SUMMARY OF INSURANCE COVERS
Registered Insurer Dotsure Limited
Cover Options Comprehensive Cover
Total annual premium for the first 12 months of insurance cover:
(Inclusive of broker commission at 12,5%)
Datsun GO MC Mid R 12 294 ☐
Datsun GO MID DR & PR SBR R12 249 ☐
Datsun GO MC Lux R12 935 ☐
Datsun GO MC LUX ULC 4.0 R12 935 ☐
Datsun GO LUX DR & PR SBR & VDC R12 935 ☐
Datsun GO T(O) LUX CVT R13 857 ☐
Datsun GO FIVE Special Version R12 515 ☐
Datsun GO+ MC Mid R12 899 ☐
Datsun GO+ MID DR & PR SBR R12 899 ☐
Datsun GO+ MC Lux R12 770 ☐
Datsun GO+ MC LUX ULC 4.0 R13 610 ☐ Datsun GO+ LUX DR & PR SBR & VDC R13 610 ☐ Datsun GO+ T(O) - LUX CVT R13 431 ☐ PREMIUM DECLARATION
I understand that I have applied for an annual insurance policy and that the insurance cover will be valid for 12 calendar months from the date stipulated on the confirmation of cover.
I understand that Datsun South Africa has undertaken to pay my first year’s annual premium payable under the
Dotsure Comprehensive Insurance policy on my behalf.
I understand that I will be liable for the full payment of future subsequent premiums to be determined by Dotsure after the first 12 months cycle of insurance cover is complete.
EXCESS
Basic excess R8 000 – This is for damage to your own vehicle (accident,
theft or hi-jack)
Excess for key, lock and remote-control claims. R 350, Cover limited to R7 500
Excess for Windscreen and Sound system 20% of the claim with a minimum of R500 Additional excess
10% of the claim with a minimum of R 8 000 for incidents:
• where no 3rd party vehicle is involved or if you claim in the first 12 months of the start of this policy
• where the Dotsure Smart-Box is not fitted or fully functional (theft or hi-jack claims will not be covered)
• as a result of accident, hi-jacking or attempted hi-jack which occur between 10pm and 4am, or failure to
report an incident to the South African Police Service within 24hours of the incident occurring, when possible within reason
Page 2 of 5 TERMS AND CONDITIONS
Licence
• All drivers that drive the insured vehicle on the policy must have a valid driver’s licence.
• Only valid South African driver’s licence will be accepted.
• We do not accept learner licences.
• No drivers over the age of 80 will be accepted. Drivers over 75 need to produce annual medical certificates
confirming they are still fit to drive. Vehicle Use
• The vehicle is covered for Both Private and Business use.
• Cover will terminate if vehicle is repossessed, sold to another person within the first 12 months, or if the
original vehicle covered is written off (replacement vehicles do not qualify for this offer).
• Any purpose that is not defined in the schedule of the policy is not covered.
Restrictions on Vehicle Use
• Any purpose that is not defined in the schedule of the policy.
• Security companies • Funeral parlours • Ambulance • Courier services • Driving schools • Hired out for reward. • Security companies • Funeral parlours • Ambulance • Courier services • Driving schools
• Owned or used by a car hire company.
• Racing, testing, rallies or any such event whether publicly organized or not and whether on a track or not.
• Carrying hazardous goods.
• Carrying goods or passengers in excess of what the vehicle is legally licenced to carry.
• Carrying passengers for reward or fare-paying passengers.
Security
• Dotsure Smart-Box is Compulsory and is included in the premium (Cash install option only).
• Where the Dotsure Smart-Box is not fitted or fully functional, theft or hi-jack claims will not be covered.
Exclusions or Limitation
• Damage to tyres, springs and shock absorbers punctures, cuts or bursts as a result of potholes
• Consequential loss
• Loss or damage outside South Africa (business use)
• Third party liability outside South Africa
• Vehicles used for driving instruction or transportation for reward
• Vehicles owned or used by a hire company
• Vehicle used without permission
• Alcohol and drug abuse overthe limits
• Not roadworthy vehicle
• Vehicles in the motor trade
Disclaimer
• I understand that the contract will be based on the information I have provided to the insurer on the
application form.
• I understand that the insurer may refuse to pay a claim under this policy or cancel the policy from the date
on which I have tried to deliberately or dishonestly take advantage of them. In other words, if I am dishonest in any way or if I exaggerate (overstate) the amount of my claim or submit a fraudulent claim to get a claims payment under my policy or to get cover which I do not qualify for, all benefits under this policy will end, the policy will be deemed invalid and all premiums will be forfeited.
Signed at on this day of _ (Month, Year)
Name of Applicant:
Page 4 of 5
A.AUTHORITY
GIVEN BY: (NAME OF ACCOUNTHOLDER)
(ADDRESS)
(BANK ACCOUNT DETAILS):
BANK NAME :
BRANCH NAME : BRANCH NUMBER :
ACCOUNT NUMBER :
TYPE OF ACCOUNT : ☐Current ☐Cheque ☐Savings ☐Transmission
DATE OF FIRST DEBIT : _
CHOSEN DEBIT DATE : ☐1st of the month ☐15th of the month ☐Last day of the month ☐Other, please specify:
TO : DOTSURE LIMITED
REFERENCE : DOTSURE
I hereby authorise DOTSURE LIMITED to issue and deliver payment instructions to your banker for collection against my above-mentioned account at my above-mentioned bank in relation to my insurance premium.
The individual payment instructions so authorised to be issued, must be issued and delivered monthly on the date when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not differ as agreed to in terms of the Agreement.
Premium from month thirteen
Datsun GO MC Mid - Client premium is (R 12 294/12) R 1 025 monthly ☐
Datsun GO MID DR & PR SBR - Client premium is (R 12 294/12) R 1 025 monthly ☐ Datsun GO MC Lux - Client premium is Client premium is (R12 935/12) R 1 078 monthly ☐ Datsun GO MC LUX ULC 4.0 - Client premium is (R12 935/12) R 1 078 monthly ☐ Datsun GO LUX DR & PR SBR & VDC - Client premium is (R12 935/12) R 1 078 monthly ☐ Datsun GO T(O) LUX CVT - Client premium is (R13 857/12) R 1 155 monthly ☐ Datsun GO FIVE Special Version - Client premium is (R12 515/12) R 1 043 monthly ☐
Datsun GO+ MC Mid - Client premium is (R12 899/12) R1 075 monthly ☐
Datsun GO+ MID DR & PR SBR - Client premium is (R12 899/12) R1 075 monthly ☐
Datsun GO+ MC Lux - Client premium is (R12 770/12) R1 064 monthly ☐
Datsun GO+ MC LUX ULC 4.0 - Client premium is (R13 610/12) R1 134 monthly ☐ Datsun GO+ LUX DR & PR SBR & VDC - Client premium is (R13 610/12) R1 134 monthly ☐ Datsun GO+ T(O) - LUX CVT - Client premium is (R13 431/12) R1 119 monthly ☐
Page 6 of 5 I agree that the first payment instruction in the amount of R will be issued and delivered on the above mentioned first debit date and thereafter regularly according to the agreement on the above chosen debit date of every succeeding month.
I authorise the originator to make use of the tracking facility as provided for in the EDO system at no additional cost to myself.
Subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the Agreement have been paid or until this authority is cancelled by me in terms of the Agreement.
B.MANDATE
I acknowledge that all payment instructions issued by you shall be treated by my abovementioned bank as if the instructions had been issued by me personally.
C.CANCELLATION
I agree that although this authority and mandate may be cancelled by me, such cancellation will not cancel the Agreement. I also understand that I cannot reclaim amounts, which have been withdrawn from my account (paid) in terms of this authority and mandate if such amounts were legally owing to you.
D.ASSIGNMENT:
I acknowledge that this authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party.
Signed at on this day of _ (Month, Year)
Name of Applicant:
