DECLARATION
INFORMATION SHARING – CONSENT OF INSURED
1. I acknowledge that sharing of insurance information for underwriting and claims purposes
(including credit information) between insurers is in the best interest as it enables insurers to
underwrite policies and assess risks fairly and to reduce the incidence of fraudulent claims with a
view to limiting premiums.
2. I waive my right to privacy with regard to underwriting or claims information (including credit
information) that I provide or that is provided by another person on my behalf in respect of any
insurance policy or claim made or lodged by me. This is on my own behalf as well as on the behalf of
any person I represent in terms of this insurance policy.
3. I acknowledge that the Insurance information provided by me may be stored in the shared
database and used as set out above as well as for any decision pertaining to the continuance of my
policy or the meeting of any claim I may submit.
4. I consent to such information being disclosed to any other insurance company or its agent.
5. I acknowledge that the information may be verified against legally recognised sources or
database.
DECLARATION
I/ we hereby acknowledge that Refiloe Wealth (Pty) Ltd may make an enquiry, where applicable,
to the South African Crime Bureau or their authorised representatives to obtain any information or
detail as being
reported on this claim form.
I/ we hereby declare that the afore going to be true in every respect.