Please complete SECTIONS; SECTION 1 - Your details. SECTION 2 & 3 - partner and dependants. SECTION 5 - Choice of plan.

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1 Please complete SECTIONS; SECTION 1 - Your details SECTION 2 & 3 - partner and dependants SECTION 5 - Choice of plan. SECTION 6 - (IF KEYCARE PLUS - PLEASE ENSURE YOU: INSERT INCOME FOR YOU AND YOUR PARTNER (IF THEY ARE JOINING) NOMINATE A KEYCARE DOCTOR FOR EACH PERSON SECTION 7 ONLY if your Employer pays your contribution. SECTION 8 YOUR DEBIT ORDER DETAILS - SIGN 8.2 YOUR ACCOUNT for refunds - SIGN SECTION 9 - Previous medical aid details. SECTION 10 If you are joining from another medical aid. check if you need to answer Section 10.2 If your debit date is after the 10th of a month, the first debit will be a double. If you can't meet this, ensure your debit date is the 1st or the 10th. SECTION 11 - Complete ALL QUESTION SECTION 12 - SIGN SECTION 13 SIGN and DATE Vitality or Keyfit - additional premium required. PLEASE FAX A CERTIFICATE OF MEMBERSHIP - get from the old scheme. This may avoid a late joiner penalty. I ALSO NEED ID COPIES! Then FAX the completed application OR SCAN AND I CAN OFFER YOU THE SERVICES OF A DEDICATED TEAM WITHIN THE MEDICAL AID. ALWAYS THERE TO ASSIST YOU. NO CALL CENTRES HERE. AND AT NO ADDED COST! ABSOLUTELY FREE. Kind regards, PETER PS. Please visit my Web page as below. Peter J Pyburn Approved Financial Services Provider Licence # Financial Life Planner Member: Masthead, FIA, Council for Medical Schemes. Mobile : Fax :

2 Appl i g to e o e a e e of Dis o e Health Medi al he e i Co ta t us Tel Me e s :, Tel Health pa t e s :, PO Bo, a dto,,.dis o e. o.za Who e a e Dis o e Health Medi al he e efe ed to as the he e, egist atio u e, is the edi al s he e that ou a e appl i g to e o e a e e of. This is a o -p ofit o ga isatio, egiste ed ith the Cou il fo Medi al he es. Dis o e Health Pt Ltd, egist atio u e / /, efe ed to as the ad i ist ato is a sepa ate o pa a d a autho ised fi a ial se i es p o ide a d is the ad i ist ato a d a aged a e o ga isatio fo Dis o e Health Medi al he e a d takes a e of the ad i ist atio of ou e e ship. Pu pose of the fo Tha k ou fo de idi g to appl to joi the Dis o e Health Medi al he e. This do u e t is a appli atio fo fo e e ship. It also o tai s so e ules fo e e ship e tio. Please ake su e ou ead a d u de sta d these ules. What ou ust do Fill i the fo i la k i k a d p i t lea l, o o plete the fo digitall usi g Mi osoft Wo d. All ele a t se tio s ust e ph si all sig ed the ai appli a t a d a ot e sig ed digitall. The ai appli a t ust sig a d date a ha ges. ead a d u de sta d the ules fo e e ship e tio. ig se tio if appl i g to e o e a Ke Ca e e e, a d. Fa the o pleted a d sig ed fo to o e ail it to appli o e. o.za Please atta h a op of ea h appli a t s ide tit do u e t. We also a ept alid passpo ts a d i th e tifi ates fo hild e. O e ou su it ou appli atio fo, he e is hat ill happe : You ill e o ta ted if a details a e issi g o if o e i fo atio is e ui ed fo u de iti g pu poses. You e e ship ill e a ti ated a d ou o ou fi a ial ad ise ill e ei e a lette of o fi atio he sta da d te s of a epta e a e offe ed o aiti g pe iods o late-joi e pe alties. Fo a o -sta da d te s, a ou te -offe lette ill e issued, hi h ill i di ate a o ditio s appli a le to ou e e ship aiti g pe iods a d/o late-joi e pe alties. You a a ept the offe sig i g a d etu i g this lette to a ti ate ou e e ship. You o ou fi a ial ad ise ill e ei e a el o e lette, M o a e ail to let ou k o he ou appli atio is o side ed to ha e ee full a d o pletel ade. This date a diffe f o the date o hi h ou sig the appli atio fo. If ou do ot hea f o the he e se e da s afte su itti g ou appli atio fo, please o ta t us o o ou fi a ial ad ise. When you sign this application, you confirm that you have read and understood the rules for membership and agree to them. 1. A out ou self ai appli a t Whe do ou a t ou o e to sta t? Y Y Y Y M M Title I itials u a e Fi st a e s (as per identity document) P efe ed a e Ge de M F Date of i th Y Y Y Y M M D D P e ious o aide a e O upatio Total o thl ea i gs ID o passpo t u e Telepho e H Cellpho e E ail Ph si al add ess i outh Af i a uite/u it u e t eet u e u u Co ple a e t eet a e Ma ital status Ta u e Cou t of issue Telepho e W Fa Post ode Page 1 of 12

3 A out ou self o ti ued Postal add ess Post olle ted f o post o, suite o p i ate ag If ou do ot o plete a postal add ess, e ill use ou ph si al add ess fo post. PO Bo P i ate Bag Bo u e uite Post et uite Nu e u u Post ode 2. A out ou spouse o pa t e o l o plete if appl i g fo o e Title I itials u a e Fi st a e s (as per identity document) P efe ed a e Ge de M F Date of i th Y Y Y Y M M D D Ma ital status Ma ied i gle Di o ed Wido ed ID o passpo t u e Cou t of issue Telepho e H Cellpho e E ail Telepho e W Fa 3. A out ou depe da ts o l o plete if appl i g fo o e Depe da t Title I itials u a e Fi st a e s (as per identity document) P efe ed a e Ge de M F Date of i th Y Y Y Y M M D D ID o passpo t u e Cou t of issue elatio ship to ai e e (For example, mother, child etc. Where your child is not your biological child, please state relationship, i.e. adopted child, foster child. Please provide legal proof) If ou depe da t is ea s a d olde, a e the : Ma ied Yes No Fi a iall depe de t o ou? Yes No Does ou depe da t ea a i o e? Yes No Ho u h does ou depe da t ea ea h o th? Depe da t Title I itials u a e Fi st a e s (as per identity document) P efe ed a e Ge de M F Date of i th Y Y Y Y M M D D ID o passpo t u e Cou t of issue elatio ship to ai e e (For example, mother, child etc. Where your child is not your biological child, please state relationship, i.e. adopted child, foster child. Please provide legal proof) If ou depe da t is ea s a d olde, a e the : Ma ied Yes No Fi a iall depe de t o ou? Yes No Does ou depe da t ea a i o e? Yes No Ho u h does ou depe da t ea ea h o th? Depe da t Title I itials u a e Fi st a e s (as per identity document) P efe ed a e Ge de M F Date of i th Y Y Y Y M M D D ID o passpo t u e Cou t of issue elatio ship to ai e e (For example, mother, child etc. Where your child is not your biological child, please state relationship, i.e. adopted child, foster child. Please provide legal proof) If ou depe da t is ea s a d olde, a e the : Ma ied Yes No Fi a iall depe de t o ou? Y Does ou depe da t ea a i o e? Yes No Ho u h does ou depe da t ea ea h o th? Yes No Page 8 of 12

