Replacement Policy Advice Record

REPLACEMENT POLICY ADVICE RECORD

NAME OF THE POLICYHOLDER:_______

DATE OF BIRTH: ________

1. REPLACEMENT MAY NOT BE ADVISABLE

It may not be to your advantage to change your existing insurance policy in any of the following ways:

• lapse or cancel;
• surrender (wholly or partly);
• cease or decrease the premium ;
• reduce benefits or not take benefits up, and to replace it with a new policy.

1. REASONS WHY REPLACEMENT MAY NOT BE ADVISABLE

If you do replace any policy, we want to ensure that you make an informed choice. Please read the following information and the Table overleaf, carefully.

• You will pay some charges twice (e.g. commission, underwriting expenses & other initial charges levied by the insurer) – initially on the existing policy and once again on the new policy.
• You may pay higher premiums on the new policy because you are older now.
• Your new policy may not have the same life cover or premium guarantees as the existing policy.
• Your new policy may not have the same investment performance guarantees as the existing policy (if applicable).
• Your new policy may have more exclusions or restrictions, particularly if your health has deteriorated.
• The amount of money that you can withdraw under the new policy may be less (if applicable).
• You may lose the tax advantage of your existing policy (if applicable).
• A new policy will have new legal restrictions onsurrendering within the first 5 years.
• The surrender value or paid up value of your existing policy may be low (even less than premiums paid in) since un recovered initial expenses must first be deducted.
• The past investment performance of a fund or an asset manager is not necessarily an indication of future performance.
• The investment risk under the new policy may be higher.

1. COMPARISON BETWEEN EXISTING AND RECOMMENDED NEW POLICY

Please ensure that you fully understand the following comparison of the conditions and benefits of your existing policy and the recommended new policy. Please initial the items marked.

Your adviser must complete all the required information (Please use another form if more than one policy is involved).

POLICY DETAILS / Existing policy / Recommended new Policy
Insurance company
Policy number
Age of life assured at inception date
Type of policy (e.g. life cover, investment, Pension)
* Premium (R)
(state whether annual, quarterly, monthly or single)
*Automatic premium escalation (%)
Term / initial term of policy
Commission
(Refer to quotation from Insurer)
Initial policy fees or charges
(Refer to quotation from Insurer)
Ongoing policy fees or charges
*Life Cover (R)
*Disability Cover (R)
*Functional Impairment cover (R)
Trauma/Dread disease cover (R)
Health cover (R)
Other types of cover (cover type and R)
*Aids exclusions / cover limits (Y/N or R limit)
*Other exclusions and restrictions
*Waiting period for claims (months)
*Accessible cash / Surrender Value (R)
(NB. The difference, if any, between this cash / surrender value and the fund / investment value below, demonstrates the effect of early termination of a policy)
*Fund/Investment value (R)
*Net investment/allocation amount (R)
*Projected maturity value (R)
*Investment/Capital guarantees (describe guarantee basis)
*Risk profile of investment funds
(conservative/moderate/aggressive)
Availability of cash value at time of replacement (Y/N)

*Initials required

Important: If the conditions of the recommended new policy change from the quotation used to complete this form, e.g. additional exclusions or loadings to the premiums, this form needs to be amended, with both the intermediary and the client initializing each amendment.

Alternatively, a new RPAR may be completed.

4.REASONS FOR THE CHANGE OF POLICY / POLICIES

Please provide a brief explanation of:

The main differences between the terminated and replacement policies that have been taken into account in deciding to effect a replacement:

Reasons why the replacement policy/ies is/are considered more appropriate to the policyholder’s needs and objectives.

Reasons why a replacement was considered preferable to amending the terminated policy/ies.

5.DECLARATION (COMPULSORY)

ADVISER
I declare that this Replacement Policy Advice Record is an accurate and complete record of the advice and recommendations that I have given the policyholder.
Signature:
Name:
Date: / POLICYHOLDER
I declare that this Replacement Policy Advice Record is an accurate and complete record of the advice and recommendations given to me by the adviser. I declare that I have read and understand the advice given in this Replacement Policy Advice Record.
NB! I am responsible for ensuring that no further debit orders are taken off my bank account once the new policy is in force.
Signature:
Name:
Date: