shall include coverage at events where members provide chiropractic healthcare services at public events,
including, but not limited to: field-side and roadside services and goods rendered or provided at sporting events, charitable functions and wellness days.

• Subject to the following conditions

a) This cover applies only in respect of anyone reflected as an “Insured member” on the Schedule.

b) Indemnity shall not extend to events where a member is an exhibitor or is manning an exhibition stand. In these instances, the member should approach
Shackleton Risk Management, or any other broker for quotes for a specific events’ liability insurance

c) Where an Insureds attendance at an event includes a marketing initiative or marketing of an incidental nature, the extended cover provided by this endorsement
will still apply.

d) For the sake of clarity an event is defined as a sports event, conference, congress, function, festival, music concert, charitable function, wellness day or any other
event of a similar nature.

e) Claims arising out of the following are specifically excluded from cover under this extension:

i. Loss of, or damage to property belonging to the Insured member or in the Insured’s care, custody or control;

ii. Where insured members have failed to take all reasonable precautions to follow all safety briefings and requirements of event supervisors and/or marshals, and,
where relevant, competition organisers and track owners.

28. Indemnity for Claims arising from Dry Needling will be subject to the Insured member:

a) being able to prove he/ she has adequate training in dry-needling and in cases where the incident occurs during training, proof will be required showing that
training was under the direct supervision and guidance of a fully qualified chiropractor.

b) Complying with the Ethical guidelines as determined by the HPCSA or AHPCSA pertaining to clinical notes, report writing and/or obtaining of informed consent.
The informed consent should signify the patient’s consent to receiving the specific treatment concerned. Failing to obtain the patient or legal guardian’s consent
will give rise to a rejection of the claim by the Insurer.

c) Informed consent means that the patient agrees to the procedure after the procedure has been explained in detail (eg sterile needles will be used, how many
needles will be used, the nature of the needles and area of body that the needles will be applied to as well as all known mild, moderate and severe risks associated
with procedure).

d) Clinical notes must disclose the patient’s condition before, during and after treatment.

29. Indemnity shall extend to claims arising out of treatment rendered to animals by a licensed chiropractor who has the appropriate qualifications in animal
healthcare provided that:

a) Claims arise out of death of, bodily injury to, illness or disease sustained by or loss of any animal in the care, custody or control of the Insured caused or alleged
to have been caused by medical malpractice and not by any product or prescription of products;

b) The Insured obtained a written report on the details and condition of the animal being prior to treatment, including the history of any ailments and or treatments
undertaken on the animal, any known allergies / problematic treatments.

c) If the animal is a thoroughbred, rare and/or an exotic species then an informed consent form incorporating an indemnity clause should be signed by the owner
of the animal prior to treatment.

d) All treatments must be undertaken only once the advice of the treating veterinarian of the affected animal has been obtained.

e) The applicable Excess is R5,000.00 each and every claim.

30. In the event of any fraud, misrepresentation or Non-Disclosure, benefits afforded in terms of the policy shall be forfeited and the Insurer shall have no liability
whatsoever to the Insured member or any other person in respect of a claim in its totality.

31. The Insurer may cancel the insurance cover for any member with immediate effect in the event that the Insured member has induced a fraudulent claim or has
misrepresented, misdescribed or not disclosed any material particulars to it. In such event, an endorsement will be made to the policy schedule reflecting the
name of the member who can no longer take up cover under this policy going forward. Such endorsement will appear on a separate sheet to the policy schedule
for the purposes of protecting the personal information of the individual involved and a copy will only be provided to CASA itself but will not be made available
to the general body of members.

32. The Insurer also reserves the right to remove an individual member from the scheme should their risk profile no longer fit the scheme’s appetite.

33. Sanctions Exclusion

Neither Safire Insurance Company Limited (Insurer), nor any of its reinsurers shall be deemed to provide indemnity and no (Re)insurer shall be liable to pay any
claim or provide any benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose Safire
Insurance Company Limited (Insurer) and/or its Reinsurers to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic
sanctions, laws or regulations of the European Union, United Kingdom or United States of America.

Policy Holder : The Chiropractic Association of South Africa (CASA) 6/9
Date Printed: 06 December 2021
Schedule Version: 1

Policy Number: CASA0001/0001

STATUTORY DISCLOSURE NOTICE
Disclosure and other legal requirements related to your Insurance policy.

This notice does not form part of your Insurance Contract or any other document.

Financial Service Provider contact details and other information

Genoa Underwriting Managers Physical address:
An Authorised Financial Services Provider Upper Grayston Office Park,
[FSP Number: 38225] Block E, 150 Linden Road
Sandton, Johannesburg
VAT Registration Number:4530234634 2196
Company Registration Number: 2005/027420/07
Postal address:
Contact details: PO Box 393
Telephone: (010) 286 1915 Strathavon
Email: [email protected] 2196
Website: www.genoa.co.za

Complaints department: Client Services department
[email protected] [email protected]

Genoa Underwriting Managers is the policy underwriter and administrator and has a written mandate with the Insurer, Safire Insurance Company Limited, whose details are listed below.

We receive our fees from the Insurer as set out in terms of the Short-Term Insurance Act.

Categories of financial services for which we are licensed to provide advice and intermediary services:
Short-term Insurance: Commercial Lines. Advice and Intermediary Services.
Short-term Insurance: Personal Lines. Advice and Intermediary Services.

Genoa Underwriting Managers accepts responsibility for the actions of its Representatives acting in the course and scope of their employment. The company will not be held liable in respect of
services or advice provided by a Representative which falls outside the scope of his/her authorisation.

Insurer Contact Details Professional indemnity cover:
Lloyds of London
Safire Insurance Company Limited
(Hereinafter referred to as “Safire”) Compliance officer / department:
An Authorised Financial Services Provider Head of Compliance Control Function
[FSP Number: 2092] [email protected]

VAT Registration Number:4370196034
Company Registration Number: 2000/027673/06

Physical address: External Compliance Officer: Moonstone Compliance (Pty) Ltd is the
Redlands Estate, 1 George MacFarlane Lane, FSP’s Compliance practice on record and is represented by:
Wembley, Pietermaritzburg Carrie-Lee Wolff
3201 1st Floor, Valerida Centre, Piet Retief Street
Stellenbosch, 7600
Postal address: PO Box 12662, Die Boord
PO Box 11475 Stellenbosch
Dorpspruit 7613
3206
Client Services department:
[email protected]

Contact details: Complaints department:
Telephone: (033) 264 8500 [email protected]

Fax: (033) 264 8501 FAIS licence information:
Email: [email protected] Categories: Personal & Commercial Lines
Website: www.safireinsurance.com

Payment of Premiums and consequences of non-payment

Upon inception of your policy documents you are liable to pay the premium due. It is important to note that all short-term premiums are due
and payable in advance and in the event of non-payment of premium, your cover may be affected.

All information regarding the amount of premium due, the frequency of payment and the date upon which payment is due will be contained in your schedule, read together with your policy
document.

Should you have any queries regarding premium payments or advice received, please contact your advisor / broker or alternatively our Client Services Department ([email protected]).

Policy Holder : The Chiropractic Association of South Africa (CASA) 7/9
Date Printed: 06 December 2021
Schedule Version: 1

Policy Number: CASA0001/0001

Premium Obligation

Your premium obligations are as follow:

Total Payable

VAT amount
Broker Commission

The Broker receives commission for providing advice and intermediary services on behalf of the Insurer.
The Broker receives fees as detailed on the index page for any ancillary services which do not include advice and intermediary services.
Fees mentioned above excludes once-off fees.

Complaints Policy

In the event that we reject a claim, or if you dispute the amount determined by us to be payable in respect of any claim, you may within 90 (ninety) days after the date of rejection or the date the
amount was communicated to you in writing, appeal the decision by making written representations to [email protected]. Please include all necessary information with your email and attach
copies of all relevant documentation to your written complaint to enable us to properly and adequately investigate the matter.

We will notify you in writing of the outcome of your appeal within 45 (forty-five) days of receipt of such appeal.

OMBUD or LEGAL PROCEEDINGS

a) If you are not satisfied with the outcome of your appeal, you may within 180 (one hundred and eighty) days after the expiry of the initial 90 (ninety) day period referred to in a) above, escalate
your complaint to the Ombudsman for Short Term Insurance (OSTI).

b) If you are not satisfied with the decision taken by OSTI and wish to pursue the matter in Court, you must within 180 (one hundred and eighty) days after the expiry of the initial 90 (ninety) day
period referred to in a) above, institute legal proceedings against us, failing which, all benefit under the policy in respect of that claim will be forfeited. (Please note that this 180-day period will be
interrupted for the duration that the matter is being considered by OSTI).

At Genoa Underwriting Managers, we take all complaints seriously and are committed to deal with each complaint as quickly and fairly as possible. A copy of the Complaints Management Process
and Conflict of Interest Policy is available upon request and is also available on www.genoa.co.za.

Details of the Ombudsman

If any complaint is not resolved by Genoa Underwriting Managers to your satisfaction within a reasonable period, you have the right to escalate your complaint to the appropriate Ombud.

If you have a complaint regarding the rejection of a claim or the amount determined by us to be payable in respect of any claim, you may escalate your complaint to:

Ombud for Short-term Insurance (OSTI)

Physical address: Contact details:
1 Sturdee Avenue Telephone: ( 011) 726 8900
Cnr Bolton and Baker roads Fax: ( 011) 726 5501
First Floor, Block B Email: [email protected]
Rosebank Website: www.osti.co.za

Postal address:
PO Box 32334
Braamfontein
2017

OSTI limitations:
a) R6.5 million for houseowner’s claims or claims relating to buildings;
b) R3.5 million for all other claims.

If you have a complaint regarding advice or treatment received from your advisor / broker, you may escalate your complaint to:

FAIS Ombud

Physical address: Contact details:
Sussex Office Park, Ground Floor, Block B Telephone: ( 012) 470 9080 / 762 5000
473 Lynnwood Road, Cnr Lynnwood & Sussex Avenue Fax: ( 012) 348 3447 / 086 764 1422
Pretoria Email: [email protected]
0081 Website: www.faisombud.co.za

Postal address:
PO Box 74571
Lynnwoodridge
Pretoria
0040

Policy Holder : The Chiropractic Association of South Africa (CASA) 8/9
Date Printed: 06 December 2021
Schedule Version: 1

Policy Number: CASA0001/0001

Details of the Financial Sector Conduct Authority (FSCA)

Financial Sector Conduct Authority (FSCA) Telephone: ( 012) 428 8000 or 0800 202 087

PO Box 35655 Fax: ( 012) 346 5841

Menlo Park Email: [email protected]
0102
Website: www.fsca.co.za

Other Matters of Importance

General
The policy wording and schedule must be read as one document. If you need advice on any aspect of your policy, first amounts payable or any claim procedures as well as your responsibility to pay
the premium, please contact your advisor / broker or Genoa Underwriting Managers Client Services Department.

Confidentiality
All information obtained or acquired from you shall remain confidential, unless Genoa Underwriting Managers is required by law or in the course of an investigation to disclose such information.

Copy of policy document
You are entitled to a copy of your policy free of charge.

Policy Holder : The Chiropractic Association of South Africa (CASA) 9/9
Date Printed: 06 December 2021
Schedule Version: 1