4 4. You fi a ial ad ise s details Fi a ial ad ise s a e Peter Pyburn I te edia house Peter J Pyburn Fi a ial ad ise s telepho e u e W E ail peter@peterpyburn.co.za Ba k efe e e u e if appli a le Lead u e Code Code (Mandatory for all ABSA and FNB financial advisers) I de la e that: I a a a edited fi a ial ad ise i te s of the Medi al he es A t a d li e sed the Fi a ial e i es Boa d i te s of the Fi a ial Ad iso a d I te edia e i es A t at the date of sig i g this appli atio fo. I a appoi ted the lie t to p o ide ad i e a out this appli atio. I ha e a alid o t a t ith Dis o e Health Medi al he e a d I ha e ade the lie t a a e of the o issio pa a le Dis o e Health Medi al he e. I a espo si le fo p o idi g the ai appli a t ith: a e, ph si al add ess, postal add ess a d telepho e u e. i pa tial ad i e that is i his o he est i te est. I a a ou ta le fo a ad i e gi e to the ai appli a t a out o pletio of this appli atio fo a d joi i g Dis o e Health Medi al he e. Fi a ial ad ise s sig atu e 5. Please sele t ou health pla E e uti e Pla Co p ehe si e e ies P io it e ies a e e ies a t e ies Co e e ies Ke Ca e e ies E e uti e Classi Classi Classi Classi Classi Ke Ca e Plus Classi Delta Esse tial Classi Delta Esse tial Classi Delta Ke Ca e A ess Classi )e o M A Esse tial Esse tial Ke Ca e Co e Esse tial Esse tial Delta Esse tial Delta Esse tial Delta Coastal Coastal Ho ould ou like us to efu d lai s f o the Medi al a i gs A ou t if ou pla has o e? Dis o e Health ate Cost You ha e the ight to ask fo help i sele ti g a health pla that suits ou eeds. Whethe ou ha e e uested help o ade the de isio o ou o, sig i g this appli atio, ou o fi that ou a e fa ilia ith the o ditio s a d e efits of the pla ou sele t. 6. If ou hoose a Ke Ca e Pla I o e e ifi atio ill e o du ted fo the lo e i o e a ds. I o e is o side ed as: The highe of the ai e e s o egiste ed spouse o pa t e s ea i gs, o issio a d e a ds f o e plo e t; i te est f o i est e ts; i o e f o leasi g of assets o p ope t ; dist i utio s e ei ed f o a t ust, pe sio a d/o p o ide t fu d; e eipt of a fi a ial assista e i te s of a statuto so ial assista e p og a e. IMPORTANT NOTICE: De la i g i o e lo e tha ou a tual i o e is f aud. This a lead to the te i atio of ou e e ship a d i i al ha ges a e ought agai st ou. B sig i g this appli atio fo, ou gi e ou pe issio fo us to e if ou de la ed i o e usi g all ele a t i te al a d e te al sou es, as set out i.. Mai e e pouse o Pa t e Total ea i gs o e the last o ths Total o thl ea i gs I de la e that this i o e de la atio is t ue a d a u ate. ig atu e of ai appli a t Please o l sig if i fo atio is t ue, o plete a d o e t. If the highest ea e ea ed less tha fo ea h ea, the please p o ide the follo i g suppo ti g do u e tatio as p oof of i o e: Last o ths o se uti e da s a k state e ts; a d If e plo ed, ou last o ths pa slips a d o issio s hedules, o ost e e t ta ea s I P e tifi ate If stude t, p oof of e ol e t at a ade i i stitutio If self-e plo ed, ost u e t fi a ial state e ts If pe sio e, p oof of a uit a d/o e plo e pe sio a d/o tate Olde Pe so s G a t If u e plo ed, UIF e tifi ate Page 8 of 12

5 If ou hoose a Ke Ca e Pla o ti ued Please o plete this if ou ha e sele ted the Ke Ca e Plus o Ke Ca e A ess Pla. Please sele t a GP o the Ke Ca e GP Net o k. * If ou li e fa a a f o he e ou o k o ou ofte eed to o k i diffe e t to s o p o i es, ou a eed a se o d GP. Na e GP a e P a ti e u e e o d GP a e* P a ti e u e Mai appli a t pouse o pa t e Depe da t ** Depe da t ** Depe da t ** ** Please ake su e that the depe da t i fo atio ou gi e a o e is the sa e as the depe da t i fo atio i se tio of this fo. 7. You e plo e t details o l o plete if ou e plo e pa s the o t i utio s o ou ehalf If ou e plo e is pa i g ou full o t i utio o a pa t of it a d e eed to de it thei a ou t, please o plete this se tio : Na e of e plo e E plo e o illi g u e E plo ee u e Date of e plo e t Y Y Y Y M M D D (or PERSAL number for government employees. Please attach a clear copy of your salary slip.) B a h a e B a h u e E plo e a a t Please e su e ou e plo e o pletes this a a t if this appli atio fo is ot su itted ith a e plo e appli atio fo : We a a t that the ai appli a t detailed i se tio is a e plo ee of ou o ga isatio. The Dis o e Health Medi al he e a ill us fo the a ou t due fo this e e i the sa e a as it does fo ou othe e plo ees ith the Dis o e Health Medi al he e. Autho ised sig ato Na e Desig atio O l o plete this se tio if ou o ou o usi ess a d ou usi ess ill e pa i g ou o t i utio : Na e of ou usi ess egist atio u e Telepho e Ph si al add ess Postal add ess Fa VAT u e Code Code 8. You a ki g details You o t i utio s If ou ill e pa i g ou o t i utio s i full, please o plete this se tio : Please ote: We a ot a ept edit a d a ou t details a d o l outh Af i a a ki g details a e a epted. If e a e de iti g a thi d pa t a ou t, the ai e e ust sig e t to the a ou t holde. Ba k a e B a h a e A ou t u e A ou t holde B a h ode T pe of a ou t Che ue a i gs We ill de it ou a ou t o the fi st o ki g da of the o th. If ou e e ship is ot a ti ated i ti e fo the de it o de olle tio, ou fi st p e iu ill e olle ted ith the e t de it o de u less it has ee paid i the i te i. Afte e ha e e ei ed ou fi st de it o de a d ou a e pa i g i ad a e, ou a ha ge ou de it o de date to a a ia le de it o de date o ta ti g us o. You lai s efu d Ca e use the sa e a ou t e dedu t o t i utio s f o to efu d ou lai s? Yes No If ou do ot a t to use the sa e a ki g details fo ou o t i utio s a d lai s efu ds, please gi e us the details ou ould like to use: Please ote: We a ot a ept edit a d a ou t details. We o lo ge issue he ues, if o details a e p o ided e ill ot e a le to efu d ou lai s. Ba k a e B a h a e A ou t u e A ou t holde B a h ode T pe of a ou t Che ue a i gs Page 8 of 12

