Policyholder Declaration

POLICYHOLDER DECLARATION OF CONSENT TO CHANGE UNDERWRITER

I, the undersigned (hereinafter referred to as the "Policyholder"), hereby expressly grant Richter Funerals CC the authority to act on my behalf as follows:

1. I appoint Richter Funerals CC as my authorised representative to cancel my current funeral policy underwritten by African Unity Life Limited (FSP8447) and replace it with a new policy underwritten by Sanlam Developing Markets (FSP11230), an authorised Financial Services Provider and licensed insurer.

2. I authorise Richter Funerals CC to proceed with the policy replacement, provided that the new policy does not result in a reduction of my current benefits or place me in a less favourable position. I understand that all my benefits and terms and conditions will remain the same under my new policy as they are under my current policy.

3. I hereby designate Richter Funerals CC as my authorised and primary point of contact in relation to my funeral policy. I acknowledge and agree that Richter Funerals CC shall provide me with at least thirty-one (31) days' prior written confirmation of this change in the policy underwriter and shall furnish me with any additional information reasonably requested by me regarding such change before it is implemented, should it be required.

4. I further acknowledge and agree that Richter Funerals CC shall act as the administrator of my policy. For the purposes of ensuring efficient administration and service delivery, Groups R Us (Pty) Ltd (FSP45735) has been appointed as the Binder Holder and intermediary in respect of this policy. Accordingly, all policy administration, servicing, communication and related functions shall be conducted in accordance with the applicable regulatory and contractual requirements.

5. I understand that the full details of my current policy, including benefits, premiums and terms, will be communicated to me via SMS, or provided to me in hard copy upon request, in the form of a policy or member certificate. Your policy will continue to uphold the same terms and conditions as those of your original policy.

6. I acknowledge that Richter Funerals CC will ensure compliance with all relevant legislation during this process, and I will be kept informed throughout. Any queries will be addressed promptly to ensure transparency and clarity.

By signing below, I acknowledge that I have read, understood and consent to the contents of this declaration. I hereby authorise Richter Funerals CC to take the necessary steps to give effect to the matters set out herein. I further confirm that I wish for my current policy to be cancelled and request that my new policy commence on 1 August 2026, with no interruption in cover and no changes to the existing terms and conditions applicable to my policy. I consent to the arrangements and terms outlined above and acknowledge that I will receive all relevant information and communications relating to the transition of my policy.