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Gap Cover - Online Application

Gap Cover: Apply Nowwpadminby0012022-07-18T12:47:47+00:00

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Step 1 of 5

20%

Product
Selection

Personal
Details

Medical
Details

Declaration

Payment

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Product Selection

Select the product that you require:
Select any additional cover that you require. These extended benefits expire at age 65 and a 6 month waiting period applies.
Please ensure that your answer is accurate. Should your answer be untruthful or inaccurate it may lead future claims being declined.
Please note: Premiums are valid for 2022. Prices to increase 1 Jan 2023.

Product
Selection

Personal
Details

Medical
Details

Declaration

Payment

Finish

Personal Details

Date of Birth*
Form of Identification*
Country that issued Passport*
Email address*

Product
Selection

Personal
Details

Medical
Details

Declaration

Payment

Finish

Medical Aid Details

 
You will not be entitled to claim a benefit for a period of 12 months from the start date of your policy in respect of a medical condition for which in the 12 months preceding the start date of your policy medical advice, diagnosis, care or treatment was received or would reasonably have been recommended. If you fall pregnant before the start date of your policy this will be regarded as a pre-existing condition and any pregnancy and birth-related claims will be excluded for a period of 12 months from the start date of your policy. If, immediately before the start date of this policy, you were insured under a medical expense shortfall policy with similar benefits to this policy, then the pre-existing condition waiting period will only be applied to the unexpired part of the pre-existing condition waiting period in the previous policy. The pre-existing condition waiting period will apply for a period of 12 months for any benefit not provided under your previous medical expense shortfall policy.

Product
Selection

Personal
Details

Medical
Details

Declaration

Payment

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Declaration

I, {Full names:13} {Surname:14}, {ID Number:17}, hereby acknowledge that:

  • The information provided in this application is true and I have not withheld any facts. Misrepresentation of non-disclosure may result in us refusing to pay a claim or voiding this policy.
  • I am currently a member of a South African medical aid and I understand I have to remain a member to qualify for Gap Cover.
  • I understand and agree to abide to the terms and conditions of this policy. Please click here to read the full terms and conditions.
Marketing Consent*
I confirm that by submitting this application form I agree that Zestlife will hold and use the details that I have given them to enable them to give me excellent service. Zestlife will also hold my information so that they are able to look after my needs by offering me appropriate insurance products in the future via electronic communication or telephonically.
Acknowledgement*

Product
Selection

Personal
Details

Medical
Details

Declaration

Payment

Finish

Payment

TOTAL PREMIUM: R{Hidden Total Premium:9} pm

The above premium includes:

  •  {Medical Gap Option:5}
  •  {Apply Excess?:6}
  •  {Optional Extended Benefits:7}
Authorisation*
Form of Identification of account holder*
Country that issued account holder's Passport*
DD dash MM dash YYYY
Please enter the one-time password (OTP) code that we have sent to your cellphone.
This field is for validation purposes and should be left unchanged.

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