6 X You a ki g details o ti ued B sig i g this appli atio, ou ag ee that o e lai s ha e ee efu ded i to the a k a ou t ou ha e hose, the he e ill ot e espo si le i a a fo the a ou ts efu ded. ig atu e of a ou t holde ig atu e of ai appli a t 9. P e ious edi al s he e details Please gi e us p oof i the fo of a e e ship e tifi ate Please gi e us the details of all egiste ed outh Af i a edi al s he es that ou p e iousl elo ged to. We ill use this i fo atio to dete i e if e eed to appl a aiti g pe iods, late-joi e pe alt fees, o oth. Please gi e us p oof i the fo of a e e ship e tifi ate. Were all your dependants on the same medical scheme. Yes No If any of your dependants applying for cover belonged to different medical schemes, please complete them below: Na e he e a e ta t date E d date if al ead esig ed A e the still a e e? Y Y Y Y M M D D Y Y Y Y M M D D Yes No Y Y Y Y M M D D Y Y Y Y M M D D Yes No Y Y Y Y M M D D Y Y Y Y M M D D Yes No Y Y Y Y M M D D Y Y Y Y M M D D Yes No Y Y Y Y M M D D Y Y Y Y M M D D Yes No Reaso fo lea i g 10. Mo i g f o a othe edi al s he e Please ake su e that ou ha e o pleted se tio. I o fi that all people a ed o this appli atio : ha e ot had a eak i e e ship of o e tha da s si e esig i g f o the p e ious outh Af i a edi al s he e, a d a e u e tl o ha e ee e e s of a outh Af i a edi al s he e fo at least the past o ths. If ou a s e ed es to the a o e uestio s, please a s e the uestio s i.. If ou a s e o to a uestio i., ou ust o plete all the edi al uestio s i se tio. Fo a pe so a ed o this appli atio fo : Ha e ou o a of ou depe da ts ee ad itted to hospital i the o ths efo e this appli atio? A e ou o a of ou depe da ts u e tl taki g egula, o goi g edi i e a d/o t eat e t of a edi al o ditio? A e ou o a of ou depe da ts pla i g to o easo a l e pe ti g to e hospitalised i ludi g fo p eg a o e pe ti g to e ei e de tal o edi al t eat e t osti g o e tha i the e t o ths? Yes No Yes No Yes No Yes No Yes No If ou a s e ed o to all uestio s i., e ill ot appl a aiti g pe iods a d ou do ot ha e to o plete se tio. If ou a s e ed es to a uestio s i., e ill appl a th ee- o th ge e al aiti g pe iod to ou appli atio a d ou do ot ha e to o plete e tio. If ou feel that a th ee- o th ge e al aiti g pe iod should ot e applied a d ou a t to gi e us o e i fo atio, please o plete se tio. Du i g these th ee o ths, e ill o l o e lai s elati g to P es i ed Mi i u Be efits a o di g to the he e s ules. 11. You health uestio s The ai appli a t, spouse o pa t e a d all depe da ts appl i g fo o e eeds to o plete this se tio Mai appli a t T eati g health a e p ofessio al s a e Telepho e Ho tall a e ou?. et es Ho u h do ou eigh? kilog a s Do ou d i k al ohol? Yes No Ho a u its of al ohol do ou d i k ea h eek? u it of al ohol = easu e of spi its, ½ pi t of ee o glass of i e Do ou s oke? Yes No A ou t ea h da If o, ha e ou s oked i the last o ths? Yes No If es, a ou t ea h da If ou stopped s oki g, hat as ou easo fo stoppi g? pouse o pa t e T eati g health a e p ofessio al s a e Telepho e Ho tall a e ou?. et es Ho u h do ou eigh? kilog a s Do ou d i k al ohol? Yes No Ho a u its of al ohol do ou d i k ea h eek? u it of al ohol = easu e of spi its, ½ pi t of ee o glass of i e Do ou s oke? Yes No A ou t ea h da If o, ha e ou s oked i the last o ths? Yes No If es, a ou t ea h da If ou stopped s oki g, hat as ou easo fo stoppi g? Page 8 of 12

7 You health uestio s o ti ued Depe da t Na e T eati g health a e p ofessio al s a e Telepho e Ho tall a e ou?. et es Ho u h do ou eigh? kilog a s Do ou d i k al ohol? Yes No Ho a u its of al ohol do ou d i k ea h eek? u it of al ohol = easu e of spi its, ½ pi t of ee o glass of i e Do ou s oke? Yes No A ou t ea h da If o, ha e ou s oked i the last o ths? Yes No If es, a ou t ea h da If ou stopped s oki g, hat as ou easo fo stoppi g? Depe da t Na e T eati g health a e p ofessio al s a e Telepho e Ho tall a e ou?. et es Ho u h do ou eigh? kilog a s Do ou d i k al ohol? Yes No Ho a u its of al ohol do ou d i k ea h eek? u it of al ohol = easu e of spi its, ½ pi t of ee o glass of i e Do ou s oke? Yes No A ou t ea h da If o, ha e ou s oked i the last o ths? Yes No If es, a ou t ea h da If ou stopped s oki g, hat as ou easo fo stoppi g? Depe da t Na e T eati g health a e p ofessio al s a e Telepho e Ho tall a e ou?. et es Ho u h do ou eigh? kilog a s Do ou d i k al ohol? Yes No Ho a u its of al ohol do ou d i k ea h eek? u it of al ohol = easu e of spi its, ½ pi t of ee o glass of i e Do ou s oke? Yes No A ou t ea h da If o, ha e ou s oked i the last o ths? Yes No If es, a ou t ea h da If ou stopped s oki g, hat as ou easo fo stoppi g? I fo atio o s pto s, o ditio s o diso de s Must e o pleted fo the ai appli a t, spouse/pa t e a d all depe da ts Ha e ou o a depe da t i this appli atio e e e pe ie ed, ee t eated fo, o a e ou u e tl suffe i g f o a of the follo i g s pto s, o ditio s o diso de s? We ha e listed so e e a ples of o ditio s, s pto s o diso de s u de ea h uestio. These a e o l e a ples a d ot the full list of o ditio s, s pto s o diso de s. Please i lude o ge ital a o alities. You ust tell us i iti g if a of the i fo atio ou ga e, i ou appli atio fo e e ship, ha ges et ee the da ou sig this do u e t a d the da ou e e ship sta ts. This i ludes i fo atio a out ou health a d the health of those ou appl fo. Please take ote that if ou o a of ou depe da ts ha e a s pto o o ditio ot listed i the uestio s elo, ou should highlight a d p o ide full details of this s pto o o ditio i espo se to uestio. elo. Please a s e ALL uestio s ti ki g Yes o No. Tu ou s a d g o ths Yes No E a ple: a o al pap s ea esults, p e- a e ous ski lesio s, east disease, o - a e ous tu ou s, a e ous tu ou s, fi o sti east disease, fi oade o a, fi oade osis, lu p i east, a o al a og a esult, a o al P A p ostate spe ifi a tige esult. Hea t a d i ulatio o ditio s Yes No E a ple: hest pai, palpitatio s, sho t ess of eath, o o a hea t disease, a gi a, hea t atta k, a h th ia, high lood p essu e h pe te sio, a dio opath, al ula hea t disease o hea t al e epla e e t, o ge ital hea t disease, heu ati fe e, high holeste ol, p e ious hea t su ge, ste ts, pa e ake. Page 8 of 12

8 You health uestio s o ti ued G ae ologi al a d o stet i s o ditio s Yes No E a ple: a o al pap s ea esults, a o al e st ual leedi g, e do et iosis, is a iage, pol sti o a ia s d o e, i fe tilit. A e ou o a of ou depe da ts p eg a t? Yes No Patie t a e Me tal health Yes No E a ple: ood diso de s dep essio, ipola diso de, a iet diso de s, s hizoph e ia, pe so alit diso de s, sleepi g diso de s like a oleps, eati g diso de s, Alzhei e s disease, autis, de e tia, atte tio defi it-h pe a ti it diso de, d ug a d/o al ohol eha ilitatio, sui ide atte pt, ou selli g, uli ia a d a othe ps hologi al o ditio s. Meta oli o e do i e o ditio s Yes No E a ple: dia etes high lood suga, th oid disease, Addiso s disease, Cushi g s s d o e, eta oli s d o e, pa ath oid disease, Paget s disease, osteopo osis, g o th defi ie, eta oli diso de s, Co s s d o e. A do i al o ditio s Yes No E a ple: hepatitis, i hosis, po tal h pe te sio, al oholi li e disease, li e failu e, hae o h o atosis, pa eatitis, sti fi osis, gall ladde, gall sto es, GO D eflu, hea t u, oesophageal disease, he ias, at ophi gast itis, ul e s, ala so ptio, C oh s disease, ul e ati e olitis, di e ti ulitis. B ai a d e e o ditio s Yes No E a ple: st oke, epileps, ultiple s le osis, oto eu o disease, asthe ia g a is, ig ai e, e e al pals, Pa ki so s disease, pa aplegia, he iplegia, uad iplegia, spi al o d i ju, h d o ephalus, e tal eta datio, CVA. Patie t a e Medi al diag osis Date fi st diag osed B eathi g a d espi ato o ditio s Yes No E a ple: asth a, h o i o st u ti e pul o a disease, o hie tasis, tu e ulosis, o hitis o e ph se a, sti fi osis, sa oidosis, p eu o ia. Mus uloskeletal a k, o e a d us le pai Yes No E a ple: a th itis a fo, o goi g a k pai, a k losi g spo d litis, lupus, jög e s s d o e, s le ode a, pol ositis, de ato ositis, pol a te itis odosa, Wege e s g a ulo atosis, sa oidosis, fi o algia, dege e ati e dis disease, s oliosis, k phosis, spi al ste osis, gout, f a tu es, ph si al disa ilit. Page 8 of 12

9 You health uestio s o ti ued Kid e o u i a o ditio s i ludi g u e t o past dial sis Yes No E a ple: kid e a d/o e al failu e, kid e sto es, e u e t u i a i fe tio s, glo e ulo eph itis, eph oti s d o e, pol sti kid e disease, u i a i o ti e e, ladde i fe tio s, othe ladde o kid e p o le s. Blood o ditio s Yes No E a ple: deep ei th o osis, a ae ia, ITP platelet defi ie, pol thae ia e a, lood lotti g diseases, leukae ia, l pho a, pul o a e olus, hae ophilia a d othe leedi g diso de s. E e o ditio s Yes No E a ple: ata a t, ke ato o us, o eal ul e, u eitis, glau o a, s ui t, ptosis, a a o alit of e elids, eti opath, a ula dege e atio, o ea t a spla t, e e su ge, lu isio, li d ess pa tial o full, eti al deta h e t. Ea, ose a d th oat ENT a d de tist o ditio s Yes No E a ple: h o i otitis edia iddle ea i fe tio, h o i otitis e te a, hea i g p o le s, hea i g aid, o hlea i pla t, to sillitis, ade oiditis, e tigo, deaf ess, si us p o le, asal su ge, de tal t eat e t o de tal su ge. Male u oge ital o ditio s Yes No E a ple: p ostate diso de s, u oge ital defe ts, a i o ele, tu ou s, u des e ded testes, phi osis, u i a i o ti e e. A e ou o a of ou depe da ts e pe ti g to ha e edi al i estigatio s o su ge o pla i g o t eat e t i the e t o ths o ha e ou ee ad itted to hospital i the last o ths? Yes No Ha e ou o a of ou depe da ts e ei ed o ot et e ei ed edi al ad i e o t eat e t fo s pto s, ot et diag osed a edi al p ofessio al, i the last o ths efo e this appli atio? Yes No Page 8 of 12

10 You health uestio s o ti ued Ha e ou o a of ou depe da ts ee diag osed ith o e ei ed t eat e t fo, a o ditio ot e tio ed i the uestio s a o e, i the last o ths efo e this appli atio? Yes No HIV If ou, o o e o o e of ou depe da ts, a e HIV-positi e, ou o the ust all us o ithi se e o ki g da s f o the date e a ti ate ou Dis o e Health Medi al he e e e ship. We t eat this i fo atio i the st i test o fide e. If ou, o o e o o e of ou depe da ts a e HIV-positi e, it is i ou i te est to egiste o the HIVCa e P og a e. Dis o e Health Medi al he e a ha e aiti g pe iods that appl i e tai i u sta es. This ea s the e a e a set ti e pe iod efo e Dis o e Health Medi al he e sta ts pa i g fo a ge e al o spe ifi edi al o ditio s. A - o th o ditio spe ifi aiti g pe iod a the efo e appl to this o ditio. If ou do ot let us k o a out ou HIV status ithi da s of ou e e ship ei g a ti e, e a e d ou Dis o e Health Medi al he e e e ship. 12. Ou P i a tate e t Ho e ill p o ess a d dis lose ou pe so al i fo atio a d o u i ate ith ou Defi itio s The he e efe s to Dis o e Health Medi al he e, egist atio u e, egiste ed ith the Cou il fo Medi al he es. Ad i ist ato efe s to Dis o e Health Pt Ltd, egist atio u e / /, a autho ised fi a ial se i es p o ide, the ad i ist ato a d a aged a e o ga isatio fo Dis o e Health Medi al he e a d a su sidia of the Dis o e G oup. Dis o e G oup efe s to Dis o e Li ited, egist atio u e / /, i ludi g all su sidia ies of the g oup. u sidia ies i the G oup a e autho ised fi a ial se i es p o ide s. You a d ou efe s to the e e a d ou egiste ed depe da ts o ou edi al s he e pla. You pe so al i fo atio efe s to pe so al i fo atio a out ou, ou spouse, ou depe da ts, ou e efi ia ies, a d ou e plo ees as ele a t. It i ludes i fo atio a out health, fi a ial status, ge de, age, o ta t u e s a d add esses. P o ess i g of i fo atio ea s the auto ated o a ual a ti it of olle ti g, e o di g, o ga isi g, sto i g, updati g, dist i uti g a d e o i g o deleti g pe so al i fo atio. Co pete t pe so ea s a o e ho is legall o pete t to o se t to a a tio o de isio ei g fo a atte o e i g a e e o depe da t fo e a ple a pa e t o legal gua dia. Whe ou e gage ith the he e a d Ad i ist ato, ou t ust us ith pe so al i fo atio a out ou self, ou fa il, a d i so e ases, ou e plo ees. We a e o itted to p ote ti g ou ight to p i a. The pu pose of this P i a tate e t is to set out ho e olle t, use, sha e a d othe ise p o ess ou pe so al i fo atio, i li e ith the P ote tio of Pe so al I fo atio A t POPIA. You ha e the ight to o je t to the p o essi g of ou pe so al i fo atio a d ha e a hoi e hethe o ot to a ept these te s a d o ditio s. Ho e e, it is i po ta t to ote that the he e a d Ad i ist ato e ui e ou a epta e to a ti ate a d se i e ou edi al s he e e e ship. If ou do ot a ept these te s a d o ditio s, e a ot a ti ate a d se i e ou edi al s he e e e ship. The he e a d Ad i ist ato ill keep ou pe so al i fo atio o fide tial. You a ha e gi e us this i fo atio ou self o e a ha e olle ted it f o othe sou es. If ou sha e ou pe so al i fo atio ith a thi d pa ties, e ill ot e espo si le fo a loss suffe ed ou o ou e plo e he e appli a le. You a a t that he ou gi e the he e a d Ad i ist ato pe so al i fo atio a out ou depe da ts, ou ha e e ei ed thei pe issio to sha e thei pe so al i fo atio ith us fo the pu poses set out i this P i a tate e t a d a othe elated pu poses. If ou a e a e plo e, ou ag ee to i de if the he e a d Ad i ist ato agai st a loss o da age, di e t o i di e t, that a e plo ee suffe s e ause of a u autho ised use of ou e plo ees' pe so al i fo atio. If ou a e gi i g o se t fo a pe so u de a i o ou o fi that ou a e a o pete t pe so a d that ou ha e autho it to gi e thei o se t fo the. You ag ee that the he e a d Ad i ist ato a p o ess ou pe so al i fo atio fo the follo i g pu poses: fo the ad i ist atio of ou health pla ; fo the p o isio of a aged a e se i es to ou o ou health pla ; fo the p o isio of ele a t i fo atio to a o t a ted thi d pa t ho e ui es this i fo atio i o de to p o ide a health a e se i e to ou o ou health pla ; to p ofile a d a al se isk; to sha e ou pe so al i fo atio ith e te al health spe ialists fo the to assess o e aluate e tai li i al i fo atio, i the e e t that ou a e su je t to su h a li i al assess e t. E a ples of ho this ill happe i lude: I. ha i g ou pe so al i fo atio ith ou hose fi a ial ad ise du i g the appli atio p o ess to help the Ad i ist ato, if e essa, hile e p o ess ou e e ship appli atio ; II. Getti g ou pe so al i fo atio f o othe ele a t sou es, i ludi g edi al p a titio e s, o t a ted se i e p o ide s, fi a ial ad ise s, edit u eaus, e tities that a e pa t of Dis o e G oup o i dust egulato odies ele a t sou es a d fu the p o essi g of su h i fo atio to o side ou e e ship appli atio, to o du t u de iti g o isk assess e ts, o to o side a lai fo edi al e pe ses. We a at a ti e a d o a o goi g asis e if ith the ele a t sou es that ou pe so al i fo atio is t ue, o e t a d o plete; III. If ou ha e joi ed as a e e of a e plo e g oup, getti g f o a d sha i g ith ou e plo e i fo atio that is ele a t to ou appli atio ; IV. Co u i ati g ith ou a out a ha ges i ou health pla, i ludi g ou o t i utio s o ha ges a d e ha e e ts to the e efits ou a e e titled to o the health pla ou ha e hose ; V. T a sfe i g ou pe so al i fo atio outside the o de s of the epu li of outh Af i a he e app op iate, fo e a ple to ad i iste i te atio al e e ge o t eat e t e efit a d Af i a Be efit, o if ou p o ide a e ail add ess hi h is hosted outside the o de s of outh Af i a, o fo p o essi g, sto age o a ade i esea h. We ill e su e that a o e to ho e pass ou pe so al i fo atio ag ees to t eat ou i fo atio ith the sa e le el of p ote tio as e a e o liged to; Page 8 of 12

11 Ou P i a tate e t o ti ued If a thi d pa t asks the he e a d Ad i ist ato fo a of ou pe so al i fo atio, e ill sha e it ith the o l if: ou ha e al ead gi e ou o se t fo the dis losu e of this i fo atio to that thi d pa t ; o e ha e a legal o o t a tual dut to gi e the i fo atio to that thi d pa t. The he e a d the Ad i ist ato ill p o ide ou pe so al i fo atio to a othe e tit ithi the Dis o e G oup ith ho ou o ou depe da t/s al ead ha e a elatio ship; o he e ou o ou depe da t/s ha e applied fo a p odu t, se i e o e efit f o su h e tit. This i fo atio ill e p o ided fo the ad i ist atio of ou o ou depe da t/s p odu ts o e efits ith othe e tities ithi the Dis o e G oup. The he e a d Ad i ist ato a sha e a d o i e all ou pe so al i fo atio fo a o e o o e of the follo i g pu poses: a ket, statisti al a d a ade i esea h; a d to usto ise ou e efits a d se i es to eet ou eeds. You pe so al i fo atio a e sha ed ith thi d pa ties su h as a ade i s a d esea he s, i ludi g those outside outh Af i a. We e su e that the a ade i s a d esea he s ill keep ou pe so ali fo atio o fide tial a d all data ill e ade a o ous to the e te t possi le a d he e app op iate. No pe so al i fo atio ill e ade a aila le to a thi d pa t u less that thi d pa t has ag eed to a ide st i t o fide tialit p oto ols that e e ui e. If e pu lish the esults of this esea h, ou ill ot e ide tified a e. If e a t to sha e ou pe so al i fo atio fo a othe easo, e ill do so o l ith ou pe issio. B sig i g this appli atio fo, ou autho ise the he e a d Ad i ist ato to o tai a d sha e i fo atio a out ou edit o thi ess ith a edit u eau o edit p o ide s i dust asso iatio o i dust od. This i ludes i fo atio a out edit histo, fi a ial histo, judg e ts, default histo a d sha i g of i fo atio fo pu poses of isk a al sis, t a i g a d a elated pu poses. The he e a d Ad i ist ato ha e the ight to o u i ate ith ou ele t o i all a out a ha ges o ou health pla, i ludi g ou o t i utio s o ha ges a d i p o e e ts to the e efits ou a e e titled to o the health pla ou ha e hose. The he e a d Ad i ist ato ha e a dut to keep ou updated a out a offe s a d e p odu ts that a e ade a aila le f o ti e to ti e. The he e, Ad i ist ato, a e tit ithi the Dis o e G oup a d o t a ted thi d-pa t se i e p o ide s a o u i ate ith ou a out these. Please let the Ad i ist ato k o if ou do ot ish to e ei e a di e t telepho i a keti g. You ha e the ight to k o hat pe so al i fo atio the he e holds a out ou. If ou ish to e ei e this i fo atio please o plete a PAIA Fo to e uest A ess to e o ds o.dis o e. o.za/ edi al-aid/a out-dis o e -health- edi als he e a d spe if the i fo atio ou ould like. We ill take all easo a le steps to o fi ou ide tit efo e p o idi g details of ou pe so al i fo atio. We a e e titled to ha ge a fee fo this se i e a d ill let ou k o hat it is at the ti e of ou e uest. You ag ee that the he e a d Ad i ist ato a keep ou pe so al i fo atio u til ou ask us to delete o dest o it. You ha e the ight to ask us to update, o e t o delete ou pe so al i fo atio, u less the la e ui es us to keep it. Whe e e a ot delete ou pe so al i fo atio, e ill take all p a ti al steps to de-pe so alise it. Whe e the he e a d Ad i ist ato a e e ui ed la to olle t a d keep pe so al i fo atio, e shall do so. At a i i u, this i ludes the follo i g: Medi al he es A t, The Co su e P ote tio A t, The P ote tio of Pe so al I fo atio A t, Ele t o i Co u i atio s a d T a sa tio s A t, P o otio of A ess to I fo atio A t, Legislatio spe ifi to Dis o e Health Pt Ltd o l : Fi a ial Ad iso a d I te edia e i es A t, You ag ee that the he e a d Ad i ist ato a t a sfe ou pe so al i fo atio outside outh Af i a: if ou gi e us a e ail add ess that is hosted outside outh Af i a; o to ad i iste e tai se i es, fo e a ple, loud se i es. Whe e sha e ou i fo atio to ad i iste e tai se i es, e ill e su e that a ou t, o pa o pe so that e pass ou pe so al i fo atio to ag ees to t eat ou i fo atio ith the sa e le el of p ote tio as e a e o liged to. If the he e o Ad i ist ato e o es i ol ed i a p oposed o a tual a alga atio, t a sfe o e ge, a uisitio o a fo of sale of a assets, as app op iate, e ha e the ight to sha e ou pe so al i fo atio ith thi d pa ties i o e tio ith the t a sa tio. I the ase of su h a e e t, the e e tit ill ha e a ess to ou pe so al i fo atio. The he e a ha ge this P i a tate e t at a ti e. The u e t e sio is a aila le o.dis o e. o.za. If ou elie e that the he e o Ad i ist ato ha e used ou pe so al i fo atio o t a to this P i a tate e t, ou ha e the ight to lodge a o plai t ith the I fo atio egulato, u de POPIA, ut e e ou age ou to fi st follo ou i te al o plai s p o ess to esol e the o plai t. We e plai the o plai ts a d disputes p o ess o the e site.dis o e. o.za. Co ta t details fo the I fo atio egulato : The I fo atio egulato outh Af i a ALU Buildi g Tha o ehu e t eet P eto ia Tel: Fa : i fo eg@justi e.go.za X ig atu e of ai appli a t Date Y Y Y Y M M D D Please o l sig if ou ha e ead a d u de sta d this state e t Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. Page 11 of 12

12 13. Dis o e Health Medi al he e ules fo e e ship Defi itio s The he e efe s to Dis o e Health Medi al he e, egist atio u e, egiste ed ith the Cou il fo Medi al he es. Ad i ist ato efe s to Dis o e Health Pt Ltd, egist atio u e / /, a autho ised fi a ial se i es p o ide, the ad i ist ato a d a aged a e o ga isatio fo Dis o e Health Medi al he e a d a su sidia of the Dis o e G oup. Dis o e G oup efe s to Dis o e Li ited, egist atio u e / /, i ludi g all su sidia ies of the g oup. u sidia ies i the G oup a e autho ised fi a ial se i es p o ide s. S he e rules for e ership The ules of the he e e o d ou ights a d espo si ilities fo ou e e ship. The a ha ge f o ti e to ti e. You a ask us fo a op of these ules at a ti e o ie these ules o.dis o e. o.za. Whe ou sig this appli atio, ou o fi that ou ha e ead a d u de stood these ules a d ou ag ee that ou a d those ou appl fo ill e ou d the. Whe e appli a le ou also a k o ledge a d o fi that ou, ou fi a ial ad ise, o ou e plo e, a o u i ate ith us o this appli atio a d ou e e ship of the he e. You gi e pe issio that the he e o Ad i ist ato a sha e ou edi al i fo atio a d othe ele a t Pe so al I fo atio a out ou a d ou depe da t/s ith ou hose fi a ial ad ise. The i fo atio ill e sha ed so that he o she a help us if e essa hile e p o ess ou e e ship appli atio. Please speak to ou fi a ial ad ise o the Ad i ist ato if the e is a thi g ou do ot u de sta d. Who you are applyi g for You a appl to joi the he e o ou o o togethe ith othe people ou spouse, ou pa t e a d people ho a e fi a iall depe de t o ou as defi ed i the he e ules, as efe ed to a o e. Fo a o e to e t eated as fi a iall depe de t fo this appli atio, ou ust ha e a espo si ilit to p o ide fi a iall fo that depe da t. The he e o Ad i ist ato ight ask ou to gi e us p oof of fi a ial o legal espo si ilit. You a e alled the p i ipal e e o ai e e i ou futu e o u i atio s to ou. A ti g for others You o fi ou ha e the ight to a t fo othe s. B sig i g this do u e t, ou o fi that: ou ha e the ight to appl fo e e ship a d to a t fo those ou appl fo i a atte elati g to this appli atio. ou ha e e ei ed pe issio f o ou spouse/pa t e a d a depe da t s o e to a t fo the i a atte elati g to this appli atio. Gi i g a d getti g i for atio You ust gi e t ue, o e t a d o plete i fo atio. To o side ou appli atio fo e e ship, the he e ust lea o e a out ou a d those ou appl fo. I fo atio a out ou a d those ou appl fo ust e t ue, o e t a d o plete. This i ludes the details ou gi e i this appli atio fo a d i futu e deali gs ith us. It is i po ta t that ou tell us a out a edi al o ditio, s pto o ill ess elati g to ou o those ou appl fo, e e if ou do ot o side it ele a t to ou appli atio. We a ask those ou appl fo ho a e a d olde fo o e i fo atio a out the sel es. You legal add ess The he e o Ad i ist ato ill se d do u e ts to ou at the add ess ou i di ated as the o u i atio ha el ou p efe to e o ta ted o. If it is e essa to se d ou a legal oti es o su o ses, ou legal tea ill se e these at the ph si al add ess ou ha e gi e, o at a othe add ess ou ha e gi e us. It is ou espo si ilit to ake su e e ha e the o e t add ess fo ou. The he e a d Ad i ist ato a e o d telepho e alls The he e a d Ad i ist ato a e o d telepho e o e satio s ith ou a d ith those ou appl fo. The e o di gs a d all i fo atio e get du i g the e o di gs ill e p o essed a d kept as e ui ed la. The he e a d Ad i ist ato a get i fo atio a out ou f o othe ele a t sou es The he e a d Ad i ist ato a at a ti e a d o a o goi g asis o tai ou pe so al i fo atio f o othe ele a t sou es, i ludi g edi al p a titio e s, o t a ted se i e p o ide s, fi a ial ad ise s, edit u eaus, e tities that a e pa t of Dis o e G oup o i dust egulato odies ele a t sou es a d fu the p o ess su h i fo atio to o side ou e e ship appli atio, to o du t u de iti g o isk assess e ts, o to o side a lai fo edi al e pe ses. We a at a ti e a d o a o goi g asis e if ith the ele a t sou es that ou pe so al i fo atio is t ue, o e t a d o plete. You gi e ou pe issio that the he e a d Ad i ist ato a get a i fo atio that is ele a t to ou appli atio f o ou e plo e. Tell the he e o Ad i ist ato i ediatel if ou i fo atio ha ges You, ou e plo e o ou fi a ial ad ise ust tell the he e o Ad i ist ato i iti g if a of the i fo atio ou ga e, i ou appli atio fo e e ship, ha ges et ee the da ou sig this do u e t a d the da ou e e ship sta ts. This i ludes i fo atio a out ou health a d the health of those ou appl fo. We eed ad a e oti e of a ad i ist ati e ha ges su h as a ellatio of e e ship, as e do ot a ept a kdated ha ges. Whe the he e a a el ou e e ship/s The he e a a el a e e ship if ou a d those ou appl fo : do ot gi e us i fo atio that late tu s out to e ele a t to this appli atio. gi e us a i fo atio that is ot t ue, o e t a d o plete. do ot tell us a out a ele a t ha ges i ludi g a out ou health a d the health of those ou appl fo et ee the da ou sig this do u e t a d the da o e sta ts. P o idi g false i fo atio a lead to i i al ha ges ei g ought agai st ou. You ill ha e to pa a a ou t o i g to the he e as a esult of this a ellatio. A out e o i g a e er The he e ight ot pa fo e tai e pe ses i ediatel afte ou e o e a e e The he e a ha e aiti g pe iods that appl i e tai i u sta es. This ea s the e a e a set ti e pe iod efo e the he e sta ts pa i g fo a ge e al o spe ifi edi al o ditio s. We ill ad ise if a aiti g pe iods appl. Please speak to ou fi a ial ad ise o the Ad i ist ato ith ega d to a aiti g pe iods appli a le to ou e e ship a d the e e ships of those ou appl fo. Resig f o u e t edi al s he es he a epted It is illegal to e a e e of o e tha o e edi al s he e at the sa e ti e. You a d those ou appl fo ust esig f o ou u e t edi al s he es he ou e ei e oti e f o the he e lette, e ail o M telli g ou that ou a d those ou appl fo ha e ee a epted. Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. Page 11 of 12

13 Dis o e Health Medi al he e ules fo e e ship o ti ued You ust e su e o t i utio s a e paid o ti e As the ai e e of the he e, ou a e espo si le fo e su i g that ou o t i utio s a d the o t i utio s of those ou appl fo a e paid o ti e e e o th to a oid suspe sio of e efits. The he e has the ight to a e d o thl o t i utio s a d e efits f o ti e to ti e ith p io otifi atio. Repayi g o ey o ed to the S he e The he e has the ight at a ti e to olle t f o ou a a ou t that ou o e. We ill otif ou if the e is a a ou t that ou o e to the he e. You ust epa a edi al sa i gs o i g if ou lea e the he e. Whe ou e o e a e e, depe di g o the pla ou hose, ou a ha e o e a aila le i ad a e to use fo edi al e pe ses du i g the ea. This o e is allo ated to a a ou t alled the Medi al a i gs A ou t. If ou lea e the he e efo e the ea is up, ou ust epa the po tio of edi al sa i gs ou ha e used that is o e tha ou ha e paid a k to the he e o e the ea. B sig i g this fo, ou ag ee that a o e ou o e to the he e a e dedu ted f o a futu e lai pa e t a ou ts that a e due to e paid to ou. X ig atu e of ai appli a t Date Y Y Y Y M M D D The ai appli a t ust sig a d date a ha ges. Please o l sig if i fo atio is t ue, o plete a d o e t. Dis o e Health Medi al he e is a egiste ed edi al s he e a d egulated the Cou il fo Medi al he es CM. The CM o ta t details a e as follo s: E ail: o plai ts@ edi als he es. o Custo e Ca e Ce t e: We site:. edi als he es. o Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. Page 12 of 12

14 Appli atio to joi Vitalit Co ta t us Tel:, PO Bo, Be o e,.dis o e. o.za Pu pose of the fo Tha k ou fo de idi g to appl to joi Dis o e Vitalit. This do u e t is a appli atio fo fo e e ship. It also o tai s so e ules fo e e ship. Please ake su e ou ead a d u de sta d these ules. What ou ust do Please p i t this fo i its e ti et, please p i t lea l. ead a d u de sta d the e e ship ules. ig the appli atio fo. u it the fo e ail at italit sales@dis o e. o.za o fa to. Mai appli a t s a e a d su a e Mai appli a t s ID u e Health e e ship u e Vitalit o e e e t date / / *E plo e u e *A e plo e u e is o l e ui ed fo e e s hose e plo e s ill pa fo thei Vitalit p e iu.. Ba ki g details a d pa e t date If ou a e pa i g ou o Vitalit o t i utio, please o plete this se tio. Ba k a e B a h a e A ou t u e A ou t holde B a h ode T pe of a ou t Che ue a i gs A ou tholde s sig atu e ig atu e of ai appli a t Please ote: If ou a e usi g so eo e else s a k a ou t, the a ou tholde ust sig a o e to o fi a d o se t to this. If ou a ti atio e uest ea hes Vitalit et ee the st a d th of the o th, the poli ill e effe ti e f o the fi st of the u e t o th. If ou a ti ate Vitalit et ee the th a d last da of the o th, the poli ill e effe ti e f o the fi st of the follo i g o th. If ou e e ship is ot a ti ated i ti e fo the de it o de olle tio, ou fi st p e iu ill e olle ted ith the e t de it o de u less it has ee paid i the i te i. You o fi that the a ou t i fo atio p o ided a o e is a a ou t i ou a e a d as su h ou ha e the ight to gi e Dis o e Vitalit Pt Ltd the autho it to de it su h o a o thl asis. You o fi that the a ou t listed a o e is o plia t ith the Fi a ial I tellige e Ce t e A t FICA.. Vitalit o t i utio s fo Me e Me e + spouse o depe da t Me e + o o e depe da ts Vitalit The Dis o e Ca d Dis o e Ca d is a Visa edit a d hi h oosts Vitalit e a ds. Vitalit e e s get ette sa i gs a d igge e a ds. Get the Ca d a d Get e a ded. Would ou like to appl fo a Dis o e Ca d? Yes No Please ote: Whe assessi g ou Dis o e Ca d appli atio, a edit he k ill e do e. A a edited o sulta t ill pho e ou to o plete the appli atio. A Dis o e Ca d ill o l e issued if ou eet the edit app o al ite ia. You gi e o se t to Dis o e Vitalit to sha e i fo atio ith Dis o e Ca d to fa ilitate this appli atio p o ess Yes No Discovery Vitality (Pty) Ltd is an authorised financial services provider. Registration number: 1999/007736/07 Page 1 of 3 DH-09/2017

