EMERGIVAC is a product of The Activation Agency (Pty), an authorized financial services provider FSP No. 44785 Ltd. Block F, Acacia Building, Hurlingham Office Park, Sandton, 2196.
This product and its benefits are only valid within the borders of South Africa. The long-term insurance benefits of the EMERGIVAC Plan are underwritten by are underwritten by Clientèle Life Assurance Company Limited. A licensed life insurer and authorised FSP. 15268. Company Registration No. 1973/016606/06.
The Emergency Services and Non-Insured Benefits are administered by The Activation Agency (Pty) Ltd. FSP:44785, through their network of Service Providers and Partners. By applying for and submitting your information you agree to the Clientèle Group processing and retaining your personal information in line with their privacy policy which is available at www.clientele.co.za
I /We agree to participate in Emergivac and pay the Takaful contributions into the Participant Special Account ("PSA") based on Tabarru'. You authorize us, based on Wakalah, to manage the PSA and allow us to receive the Wakalah Fee. Furthermore, you agree that any surplus arising from the PSA will be kept in the PSA. Your Takaful certificate will be shared with you upon successful completion and submission of your application.
This signed Authority and Mandate refers to our contract as dated as on signature hereof ("the Agreement"). I / We hereby authorise you to issue and deliver your Takaful contributions.
I /We, the undersigned, hereby authorise you to issue and deliver Takaful contribution instructions to the bank for collection against my / our abovementioned account at my / our above mentioned bank (or any other bank or branch to which I / We may transfer my / our account) on condition that the sum of such Takaful contribution instructions will never exceed my / our obligations as agreed to in the Agreement, and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me / us by giving you notice in writing of no less than 20 ordinary working days, and sent by prepaid registered post or delivered to your address indicated above.
The individual Takaful contribution instructions so authorised to be issued must be issued and delivered as follows:
1) On the preferred debit date of each and every month commencing on:
2) In the event that the debit day falls on a Saturday, Sunday or recognized South African public holiday, the debit day will automatically be the very next ordinary business day.
Further, if there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for Takaful contributions as soon as sufficient funds are available in my account;
I / We understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement.
Each transaction will contain a number, which must be included in the said Takaful contribution instruction and if provided to you should enable you to identify the Agreement. A Takaful contribution reference is added to this form before the issuing of any Takaful contributions instruction.
I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.