15 . Ou P i a tate e t 1. Defi itio s 1.1. We, us a d ou efe s to Dis o e Vitalit Pt Ltd You a d ou efe s to the o e of the Vitalit Poli You pe so al i fo atio efe s to pe so al i fo atio a out ou, ou spouse, ou depe de ts, ou e efi ia ies a d ou e plo ees as ele a t. It i ludes i fo atio a out health, fi a ial status, ge de, age, o ta t u e s a d add esses P o ess i fo atio ea s the auto ated o a ual a ti it of olle ti g, e o di g, o ga isi g, sto i g, updati g, dist i uti g a d e o i g o deleti g pe so al i fo atio Co pete t pe so ea s a o e ho is legall o pete t to o se t to a a tio o de isio ei g fo a atte o e i g a hild, fo e a ple a pa e t o legal gua dia. 2. Whe ou e gage ith us, ou t ust us ith pe so al i fo atio a out ou self, ou fa il, a d i so e ase, ou e plo ees. We a e o itted to p ote ti g ou ight to p i a. The pu pose of this P i a tate e t is to set out ho e olle t, use, sha e a d othe ise p o ess ou pe so al i fo atio, i li e ith the P ote tio of Pe so al I fo atio A t POPIA. 3. You ha e the ight to o je t to the p o essi g of ou pe so al i fo atio. It is olu ta to a ept these te s a d o ditio s. Ho e e, e e ui e ou a epta e to a ti ate a d se i e ou Vitalit poli. This ea s that if ou do ot a ept, e a ot a ti ate a d se i e ou Vitalit Poli. 4. We ill keep ou pe so al i fo atio o fide tial. You a ha e gi e us this i fo atio ou self o e a ha e olle ted it f o othe sou es. If ou sha e ou pe so al i fo atio ith a thi d pa ties, e ill ot e espo si le fo a loss suffe ed ou, ou depe da ts, ou e efi ia ies, ou spouse o ou e plo ees>. 5. You a a t that he ou gi e us pe so al i fo atio a out ou depe da ts, e efi ia ies, spouse, o e plo ees, ou ha e e ei ed thei pe issio to sha e thei pe so al i fo atio ith us fo the pu poses set out i this P i a tate e t a d a othe elated pu poses. 6. If ou a e a e plo e, ou ag ee to i de if us agai st a loss o da age, di e t o i di e t, that a e plo ee suffe s e ause of the u autho ised use of ou e plo ees' pe so al i fo atio. 7. If ou a e gi i g o se t fo a pe so u de a i o ou o fi that ou a e a o pete t pe so a d that ou ha e autho it to gi e thei o se t fo the. 8. You ag ee that e a p o ess ou pe so al i fo atio fo the follo i g pu poses: 8.1. The ad i ist atio of the Vitalit p og a e; 8.2. The p o isio of a se i es that ou o a depe da t o ou Vitalit poli a e ui e; 8.3. The e de i g of se i es Vitalit ; a d 8.4. The p o isio of ele a t i fo atio to a o t a ted thi d pa t ho e ui e su h i fo atio to e de a se i e to ou o a depe da t o ou Vitalit poli a d o l if su h o t a ted thi d pa t ag ees to keep the i fo atio o fide tial. 9. If a thi d pa t asks us fo a of ou pe so al i fo atio, e ill sha e it ith the o l if: 9.1. ou ha e al ead gi e ou o se t fo the dis losu e of this i fo atio to that thi d pa t ; o 9.2. e ha e a legal o o t a tual dut to gi e the i fo atio to that thi d pa t ; o 9.3. fo isk a d f aud p e e tio pu poses. 10. You o fi that e a sha e ou pe so al i fo atio ithi the Dis o e G oup of o pa ies fo : ad i ist atio f aud p e e tio ; a d he e e essa to p o ide G oup- ide se i es, e efits a d i f ast u tu e to help ou i ou pe so al o p ofessio al apa it. 11. You also o fi that e a sha e a d o i e all ou pe so al i fo atio fo a o e o o e of the follo i g pu poses: a ket, statisti al a d a ade i esea h; a d to usto ise ou e efits a d se i es to eet ou eeds. You ag ee that ou pe so al i fo atio a e sha ed ith thi d pa ties su h as a ade i s a d esea he s, i ludi g those outside outh Af i a. We e su e that the a ade i s a d esea he s ill keep ou pe so al i fo atio o fide tial a d all data ill e ade a o ous to the e te t possi le a d he e app op iate. No pe so al i fo atio ill e ade a aila le to a thi d pa t u less that thi d pa t has ag eed to a ide st i t o fide tialit p oto ols that e e ui e. If e pu lish the esults of this esea h, ou ill ot e ide tified a e. If e a t to sha e ou pe so al i fo atio fo a othe easo, e ill do so o l ith ou pe issio. 12. B sig i g this appli atio fo, ou autho ise us to o tai a d sha e i fo atio a out ou edit o thi ess ith a edit u eau o edit p o ide s i dust asso iatio o i dust od. This i ludes i fo atio a out edit histo, fi a ial histo, judg e ts, default histo i a o da e ith the e ui e e ts of the Natio al C edit A t a d egulatio s a d sha i g of i fo atio fo pu poses of isk a al sis, t a i g a d a elated pu poses. 13. We ha e the ight to o u i ate ith ou ele t o i all a out a ha ges o ou Vitalit poli, i ludi g ou o t i utio s o ha ges a d i p o e e ts to the e efits ou a e e titled to o ou Vitalit poli. 14. We ha e a dut to keep ou updated a out a offe s a d e p odu ts that e ake a aila le f o ti e to ti e. A e tit ithi the Dis o e G oup a d o t a ted thi d-pa t se i e p o ide s a o u i ate ith ou a out these. 15. Please let us k o if ou do ot ish to e ei e a di e t telepho e a keti g f o us. 16. You ha e the ight to k o hat pe so al i fo atio e hold a out ou. If ou ish to e ei e a op, please o plete a fo alled a A ess e uest Fo o.dis o e. o.za a d spe if the i fo atio ou ould like. We ill take all easo a le steps to o fi ou ide tit efo e p o idi g details of ou pe so al i fo atio. We a e e titled to ha ge a fee fo this se i e a d ill let ou k o hat it is at the ti e of ou e uest. 17. You ha e the ight to ask us to update, o e t o delete ou pe so al i fo atio. Whe e e a ot delete ou pe so al i fo atio, e ill take all steps to ake it a o ous. You ag ee that e a keep ou pe so al i fo atio u til ou ask us to delete o dest o it. This is u less the la e ui es us to keep it. 18. We a e e ui ed to olle t a d keep pe so al i fo atio i te s of the follo i g la s: The Ele t o i Co u i atio s a d T a sa tio s A t ECT The Fi a ial I tellige e Ce t e A t FICA The Fi a ial Ad iso a d I te edia e i es A t FAI The Natio al C edit A t NCA Discovery Vitality (Pty) Ltd is an authorised financial services provider. Registration number: 1999/007736/07 Page 2 of 3 DH-09/2017

16 Ou P i a tate e t o ti ued The Co su e P ote tio A t CPA ; 19. You ag ee that e a t a sfe ou pe so al i fo atio outside outh Af i a: if ou gi e us a e ail add ess that is hosted outside outh Af i a; o to ad i iste e tai se i es, fo e a ple, loud se i es. We ill e su e that a ou t, o pa o pe so that e pass ou pe so al i fo atio to ag ees to t eat ou i fo atio ith the sa e le el of p ote tio as e a e o liged to. 20. If e e o e i ol ed i a p oposed o a tual e ge, a uisitio o a fo of sale of a assets, e ha e the ight to sha e ou pe so al i fo atio ith thi d pa ties i o e tio ith the t a sa tio. I the ase of a e ge, a uisitio o sale, the e e tit ill ha e a ess to ou pe so al i fo atio. The te s of this P i a tate e t ill o ti ue to appl. 21. We a ha ge this P i a tate e t at a ti e. The ost updated e sio ill e al a s e a aila le o.dis o e. o.za. 22. If ou elie e that e ha e used ou pe so al i fo atio o t a to this P i a tate e t, ou ust fi st atte pt to esol e a o e s ith us. If ou a e ot satisfied afte this p o ess, ou ha e the ight to lodge a o plai t ith the I fo atio egulato, u de POPIA. The o ta t details a e: The I fo atio egulato outh Af i a ALU Buildi g, Tha o ehu e t eet, P ETO IA Ms M a o oke Mphelo Tel: Fa : i fo eg@justi e.go.za. Vitalit ules fo e e ship Dis o e Vitalit a d Ke FIT a e sepa ate f o the he e a d ad i ist ato Dis o e Vitalit is a sepa ate o pa f o Dis o e Health Pt Ltd the ad i ist ato a d the Dis o e Health Medi al he e efe ed to as the he e. It is fo all egiste ed u de the a e Dis o e Vitalit Pt Ltd, egist atio u e / / a d takes a e of the ad i ist atio of the Vitalit a d Ke FIT p og a es Dis o e Vitalit, Dis o e Ca d a d the Dis o e Ca d lo alt p og a e. Rules of the Vitalit p og a e A full set of ules is a aila le o.dis o e. o.za o ou a all Dis o e Vitalit o. I the e e t of a o fli t et ee hat is set out he e, o ou e site a d the ules of Vitalit, the ules ill al a s appl. You o t i utio s to Dis o e Vitalit a e sepa ate The o t i utio s ou pa a e fo Dis o e Vitalit a d a e ot pa t of the o t i utio s ou pa to the he e. Ca ellatio of Vitalit e e ship Please gi e oti e o the fi st da of the o th if ou ish to a el ou Vitalit e e ship i that o th. Othe ise, ou e e ship ill o l e d o the last da of the e t o th. You ust e a e e of Vitalit at the ti e of the * illi g le ot the ti e of the t a sa tio i o de to e eligi le fo ou e a d. *Billi g C le efe s to the date de ided Dis o e Vitalit, o hi h ou Vitalit e efits a e al ulated o a o thl asis. Whe ou sig this appli atio to joi Vitalit, ou o fi that ou a epted the ules fo e e ship a d ou ag ee that ou a d those ou appl fo ill e ou d the. ig ed at to o it o Y Y Y Y M M D D ig atu e of ai appli a t The ai appli a t ust sig a d date a ha ges. Discovery Vitality (Pty) Ltd is an authorised financial services provider. Registration number: 1999/007736/07 Page 2 of 3 DH-09/2017

If your debit date is after the 10th of a month, the first debit will be a double. If you can't meet this, ensure your debit date is the 1st or the

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